Uganda: Covid-19 – Shortage of Oxygen Worsens

A source at Mulago National Referral Hospital has revealed that the facility is facing a crisis of oxygen supply for patients in Intensive Care Unit (ICU).

The Covid-19 pandemic has escalated the oxygen shortage in the country with numbers of infections rising and patients admitted to ICU overwhelming the health facilities.

The government and health officials have blamed this surge largely on public laxity in observing the Standard Operating Procedures (SOPs) to stop the spread of Covid-19.

Some of the patients that Daily Monitor interviewed, who needed to be put on life support within the last one month, revealed that they have been tossed from one hospital to another on claims that the hospitals are full and cannot admit anymore patients.

Some of the patients have since died due to lack of oxygen.

“We wanted to take our patient to Mulago for better service but an officer there discouraged us saying there was a problem with their oxygen (supply),” a relative to one of the patients who died, said.

Dr Kituzi Muhereza, the Uganda Medical Association (UMA) secretary, yesterday confirmed they received complaints from their colleagues about the shortage of oxygen, especially at Mulago hospital.

He also revealed that all ICUs at Covid-19 treatment centres are full.

“The quality of oxygen plants at Mulago were defective. This means that you get interruptions in oxygen supply and that is very dangerous because a life can be lost,” Dr Muhereza said in the interview.

In just two days, Uganda has registered 1,361 new coronavirus cases.

Dr Muhereza said indications are that the situation will worsen with the ongoing election campaigns and the onset of the festive Christmas season.

A number of caretakers who have lost their relatives to Covid-19 as well as those attending to Covid-19 patients have complained about the shortage of oxygen and space at Mulago and other hospitals despite official denials from health administrators.

Some of the caretakers who have had Covid-19 patients revealed to this newspaper that it is now difficult to get a bed for a patient that requires ICU whether in private or government hospitals in the country.

In some cases, caretakers beg hospital managers to allow them carry their oxygen cylinders to the hospital so their patients can be guaranteed supply of oxygen.

Jane (not real name) said: “We went to Entebbe Hospital but the doctor told us the ICU was not fully operational because they did not have an oxygen plant. They depend on cylinders.”

Although Mr David Nuwamanya, a principal administrator at Mulago hospital, denied that the hospital has suffered an oxygen crisis, he admitted that the hospital is currently overstretched.

“I want to assure you that we have oxygen but it is a variable factor. Sometimes we are strained. We have not said we have any shortages that have caused any problem but we are constrained in the sense of having to replace cylinders to ensure that at no point there is no shortfall. That’s the challenge we get,” Mr Nuwamanya said.

He explained that they have a plant dedicated to serve Covid-19 patients who are currently consuming 2,000 litres per minute.

Mr Nuwamanya said when the numbers were still few and without severe cases, a patient could use five litres of oxygen but now a patient uses 20 litres of oxygen per minute, hence straining the supply.

Mr Nuwamanya further explained that there are patients who require oxygen beyond the normal gauge, forcing the hospital to use both wall oxygen as well as cylinders.

“Cylinders are fillable, so those that are on dual (the wall and cylinders) whenever they see us change them, they will start saying oxygen is finished but we get the cylinders filled so that we supplement the wall oxygen,” Mr Nuwamanya said.

According to Ministry of Health, a Covid-19 patient in ICU requires up to 30 litres of oxygen per minute compared to an ordinary patient in ICU who requires five litres.

Given the increase in the number of Covid-19 cases, Mulago hospital said they are planning to expand the capacity.

“We are expanding the High Dependency Unit (HDU) from what it has been. By next week, we will have expanded it to 100 beds. HDU has been running at a capacity of 120. We want to increase the capacity to 900 beds. We hope this will happen by the end of this month,” Mr Nuwamanya said.

Mulago hospital has already warned that they are going to be receiving only severe Covid-19 cases, not mild cases.

Situation in other hospitals

Dr Emmanuel Tugeinayo, the director of Mbale Regional Referral Hospital, in a telephone interview with Daily Monitor yesterday, said they do not have an ICU.

“We have received some equipment for ICU from the Ministry of Health, but we have not installed it yet because of lack of space. We are referring those who need intensive care to Mulago National Referral Hospital,” he said.

He added: “In August, we were referring one patient or none to Mulago each week, but currently, we are referring two patients each week.”

He said they are using simple oxygen equipment to give breathing assistance to those who are severely ill and admitted to the hospital.

The hospital currently has seven patients who are severely ill, according to the director.

Oxygen can be provided outside an ICU setting as long as there is an oxygen cylinder or equipment that generates oxygen, and the means to plug it onto a patient with breathing difficulties.

“As the patient progresses to severe sickness, they will need oxygen that is supplied at high pressure and this needs special equipment that is not here at Mbale Regional Referral Hospital,” Dr Tugeinayo said.

The bed capacity for isolation of Covid-19 patients is at 50 but since patients who are not severely ill are being managed from home, most beds are empty, according to the director.

Dr Moses Muwanga, the director of Entebbe General Hospital, said they have 120 Covid-19 patients who are currently admitted and 18 are on oxygen.

Dr Muwanga said the hospital has 10 ICU beds that are fully functional.

Earlier, the director told this newspaper that they had no oxygen plant.

The sharp rise in new cases of the coronavirus infection has, however, not come as a surprise to the government because scientists in the country had projected this scenario at the onset of the pandemic in Uganda in March.

The Ministry of Health has, in the last three months, been stressing how they are establishing intensive care units (ICUs) in all regional referral hospitals to prepare the country for the worst scenario.

The ministry promised that by November, all regional referral hospitals would have ICUs.

Dr Charles Olaro, the director of clinical services (curative) at the Health ministry, said all designated hospitals have oxygen but that as patient numbers continue to rise, it will overstretch the supply side.

He said the health system is facing rising pressure on the management of patients who are critically and severely ill.

“The number of those who are critically ill is increasing and they need special care and more resources. The patients need 30 liters of oxygen per minute as opposed to previously where we would provide five litres of oxygen per minute to normal (Covid-19) patients,” he said.

Dr Olaro said the ministry is expanding facilities to manage the rising cases but the biggest focus should be on how to suppress the infections by observing Covid-19 preventive measures such as hand-washing, wearing facemask and social distancing.

“We need to focus on how to make the numbers not to increase. Even when you continue to increase ICU beds and oxygen supply if the numbers are rising very fast, it can’t be handled,” he said.