Virus exposes deficit in access to oxygen therapy

A health worker demonstrates how to take temperatures from a patient. PHOTO | JOSEPH KANYI

What you need to know:

  • At least 50 percent of patients who need oxygen in Kenya don't get it.

In the latest COVID-19 briefing, the Health Secretary indicated this is the week when positive cases exponentially grow. As we brace for the impending tsunami, there are a number of things in retrospect observation from nations affected earlier we can fast-track on.

The first one, is adherence to self-isolation is hard in the absence of widespread mortality. Forceful government quarantines must be imposed if we are to curtail spread.

Secondly, advertising and marketing people can be called into action to “sell” the message. They are more persuasive.

Thirdly, Kenyan families “kadogo economy”, means no food beyond a week in many house. Unless this is addressed, quarantine imposition will be hard as many go out to eke a living. Making available funds for bulk food purchases could work.

Respiratory diseases’ vector dynamics are based on proximity to positive contacts indoors and good self-quarantine needs isolation space. While in developed nations the average cubic metres occupied by a house-dweller are three times a Kenyan’s, the pandemic is still spreading. In our context, urban area families live in shared single rooms, washrooms and poor ventilation: our projected spread-velocity models could be faster.

The 2019 Census could potentially project where hardest hit neighbourhoods will be: the higher the in-house density, the worse the spread and fatality.

In a recent discussion, an Italian colleague noted that Italy’s higher mortality rates, 8.3percent, compared to 4.3 percent in other nations, is not an indication her country’s health system’s lack of capability, but sheer overwhelm of resources and personnel.

The US affected later, is scrambling to manufacture equipment needed for intensive care cases. Lack of ventilators in has been the biggest handicap. Kenya’s current ventilator support capacity is non-existent. Dr Steve Adudans, CEO of Hewa Tele, which works towards access to oxygen, reckons we need to prepare and deliver oxygen capability as quickly as possible before Covid-19 hits landfall.

He quotes a New England Journal of Medicine (NEJM) study of 1,099 hospitalised patients with coronavirus in China where at least 41.3 per cent ended up needing supplemental oxygen and 2.3 percent needing invasive mechanical ventilation. This is in addition to the normal oxygen needs for the health system before the viral emergence.

He says at least 50 percent of patients who need oxygen in Kenya don’t get it as it is often reserved for critically ill patients. With the potential demand for oxygen owing to coronavirus spread spiking, need is likely to increase with fatal outcomes if we are unprepared.

While most facilities lack safe oxygen delivery mechanisms, daktari suggests minimal piping coupled with a cylinder manifold, can deliver oxygen safely to patients at low costs in critical units. This should be coupled with training of the healthcare workers on oxygen therapy.

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