Gas supplier Afrox has assured the public that there is no shortage of medical oxygen in South Africa, contrary to what some media reports may have suggested, reports Polity. Afrox, as the sole supplier of medical oxygen to State hospitals and clinics, as well as to privately owned hospitals and clinics, is working closely with its customers to maintain adequate cylinder stocks and says it has met all the medical oxygen demands from its customers during the COVID-19 pandemic.
Meanwhile, the company has undertaken an end-to-end oxygen supply chain risk review and business continuity planning, which included an in-depth review of its oxygen supply chain.
According to the report, Afrox assures it has emergency scenarios in place and that it is testing and implementing those on an ongoing basis to adjust where appropriate. In the unlikely event of shortages, oxygen supply will be prioritised for the healthcare sector.
Additionally, Afrox says it is possible to take non-medical grade oxygen and refine the product to meet medical oxygen grade standards.
South Africa's medical oxygen levels have raised some concern, with Health Minister Zweli Mkhize saying the country "does not, right now, have the same level of oxygen for medical usage". Polity quotes Mkhize as saying that government had held urgent weekend meetings with liquid oxygen suppliers to increase oxygen provision, as well as capacity at hospitals in the country, including field and district hospitals, in Gauteng, the Western Cape and Eastern Cape.
"We have also, in the modelling, noticed that the country doesn't right now have the same level of oxygen for medical usage, and therefore we have now been involved in these discussions to divert some of the oxygen for industrial use into the healthcare [system] and also looking at how the production must be increased," Mkhize said.
While field hospitals were originally provided to isolate patients, Mkhize said government realised it would be more useful if the beds were provided with oxygen. "Now that's a new issue that got built in long after we established the number of beds that we needed to prepare," he said. He explained that as COVID-19 patients commonly experience a lack of oxygen in the blood, they will then need to be put on oxygen to assist them.
Health Department spokesperson Popo Maja is quoted in the report as saying that the increase in demand for medical oxygen during the pandemic has led to government needing to make some "modifications" in a number of hospitals to ensure a stable supply of oxygen. Maja said there had been no issues regarding oxygen reported to the department, but he added government had embarked on a plan to address "engineering challenges" experienced by some medical facilities in the country.
"National government has approved a systematic plan to address these engineering challenges in all provinces. Oxygen suppliers have been engaged as early as the beginning of March to ramp up production of oxygen. Both national and provinces are working together to monitor the situation, just to avoid anything going wrong," Maja told News24. He added that while there had not been any obstacles regarding supplies in hospitals, adjustments had to be made to the infrastructure in some facilities to allow for more access to oxygen for patients.
"There has not been a problem with oxygen supply to any of the hospitals. In view of the increased oxygen demand for COVID-19, we have had to make some modifications to the mechanical and engineering infrastructure at some hospitals to ensure that the level of the pressure of oxygen in the system is stable.
"Some emergency engineering work has been necessary and will continue to be done wherever necessary in order to ensure that oxygen gets to the patients,” Maja said, including in Gauteng and the Eastern Cape.
"By engineering services, we mean that we are making available oxygen in wards where oxygen was not necessary before. We are also making oxygen available in field hospitals," he explained.
However, the report says, one expert, who wished to remain anonymous for fear of vilification, recently raised concern over supplies earlier this month, and said the three months of lockdown to prepare for the spike of coronavirus infections might not have been enough.
"We've stopped the lockdown right in the midst of this infection explosion, and in winter when people are getting flu anyway, but it's very worrying because even with the three months of preparation it's almost like it isn't enough. You can only do so much or have so many hospital beds or have so much oxygen in preparation."
While South Africa have ventilators for critical COVID-19 patients, "what we do not have enough (of) is the oxygen that goes through the ventilator mask to keep the person alive." Oxygen issues experienced in some hospitals have been engineering or infrastructure related, including blockages in the pipes or tubes that takes the oxygen to the patient, the source said.
Gauteng is currently the epicentre of the COVID-19 pandemic with around 5,000 new cases a day. Daily Maverick reports that the province is experiencing a public hospital crisis as all state hospitals have reached capacity and there is an urgent need to assist patients with oxygen and a collective of healthcare professionals who are volunteering at the Nasrec Field Hospital has sent out an urgent call to members of the public to lend them their oxygen concentrators or assist with financial support to enable them to rent these machines so they can also help patients who are more seriously ill.
Lynne Wilkinson, who is part of the collective, said they have not been able to find any oxygen concentrators at any suppliers in the province. “We need to get oxygen going at beds in Nasrec,” she said. “Suppliers tell us that private people have bought them up to keep them at home in case they need them. If you bought one or know of someone with one and it is sitting in your home, can you loan it to us for a week while more stock comes into the country? We will give it back as soon as you need it,” she added.
She explained that oxygen concentrators filtered surrounding air, compressing it to the required density, and then delivered purified medical grade oxygen to the patient. Oxygen concentrators cost R16,000 per machine. As they use air and not bottled oxygen there is no need to purchase oxygen cylinders.
She added that all borrowed machines will be properly disinfected before they are returned. She said 60 volunteer doctors, nurses and clinical associates have volunteered to do shifts at the field hospital this week but they were looking for more volunteers. “All personal protective equipment will be supplied,” she said.
The report says the Nasrec Field Hospital currently has 450 low acuity beds for patients who are self-caring and do not require oxygen but as the number of cases in the province increased a further 800 beds and more staff have been commissioned. Wilkinson said the beds will have piped oxygen and human resources but this is taking time to complete.
As of 14 July, with COVID-19 cases still on the rise, the Western Cape is only using approximately 60% of its available oxygen supply, the province's premier, Alan Winde, revealed. News24 reports that in his daily COVID-19 update he said: "The Western Cape is currently using approximately 29 tonnes of medical grade oxygen in our facilities daily, with the biggest consumption occurring at Tygerberg and Groote Schuur hospitals."
"We are currently using approximately 60% of the available oxygen supply, so have sufficient supply margins available in the province. Before the start of the pandemic, the Western Cape and the City of Cape Town put measures in place to ensure that the facility where medical grade oxygen is manufactured in the province is not impacted by load-shedding. It is especially important during this pandemic to ensure that production interruptions do not occur".
[link url="https://www.polity.org.za/article/concern-over-medical-oxygen-as-govt-embarks-on-plan-to-increase-supply-2020-07-14"]Full Polity report[/link]
[link url="https://www.polity.org.za/article/afrox-assures-public-there-are-sufficent-supplies-of-medical-oxygen-2020-07-10"]Full Polity report[/link]
[link url="https://www.dailymaverick.co.za/article/2020-07-10-gauteng-doctors-make-urgent-public-appeal-for-lifesaving-oxygen-concentrators/#gsc.tab=0"]Full Daily Maverick report[/link]
[link url="https://www.news24.com/news24/southafrica/news/covid-19-western-cape-using-60-of-its-oxygen-supply-in-hospitals-20200714"]Full News24 report[/link]