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Oxygen supplies and medical infrastructure: Hit hard by the third wave  

09 May 2021

By Maheesha Mudugamuwa    As the number of Covid-19-positive cases is increasing rapidly, the health sector unions allege that the country’s hospital network does not have sufficient medical infrastructure such as an adequate oxygen supply to meet a sudden increase in demand like in neighbouring India. According to them, only main hospitals have an adequate supply as of now, with only around 30 oxygen cylinders per hospital. Other hospitals such as district hospitals and base hospitals have less than five oxygen cylinders each at present. With the increasing number of patients being admitted to hospitals allocated for Covid-19 treatments, the unions urged the Government to take immediate steps to increase the oxygen supply as well as other infrastructure facilities needed for treating patients with severe complications such as breathing difficulties.    As of last Wednesday (5), 16,719 infected people are under treatment at intermediate treatment centres and the total number of daily infected persons identified from all over the country has now exceeded 1,900 from around 800 during the second coronavirus wave in the country.  Speaking to The Sunday Morning, All Ceylon Nurses' Union (ACNU) President S.B. Mediwatta said that the situation at the Colombo National Hospital has now become worse with the increasing number of Covid-19 patients being admitted on a daily basis and the expanding of the number of wards to cater to the increasing demand. “Most of these wards allocated for Covid treatments don’t even have enough facemasks. When we requested masks from the management, they only give half of the necessary demand. Around 100 masks are needed for a Covid-19 ward per day for all health workers including doctors as well as nurses. We also don’t get personal protective equipment (PPE) at present but we have to adjust accordingly,” he stressed. Commenting on the oxygen supply, Mediwatta stressed that the daily oxygen demand has now been doubled but the supply remained similar to the supply before the pandemic.  “A ward has only around five or six oxygen cylinders. Earlier, oxygen was given only to critical patients or those admitted to the recovery unit. But for Covid-19 patients, the oxygen supply cannot be stopped and therefore, the current stocks are not enough at all if there is a sudden increase in demand like in India,” the ACNU President stressed.    Nurses threaten trade union action   The union, however, noted that if the Government did not provide the necessary facilities, the nurses would take stern trade union action in the immediate future in spite of the current pandemic situation.  A similar opinion was given by the Association of Medical Specialists (AMS), as they last week claimed that oxygen and ICU (intensive care unit) care play a crucial role in critical cases and constant and uninterrupted availability of oxygen-supplied beds are needed to avert disaster. AMS President Dr. Lakkumar Fernando stated that the best way to do this is to have piped oxygen distributed from a central liquid oxygen tank rather than using cylinders. “Unfortunately, the whole country only has 28 such liquid oxygen tanks installed in hospitals. The sizes range from 3,000 to 20,000 litres, but there are only two 20,000 l tanks – one each at the National Hospital and Peradeniya, and others are relatively smaller,” he stressed.  Dr. Fernando further pointed out that with the current Covid-19 strain being highly transmissible, taking patients to hospitals with larger tanks may not be an option, as many of these hospitals mainly cater to non-Covid patients.  As he explained, with this, the system will still have to largely depend on jumbo cylinders, where each can carry 47 liquid litres that produce 7,050 gas litres of oxygen. But he stressed that even though the jumbo cylinders are bigger in size, each jumbo cylinder may not last for more than a few hours when administered to a highly oxygen-dependent patient. “Managing oxygen between hospitals and delivering to the individual patient will certainly need intelligent planning and extreme co-ordination of production, storage, and efficient delivery,” Dr. Lakkumar stressed. In the meantime, the Government Medical Officers’ Association (GMOA), the largest health sector union, also urged the Government to take immediate steps to increase the capacity of treatment centres, increase the capacity and facilities of beds in ICUs, ensure adequate oxygen storage, and provide adequate PPE to health personnel.  GMOA President Dr. Senal Fernando warned that if the number of patients exceeds the health sector capacity, the health staff including the doctors will not be able to handle it.  Commenting on the ICU capacity in the country, GMOA Executive Member Dr. Prasad Colombage stressed: “Even though ICU capacity has not reached its maximum yet, the Government should take steps to increase the capacity from now on.”  The GMOA also stressed that although there is no problem regarding oxygen reserves at present, there are problems with regard to oxygen cylinders.    Lack of cylinders the issue: Health Ministry    In such a backdrop, Health Minister Pavithra Wanniarachchi said Sri Lanka has ordered 7,000 more jumbo cylinders to store oxygen and it expects 400 cylinders by the end of the week. According to her, the hospital system currently has 24,000 medical oxygen cylinders and 4,000 jumbo cylinders.  The Minister informed Parliament that the problem is not the lack of oxygen but rather the lack of cylinders to store oxygen to distribute throughout the country, and she said the country has the capacity to produce four times the required amount of oxygen in-country at the moment. “The required amount of oxygen in hospitals is 25 tonnes,” she said, adding that the current capacity should be increased up to 80 tonnes. Meanwhile, The Sunday Morning learnt that the Medical Supplies Division (MSD) has also ordered 4,000 oxygen cylinders from the State Pharmaceuticals Corporation (SPC) and is still waiting for the stocks.  When contacted, MSD Deputy Director General – Medical Supplies Dr. D.R.K. Herath said usually the stocks are purchased from India and due to the ongoing situation there, stocks are getting delayed.  “We have requested 4,000 cylinders but still, we did not receive them,” he added.  SPC General Manager K.M.D.R. Dassanayake, meanwhile, said the SPC has received an emergency tender from the MSD to import 4,000 oxygen cylinders, which was opened last Friday (7). The corporation received several bids including one from the Czech Republic. “We have proceeded with the tender and the stocks would be received after the necessary time duration for sea delivery,” Dassanayake said.  When asked whether there are any requests from hospitals for oxygen cylinders, Dr. Herath told The Sunday Morning that as of now, there were no special requests.  Commenting on the shortage of PPE, he said even though the full PPE pack is not available, the MSD has taken steps to supply required parts separately.  Meanwhile, Ceylon Oxygen Ltd. (COL), the main oxygen supplier in the country, has stated that Sri Lanka has sufficient manufacturing and distribution capacities, including that of competitors, estimated at around three times the current demand.  In a letter written to the Director General of Health Services (DGHS) suggesting several steps to ensure an uninterrupted oxygen supply, the COL has stated that if there is good co-ordination between the oxygen manufacturers and the health authorities, they are confident that they can manage any surge in demand to a great extent.  They have suggested that the Government establish dedicated Covid-19 hospitals which have piped oxygen connected to a bulk medical oxygen storage tank, instead of cylinders, which would ensure a continued and reliable supply to patients requiring high-flow oxygen. They also proposed to establish Covid-19 specialised hospitals, and to limit them to a supply radius of 200 km from Colombo, since their main filling and manufacturing sites are located within Colombo. Meanwhile, in response to the questions raised by The Sunday Morning, the COL said: “We are proactively managing the current demand for cylinders. We have several sources of imports in different countries with the intention to secure the best lead time.” The COL said that they have witnessed an increase in consumption from several hospitals, but the current manufacturing capacity is sufficient to meet the demand. “We have recommended to the authorities that liquid medical oxygen tanks with piped outlets be installed at hospitals where the consumption is high, which will enable supply in liquid tankers at much higher capacities. This will also help to manage the cylinder demand, as there is an extended lead time for import of cylinders,” COL’s response stated.


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