Africa Is Running Out Of Oxygen

Jun 24, 2021
Originally published on July 5, 2021 8:17 am

Hospital wards across Uganda are filling with COVID-19 patients as the country faces an aggressive surge in cases. One of the biggest issues have: a serious shortage of oxygen.

Over the last month, the number of daily reported infections has increased tenfold, showing no signs of letting up. Cases have jumped from less than 100 a day in mid-May to 1,584 on June 18. "ICU bed capacity is now full, almost at 100%," says Willy Tabu, a physician based in Kampala who helps coordinate Mercy Corps response to the pandemic.

And it's not only beds that are a concern. Tabu says severely ill COVID-19 patients need oxygen, but the supply just isn't there.

Oxygen is being produced. Uganda's 14 largest federal hospitals each have oxygen generating plants and they provide cylinders to smaller hospitals and clinics. But they are struggling to meet the increased demand. There's also a shortage of cylinders to go around, says Tabu — meaning the oxygen plants have to ship the ones they have back and forth to be refilled, and that doesn't happen quickly.

'A Perfect Storm For Mass Fatality'

The numbers don't look good. Uganda has the capacity to fill 3,000 oxygen cylinders per day. But if COVID hospitalizations continue to increase at the current rate, Tabu says, Uganda could need 25,000 cylinders a day in the next month.

"That is way beyond what the government, even the government with a supplementation of the private sector, can be able to produce," Tabu says. "So that is how bad the situation looks now."

This is in a country where less than 2% of the population has been immunized against COVID.

"If you don't have oxygen and you don't have a vaccine, this is like a perfect storm for mass fatality," says Leith Greenslade, the coordinator of the Every Breath Counts Coalition, which addresses respiratory issues in low- and middle-income countries.

Oxygen Shortages Are A Problem Across Africa

Greenslade says inadequate supplies of oxygen have been a problem in many parts of the world during this pandemic but the shortages in Africa are acute. While countries like Brazil and India have industrial plants creating oxygen, much of Africa does not. Sierra Leone, for instance, has only two plants for the entire country,

"Prior to the pandemic, most of the hospitals in Africa were not properly equipped to deal with the needs of oxygen for non-COVID patients," Greenslade says.

Severely ill COVID patients on the continent die at rates far higher than anywhere else in the world. A study of COVID mortality in 10 African nations, published last month in the British medical journal The Lancet, found that half of those admitted to intensive care units didn't survive. It also found that only half of hospitalized COVID patients got access to high-flow oxygen, the most effective delivery system. The West African nation of Sierra Leone has only two functioning medical oxygen plants: one in the capital and one in a remote diamond mining district near the border with Guinea.

The oxygen plant at the Koidu Government Hospital in the Kono District of Sierra Leone. It's one of only two functioning medical oxygen plants in the country.
Jason Beaubien/NPR

"You get about ten hours of high flow delivery to a patient for each of these cylinders," says Douglass Miller, the infrastructure manager with Partners in Health assigned to the Koidu Government Hospital in northeastern Sierra Leone.

Standing outside the shipping container which houses the oxygen plant, Miller says the plant can fill 20 cylinders per day — not even enough to treat a dozen severely ill COVID patients. Fortunately, the hospital isn't seeing an influx of coronavirus cases right now.

Oxygen Isn't Just Needed For COVID Patients

Supplemental oxygen is used regularly in other parts of the hospital, particularly the neonatal intensive care unit. In addition to the bottled oxygen, the staff have several mobile oxygen concentrators on the ward. But mobile oxygen concentrators need a stable source of electricity, which isn't always available in hospitals and clinics across the continent.

The neonatal intensive care unit at the hospital was built to care for 20 infants but often holds twice that many. So many of the babies need supplemental oxygen that the staff have set up splitters so that multiple infants can be hooked up to a single tank.

Pre-term babies in the neonatal intensive care unit at the Koidu Government Hospital in Sierra Leone. Many of the infants need supplemental oxygen, which is now in short supply because of demand to treat severely ill COVID-19 patients.
Jason Beaubien/NPR

Next door in the maternity ward, the staff have been using oxygen to help stabilize a pregnant woman who has been having epileptic fits for the last five days.

"She's had two previous pregnancies, but both babies have died. They were both stillborn," says nurse-midwife Isata Dumbuya. Dumbuya is the head of reproductive and maternal health for Partners in Health in Sierra Leone. She says that this 29-year-old wasn't getting enough oxygen to her brain in the midst of her seizures. If she hadn't gotten supplemental oxygen she probably would have died several days ago, she says.

The pregnant woman finally seems to have turned a corner. She's still drowsy but is finally talking somewhat coherently with Dumbuya for the first time. She's asking for food as Dumbuya checks her vital signs.

"Everything's normal," Dumbuya says with a smile. Her oxygen saturation is back up to 98% after being in the 80's a few days ago. "This is someone who was going to die yesterday."

And of the keys to saving this woman and her baby was readily available bottled oxygen. Dumbuya this level of care is not the norm in maternity wards across much of the country.

If Sierra Leone does get hit by a significant surge in COVID cases and severely ill patients start filling hospital wards, the 20 cylinders of oxygen a day produced at this hospital will be in high demand. And that demand will be not just at Koidu General Hospital but at clinics throughout the region.

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NOEL KING, HOST:

There is a dire shortage of medical oxygen in African countries. The pandemic is making that clear. So is there a solution?

Here's NPR's Jason Beaubien.

JASON BEAUBIEN, BYLINE: The East African nation of Uganda is in the midst of an aggressive surge in COVID cases. Average daily infections in June spiked at 20 times higher than what they were in mid-May. Deaths are at an all-time high. And hospital wards are overflowing with COVID patients.

WILLY TABU: ICU bed capacity is now full. So we are almost 100%.

BEAUBIEN: Willy Tabu is a physician with Mercy Corps in Uganda. He's helping to coordinate Mercy Corps' overall response to the pandemic in the country. Uganda's largest federal hospitals each have oxygen-generating plants. And they provide cylinders to smaller hospitals and clinics. Generating enough oxygen is one challenge. Shipping it around the country is another.

TABU: Cylinders have become an issue. We don't have adequate cylinders. And then there are challenges of the transportation to go and pick up the - or to refill the oxygen cylinders.

BEAUBIEN: He says, oxygen plants at government hospitals are struggling to meet the increased demand.

TABU: So especially, though, the districts - or the district hospitals that are away from the center have voiced their concern about, A, the total lack of oxygen or increasingly reducing amounts of oxygen available to attend to patients.

BEAUBIEN: Uganda has the capacity to fill 3,000 oxygen cylinders per day, Tabu says. If COVID hospitalizations continue to increase at the current rate, Uganda could need 25,000 cylinders a day in the next month.

TABU: That is way beyond what the government can - or the government - or even with a supplementation of the private sector can be able to produce. So that is how bad the situation looks now.

BEAUBIEN: And this is in a country where less than 2% of the population has been immunized against COVID.

LEITH GREENSLADE: So if you don't have oxygen and you don't have vaccines, it's like - this is like a perfect storm for mass fatality.

BEAUBIEN: Leith Greenslade is the coordinator for the Every Breath Counts Coalition that tries to address respiratory issues in low- and middle-income countries. She says, inadequate supplies of oxygen have been a problem in many parts of the world during this pandemic. But the shortages in Africa are acute.

GREENSLADE: Prior to the pandemic, most of the hospitals in Africa were not properly equipped to deal with the needs of oxygen for non-COVID patients.

BEAUBIEN: Severely ill COVID patients on the continent die at rates far higher than anywhere else in the world. A study of COVID mortality in 10 African nations published in the British medical journal The Lancet found that half of those admitted to intensive care units didn't survive. It also found that only half of hospitalized COVID patients got access to high-flow oxygen. The West African nation of Sierra Leone has only two functioning medical oxygen plants - one in the capital and one in a remote diamond mining district near the border with Guinea.

DOUGLAS MILLER: Yeah. My name is Douglas Miller. We're at Koidu Government Hospital right now at the oxygen plant.

BEAUBIEN: Miller is the infrastructure manager with Partners in Health at the hospital. He's standing next to a 20-foot-long shipping container that houses the oxygen plant.

(SOUNDBITE OF PRESSURIZED OXYGEN)

BEAUBIEN: Gas cylinders being filled with oxygen line the outside of the container.

MILLER: You get about 10 hours of high-flow delivery to a patient for each of these cylinders.

BEAUBIEN: This oxygen plant can fill 20 cylinders per day. That's not even enough to treat a dozen severely ill COVID patients. Fortunately, this hospital isn't seeing an influx of coronavirus cases right now. But supplemental oxygen is used regularly in the neonatal intensive care unit. In addition to the bottled oxygen, they also have several mobile oxygen concentrators on the ward. So many of the babies need oxygen that the staff have set up splitters so that multiple infants can be hooked up to a single tank.

Next-door in the maternity ward, the staff have been trying to stabilize a pregnant woman who's been having epileptic fits for the last five days.

ISATA DUMBUYA: So she's had two previous pregnancies. But both babies have died. They were both stillborn.

BEAUBIEN: Isata Dumbuya, the head of maternal health for Partners in Health in Sierra Leone, says that if this 29 year old hadn't gotten supplemental oxygen, she probably would have died several days ago.

DUMBUYA: You begin your shake, shake.

(SOUNDBITE OF BEEPING)

DUMBUYA: (Speaking Krio). Shake, shake.

UNIDENTIFIED PERSON: (Groaning).

BEAUBIEN: The patient is still drowsy. But she's now talking with Dumbuya for the first time. She's asking for food. Dumbuya checks her vital signs.

DUMBUYA: Everything normal - so saturation's 98, pulse rate, 69, 70, blood pressure, 107 over 62. This was somebody that was going to die yesterday. Yes?

BEAUBIEN: But one of the keys to saving this woman and her baby was readily available bottled oxygen, something that Dumbuya says is not the norm in maternity wards across most of the country.

Jason Beaubien, NPR News, Koidu, Sierra Leone. Transcript provided by NPR, Copyright NPR.