Covid-19 Hospitals: Gasping for oxygen.

While the Directorate General of Health Services (DGHS) claims that providing oxygen to patients will not be a problem, patients and doctors beg to differ.

"We have sufficient oxygen cylinders for coronavirus patients," said Additional Director Dr Nasima Sultana.

"At the upazila level, we have 10,394 cylinders. In divisional cities, outside of medical colleges, there are 13,745 cylinders. In Kurmitola General Hospital, there are 450 cylinders, and in Kuwait Maitree Hospital, there are 123 cylinders," she said, adding that even though there is no central oxygen supply in these hospitals, there would be no problem.

However, healthcare workers and patients alike are finding this to be a major problem.

A central oxygen supply means having a dedicated place in the hospital where oxygen is stored and supplied to all patient beds, using lines in the wall. There are staffers who monitor how much oxygen the storage chamber has and make sure that patients are not out of oxygen.

This was proving to be an issue in coronavirus-dedicated hospitals because of acute mismanagement and manpower shortage, while also increasing the chances of a patient dying.

Bikash Saha was already in need of serious medical attention when he was admitted to Kurmitola General Hospital on April 18. He had been referred to Kurmitola from a hospital in Khanpur, Narayanganj.

He started having difficulty breathing around midnight, and his wife could not manage to get oxygen for him until three hours later. The family, however, claimed the cylinder may not have been working.

Anirban Saha, son of the patient, said, "There were no doctors or nurses at the ward. They were stationed elsewhere, but nowhere near the ward. There was no way to contact them because attendants cannot go out of the wards themselves. The only way to call the nurses is through the Ansar men guarding the entrance to the floor. My mother was at the hospital as my father's attendant, and she asked the guards several times to call a nurse, but they did not pay any heed."

The nurses finally came and hooked him up to a cylinder and left again. However, Anirban claimed his father had told him that the cylinder was not working. "He had received oxygen earlier during the day and he felt better after taking it. This time the oxygen was not helping him. He still kept having breathing difficulty and kept asking us to call the nurses to check his oxygen."

Anirban's mother went to ask the guards to call the nurses again several times, but nobody came to see them. "The guards told my mother that since my father has been given oxygen, everything will be okay and we need to have patience," he claimed.

"Around 6:00am, the nurses came to see my father, but my father had died by then.

"Even before the nurses came, my father's fingers and toes were turning blue. He took four or five large breaths and went still," Anirban said.

Similarly, Snigdha Farhana Surovi claimed her father died because he did not get oxygen, the lack of which led to cardiac pain. This incident happened around 12 hours after Bikash Saha died at the same hospital.

Her father, Sohel Rana, had chronic kidney disease and has a pacemaker in his heart. He was admitted on April 17 with the need of emergency dialysis.

"Around 5:00pm on April 19, my mother noticed that my father's oxygen cylinder was empty. She tried to call the nurses but failed to do so for more than one and half hours. My father had developed intense chest pains by then," claimed Surovi.

"Since there is no central oxygen supply like in private hospitals, we have to run after nurses to get oxygen, and there is no direct way to call a nurse from the ward," she said.

"When the nurses finally came and provided him with oxygen, that cylinder too emptied very quickly. After that my mother went to call the nurses again and was able to manage another cylinder only after a similar time interval," she said.

But the chest pain that began while Surovi's mother searched for oxygen, persisted, and he expired later that night.

"He was shifted to the ICU at 11:00pm that day. Not a single doctor visited my father when he was taken to the ICU. Around 3:30am, his chest pain and breathing worsened and while my mother pleaded the guards to bring a doctor, nobody came to visit him and he died. It was only a whole hour after his death that a ward assistant dropped by the ICU to see why my mother was crying."

An oxygen cylinder contains 2000 litres of oxygen, said Rubel Ahmed Babu, proprietor of Next Care Surgical, a surgical supply shop on Topkhana Road.

"How a long a canister lasts depend on how much oxygen is being given. A minimum of 3 litres per minute has to be given," he said.

Doctors at Kurmitola General Hospital interviewed by this correspondent said that at the wards, patients get between six to 10 litres per minute. This means a 2000-litre cylinder lasts between 3.5 to 5.5 hours depending on the patient.

None of the three doctors interviewed agreed to be named because a government directive restricts them from speaking to the media.

They stated that with the kind of patient load they have, oxygen cylinders are emptying out quicker and that empty cylinders at a time of need is something that they are having to contend with.

In addition, the entire staff of the hospital has been divided into three groups, and while one group works, the other stays in quarantine. This means the hospital is running with a third of its staff, and it is impossible to monitor which patient's cylinder is emptying when.

The director of KGH could not be reached over phone.

Other hospitals dedicated to treatment of coronavirus patients do not have central oxygen supply facilities either.

While Dr Shehab Uddin, the superintendent of Kuwait Maitree Hospital, claimed that 123 canisters for the 128 patients currently admitted is enough, the director of Railway General Hospital Dr Firoz Alamgir said that this just means he cannot currently provide critical care.

"I can manage with oxygen cylinders, but I can only take patients who are medium-risk. If their condition deteriorates, I need to refer them to other hospitals with ICUs," said Dr Alamgir.

Director of Lal Kuthi Hospital, Dr Shamsul Karim, also said that the hospital has no central oxygen supply and will be dependent on cylinders.

"I cannot imagine running a hospital without a central oxygen supply. This is mandatory," said Dr ShagufaAnwar, chief of Business Development at United Hospital Ltd.

"Cylinders have a limit on how much oxygen can be provided for patients. With the cylinders, I cannot give concentrated oxygen at an increased force to critical patients. Being able to do this means I can delay putting my patient on a ventilator," she said.

Besides, they can go empty at crucial moments and then they have to be refilled by an oxygen supplier outside of the hospital, she added

Dr Nasrin Sultana of DGHS said that 3,500 more oxygen cylinders are being imported but they have not arrived yet.