Despite constantly ramping up testing and treatment services at the flagship Infectious Diseases Hospital, Lagos may soon be deluged by critical-to-severe COVID-19 cases as a result of the rapid rate of infections, reports Associate Editor ADEKUNLE YUSUF
As the ambulance screeched to a stop in front of the sparkling clean ward, many apprehensive family members of patients outside the hospital did not even bother to look at its direction. After snaking its way out of the labyrinthine traffic snarls that seem to have defined commuting in the Centre of Excellence nowadays, the branded ambulance from one of Nigeria’s upscale private hospitals soon realised that it had to compete for space in the hospital’s busy parking lot already occupied by exotic vehicles and two other ambulances.
Before transferring its content, an almost lifeless body, into the arms of medical personnel, another ambulance drove in – also with a feverish occupant gasping for breath. The paramedics were both quickly prompted to drive further down in the sprawling premises of Lagos Mainland Hospital, the state’s premier infectious disease facility, nestling in the serene part of Yaba. By the time the two ambulances reached the outpatient section, which now serves as the hospital’s central admission point, the enormity of the public health crisis, which rising COVID-19 infections in the state have engendered, became clearer.
As the two ambulances jostled for space with four other ambulances and three Sport Utility Vehicles whose occupants were being stabilised with oxygen, they were promptly greeted with an unavoidable sight: many giant cylinders – both used and recently refilled – that littered the space. An open space near the central car park, the central admission point in the hospital is where all COVID-19 patients, including referrals, first report to as it is practically impossible for anybody to access care in the facility without having paid ‘homage’ to this section. Even though it does not look like the best part of the hospital, decisions made here by medical officials determine the next lines of action for all COVID-19 patients.
As relatives agonise endlessly, patients battle for their lives
Throughout last week when this reported breezed in and out of the ever-busy COVID-19 hospital, the central admission point was not a spectacle to behold – certainly not a place the lily-livered would ever like to near. Besides regularly bringing in and offloading severely sick patients, some already gasping for air, ambulances and SUVs were sometimes converted into a temporary mobile clinic where dying patients were first placed on oxygen to stabilize before more intense diagnosis and care commenced. Some were attended to
In the three visits made by this reporter to the central admission section in the course of reporting this story, medical personnel were seen running frantically up and down to save patients who mostly arrived the open place in bad shapes. In the open space, while some healthcare givers were busy connecting face mask to an oxygen source, turning on oxygen at the required rate and adjusting flow rate for newly arrived patients right inside the ambulances that conveyed them to the isolation centre, some equally almost lifeless patients on wheelchairs and iron seats that abound also had oxygen masks either placed on their faces or applied on their noses or both – with medical personnel always adjusting elastic straps as the situation demanded.
Perhaps because the outpatient department, which now serves as the open central admission point in the ravaging virus era, is very close to the spacious car park in the hospital, it often daily evokes a scene that further helps to provide a lens to see Nigeria for what it is – a society that breathes almost solely at the mercy of the high and mighty. As many patients slowly ebb away, many powerful individuals in exotic vehicles parked around the open admission space could be seen working their phones to reach out to persons in high offices as they make frenetic efforts to save their own from the ravages of COVID-19, sometimes seen pestering supervisors of ever-busy health workers.
Last week, among many powerful men and women loudly barking orders and threatening brimstone and fire through telephone conversations, an agitated lady whose father, it was learnt, was also badly in need of help stood out in how not to behave in the public. As she was nervously called Reddington and St Nicholas hospitals on phone, she openly threatened to deflate the tyres of the ambulance and burn it down (though she did not mention the specific ambulance one among ambulances parked at the central admission point).
It all, however, ended as an empty threat because no ambulance was set ablaze throughout the day this reporter lurked around to monitor the atmospherics in the isolation centre. Later, she was as gentle as a dove after coming out of the emergency operations centre (EOC) where she had gone to have an audience with those in charge, perhaps finally trusting in the ability of caregivers to do their utmost to rescue her ailing dad from the claws of death.
Every day, relatives of patients that always abound loitering around in the various sections of the hospital’s premises are a good study in how not to handle moments of agony and despair. Like a man whose pregnant wife is embroiled in prolonged labour, many people waiting endlessly outside the wards have become emotional wrecks, looking hopeless but still somehow optimistic that their loved ones would win the battle against a vicious virus that has held the world by the jugulars.
At IDH, the beginning of what may turn out to be a journey of no return begins at an open space. Officials explained that the central admissions point was purposely designed to be an open, fresh air affair so that questions of people infecting one another may not arise. Here, officials, always without the luxury of time, have the urgent duty to determine who is truly sick and who is not among the deluge of patients thronging the facility daily. But that is not all. They are also under severe pressure to decide who should be tested for COVID-19 and who should not, which sometimes breeds controversies as everyone wants to be tested.
And after conclusive diagnosis is done, the next task involves determining who should be admitted and who should not. At IDH, there are two isolation units – isolation 1 and isolation 2. The first was the same old but refurbished infectious diseases section of IDH; while the second isolation centre is a brand new glittering facility built by the organised private sector, Coalition Against COVID-19 (CACOVID), to support the Nigerian government’s efforts in the fight against the deadly virus.
For those whose test results returned negative verdicts, isolation 1 is their automatic destination. The reason is that such individuals are often flagged as suspected, but not confirmed cases. But if a PCR test later proves a positivity case, such patients often graduate from isolation 1 to 2 immediately. And because female and male wards in isolation 1 are all single rooms, it bodes well for managing individual peculiarities often inherent in infectious diseases without endangering other patients.
The rooms in isolation 1, which were built years back specifically for tuberculosis and other infectious diseases management in the state, have undergone massive renovations to keep them attuned for handling the raging COVID-19 pandemic. The rooms, among other things, have been rewired and retiled so that medical oxygen can be piped directly to every bed.
Also, at the back of every ward at isolation 1 are newly built oxygen cubicles where scores of giant cylinders are housed – an innovation that has phased out the drudgery of having to constantly ferry huge oxygen cylinders around hospital floors and reduced chances of having the patients cut off from oxygen supply. It’s from the cubicles that pipes take oxygen directly to every patient on admission. What is more, the cubicles are equipped with sensors, which alert the hospital before the oxygen supply is exhausted so that replenishment can be quickly arranged and effected.
A donation of CACOVID, the 160-bed isolation 2 has a fully contained PCR laboratory, a routine laboratory, a female ward, a male ward, a bouquet of administrative and ancillary facilities, a water treatment plant, a waste management system and three power generators for case management. By the time inbuilt, it was the sixth isolation centre in Lagos specifically committed to COVID19.
As at the last time this reporter checked, isolation 1, which comprises a total of 94 beds, has a sixty per cent occupancy rate. For isolation 2, which can take up to 160 patients in its female and male wards, ninety-five per cent of the bed space has been occupied by COVID-19 patients. As a treatment protocol in the hospital, all persons who tested positive for COVID-19 and require close monitoring are to be moved to isolation 2 without any further delay so that appropriate therapy can commence. Like in normal hospital settings, admission or bed space is on an availability basis, but preference goes for most critical cases and elderly people.
Even as the conundrum posed by many people’s doubt about COVID-19 still subsists, Lagos is witnessing an increasing number of severe cases as infections spread like wildfire in the communities. Since Nigeria was plunged into the second wave of COVID-19 characterised by the resurgence of new variants of the virus, isolation centres in Lagos have been battling with an increasing number of patients.
Although many countries have since swung into action closing their borders against international travels, especially against countries regarded as high-risk, Nigeria has continued to operate a less punitive policy. All travellers need to get access into Nigeria is to produce evidence of a negative PCR test he or she has just undergone. This development, many public health experts said, has sadly opened a window of opportunity for nefarious individuals who illegally exploit the loopholes in the system to do brisk business at the expense of public health.
But, going by daily updates from the Nigeria Center for Disease Control (NCDC), the country is still witnessing rapidly rising rate of COVID-19 infection. As of January 23, Nigeria has recorded 120,602 confirmed cases of Coronavirus and 1,502 deaths. So far, Lagos, Nigeria’s epicentre of COVID-19 crisis, has a total of 44,580 cases, with 285 deaths.
Oxygen as the food of COVID-19
Near the main car park in the hospital stands a newly-built medium-sized oxygen plant that feeds the medical oxygen requirements of the increasing number of patients. It’s another product of collaboration and partnership between the state government, Clinton Health Access Initiative, and Bill and Melinda Gates Foundation designed to give armour to the hospital’s resolve to provide quality care for COVID-19 patients.
The technology, which became operational in the hospital about two weeks ago, works by directly drawing atmospheric air as feedstock and separating it from other components of air to produce oxygen. It then separates a mixture of different gases from which it extracts the much-needed 21 per cent of the oxygen in the atmospheric air and thrashes approximately 78 per cent of nitrogen and small amounts of lots of other gases such as carbon dioxide, neon and hydrogen. Amidst increasing demand for oxygen occasioned by the second wave of COVID-19 infections, the brand new oxygen plant provides swift support to patients who require oxygen therapy.
For every person that is hale and hearty, 21 per cent of oxygen that is readily available in the atmospheric air is enough to sustain life. But not for COVID-19 patients, especially the critical or severe cases that need oxygen therapy to breathe and stay alive because ordinary air will no longer be enough due to injury to or malfunctioning of the lungs. Doctors said such patients require ninety-nine per cent of medical oxygen, which the newly-built plant produces.
The commissioner explained that the operation of the plant, which produces about 300 cylinders per day and six cylinders per hour for use of patients admitted at the isolation facility, is making oxygen available for COVID-19 patients. Oxygen from the plant is administered to patients through cylinders made available at hospital wards. “We recognise the importance of generating oxygen because of the large number of patients who are currently on admission in our isolation centres and are, largely, depending on oxygen. This has resulted in an escalating and alarming demand for oxygen. The oxygen plant facility could not have come at a better time than now when the state is recording an increase in the number of people presenting with difficulty in breathing and requiring urgent oxygen therapy.”
Disclosing that about 400-500 cylinders of gas are being used a day in the isolation facility, Abayomi said a patient with a critical case may use about six cylinders of oxygen within 24 hours. This is so because COVID-19 is a disease of the lungs. Under normal circumstances, the facility will not need more than sixty cylinders per day, a doctor said.
He explained that oxygen plants are industrial devices designed for regular supply into healthcare facilities, adding that high purity oxygen is needed in hospitals and essential for patients undergoing COVID-19 treatments. “This is particularly useful for patients with comorbidities who require prompt oxygen for survival. Oxygen from the plant will be very helpful for effective treatment due to the proximity of the plant which serves as a source.”
He admitted that the plant has been quite helpful as the state grapples with a deluge of severe cases who often do not present to the hospital until it’s is almost too late to salvage them, with every patient requiring an average of 15 litres per minute to survive. Abayomi, who noted that medical oxygen is the primary treatment for the majority of patients with severe COVID-19 symptoms, explained that the bulk of patients the hospital manages often come in when the situation is already critical and more difficult to salvage, thus costing the state more resources.
Abayomi, however, stressed that the state remains committed to ensuring an improved healthcare system toward enhancing quality healthcare and saving the lives of its residents. “Many of these patients present late to the isolation centres, leading to fatalities. This life-saving gas helps patients breathe when they cannot do so on their own, and timely access to oxygen is critical to ensure the patient’s survival. If anyone is breathless, go to any of these centres, and the doctors and nurses there will assist to stabilise you with oxygen before moving you with the ambulance to the isolation centre.