A lack of oxygen supply in public hospitals will pose challenges for Bangladesh in battling the coronavirus pandemic, which has already infected 3,772 people and took the lives of 120 in the country.
In its latest situation report on April 20, the World Health Organisation (WHO) said a survey on oxygen supply status in public hospitals in Bangladesh showed that there is a shortage in the country considering that 20% beds were dedicated for Covid-19 management at district and upazila levels.
“The challenges to increase the oxygen supply include refilling time, cylinders for transportation, logistics from hospitals to the refilling centres and funds,” it said.
Most people with coronavirus infection develop only a mild infection and do not always require hospitalization, however, approximately 20% of them will need medical oxygen support to recover, WHO estimates.
Data compiled by the Directorate General of Health Services (DGHS) shows that till now, 3,302 oxygen cylinders were distributed for Covid-19 management across the country, and one-third of these cylinders have already been used.
The public hospitals – Sadar hospitals, medical college hospitals, and upazila health complexes – so far used 1,195 oxygen cylinders, keeping only 2,107 in reserve for the patients in need, shows the data.
In Dhaka Division, except the capital, 795 oxygen cylinders were distributed where 188 have been used and 607 are now in reserve, while in Mymensingh, 69 cylinders were distributed where 39 were used and 30 is in reserve.
Similarly, 145 cylinders were distributed in Barisal Division, where 64 were used and 81 is in reserve; 651 cylinders in Chittagong Division, where 217 were used and 434 remain in reserve; 615 cylinders in Khulna Division, where 223 were used and 392 is in reserve; 454 cylinders in Rajshahi Division, where 309 were used and 145 remain in reserve, it shows.
In Rangpur Division, 342 cylinders were distributed where 81 were used and 261 is in reserve and in Sylhet Division, 231 were distributed while 74 were used and 157 is in reserve.
Healthcare expert Prof Rashid E Mahbub said Bangladesh may face a disaster ahead if the necessary supply of oxygen is not ensured.
“Only 20% of patients out of the total infected may require oxygen support, but we do not know how many people will be infected in Bangladesh in the coming days. The government will have to take immediate steps to ensure the necessary supply of oxygen cylinders for treating critical patients,” he told Dhaka Tribune.
On April 19, Health Minister Zahid Maleque said medical oxygen support has proved to be more useful than ventilation support at Intensive Care Unit (ICU) as eight out of the nine patients provided with ventilation had died.
“Currently, we have some 10,000 cylinders at government hospitals across the country. We have ordered 3,500 more oxygen cylinders,” he said.
The Bangladesh Industrial Gas Ltd (BIGL) is now busy with producing medical oxygen at Bangladesh Small and Cottage Industries Corporation (BSCIC) industrial area in Tangail.
Following directives from the Directorate General of Drug Administration (DGDA), medical oxygen is being produced at the factory for coronavirus patients, according to a recent press release from the Ministry of Industries.
The BIGL is one of four oxygen-producing companies in Bangladesh, it now produces 700 cubic feet every day and is capable of supplying 3,000 cubic feet oxygen in 500 to 700 cylinders on a daily basis.
Manufacturers say no shortage in days ahead
There are four medical oxygen-producing companies in Bangladesh – Bangladesh Industrial Gas Ltd (BIGL) under Bangladesh Small and Cottage Industries Corporation (BSCIC); Spectra Oxygen Limited under Spectra Group; Linde Bangladesh Limited, a member of Germany's largest supplier of medical oxygen Linde; and Islam Oxygen Limited.
Market insiders said all four companies, within their production capacity, are ready to tackle the covid-19 crisis.
Among the four companies, Spectra and Linde Bangladesh are the major suppliers to all the government and private hospitals with Spectra supplying cylinder in gas, while Linde is supplying liquid gas in vacuum insulated evaporator (VIE) form.
“Currently, there is a demand of only 2lakh cubic meter per month in Bangladesh, but if the demand rises in the days ahead because of covid-19, we can supply up to 9lakh cubic meters a month,” said Md Mokhlesur Rahman Ripon, deputy general manager at Spectra Oxygen Limited, that produces oxygen from 14 depots across Bangladesh.
Currently, Spectra is supplying medical gas to all the 360 government hospitals while Linde is supplying to 15 hospitals where VIE (Vacuum Insulated Mechanism) is available.
“If the demand for oxygen supplies escalate in the next six months, still there will be no shortage,” he opined.
Md Khalid Hussain Khan, managing director at Spectra Oxygen Limited said the company has launched a three-month-long [April 1-June 30, 2020] voluntary campaign for free of cost medical oxygen gas distribution in four dedicated hospitals for treating covid-19 patients.
The hospitals are - Kuwait Bangladesh Friendship Government Hospital, Sheikh Russel Gastro Liver Hospital, Mugda General Hospital, and Kurmitola General Hospital.
On the other hand, Md Abul Hossain, managing director at Bangladesh Industrial Gas Ltd (BIGL) said the company is currently supplying 750 cubic meter of gas daily and can produce up to 2000 cubic meters per day if there is demand.
“We usually distribute oxygen in neighbouring districts like Tangail, Rajshahi, Jamalpur and Sirajganj. We can supply the gas in some other districts if the demands are higher,” he added.
Oxygen shortage may hit South Asian nations
As the coronavirus pandemic continues to spread in vulnerable nations of Africa and South Asia, experts say these countries may find the time of only weeks to fill the chronic shortages of what medics would need to help people continue to breathe.
Medical oxygen is a core component of the life-saving therapies that hospitals are giving patients with severe cases of Covid-19, as the world waits for scientists to find vaccines and treatments.
Not ventilators, but oxygen itself
"The reality is that oxygen is the only therapy that will save lives in Africa and Asia-Pacific now," said Hamish Graham, a consultant paediatrician and research fellow at Melbourne University Hospital and International Centre for Child Health, reports AFP.
"I fear that undue focus on ventilators without fixing oxygen systems will kill."
The report said surveys throughout Africa and Asia-Pacific have shown that less than half of hospitals have oxygen available in the wards at any given time, and even fewer have the pulse oximeters that allow medical staff to measure blood oxygen levels and thereby adjust dosages.
