How effective are our ventilators?

There have been extensive discussions over the number of ventilators in our hospitals for an uninterrupted oxygen supply to critical Covid-19 patients. But very few of them pay attention to a grave issue: Will the machines we already have be of any use when they are required?

Experts say there is a very little chance of that being the case.

That is because most hospitals dedicated to Covid-19 treatment have no facility to supply nonstop oxygen to patients with the worst effects of the infection.

Also, to supply the life-saving gas, they depend chiefly on cylinders whose oxygen pressure is inadequate for Covid-19 patients.

Bangladesh has procured around 1,200 ventilators so far while 300 more are in the pipeline, according to Health Minister Zahid Maleque. But data from the health directorate says that the country has only 192 machines.

Quite a few public and private hospitals in Dhaka have readied their intensive care units (ICUs) for Covid-19 patients. The hospitals include Kuwait-Bangladesh Friendship Hospital, Sheikh Russel Gastro Liver Institute and Hospital, Railway General Hospital, Mohanagar General Hospital, Mirpur Maternity and Child Health Hospital, Regent Hospital and three branches of Sajida Foundation in Uttara, Mirpur and Jatrabari.

Only a few of these hospitals have a central oxygen storage system to supply continuous mechanical ventilation to ICU patients at high pressure.

Health experts say that the worst problem for Covid-19 patients is the breathing issue. As a result, they need a continuous supply of oxygen which cannot be ensured through cylinders.

This is because cylinders cannot supply the gas at an adequate pressure, as per the World Health Organisation (WHO) standard, required for coronavirus patients.

Experts also say the essential pressure of oxygen supply to Covid-19 patients should be 50 pounds per square inch (PSI). This level of pressure can be reached only after 10 Bangladeshi cylinders are used at a time. But that too can be maintained for only 10-15 minutes. After that, oxygen will not come to the ventilators.

According to Linde Bangladesh, the country's lone registered oxygen supplier, each cylinder used in Bangladeshi hospitals can contain maximum 1,400 litres of the gas.

Nonstop oxygen can be ensured to Covid-19 patients only in those hospitals which have a central storage system for the gas supply, say doctors.

Only a few hospitals, including Dhaka Medical College Hospital, Bangabandhu Sheikh Mujib Medical University, Sir Salimullah Medical College Hospital, Square Hospitals, Apollo Hospital and Anwer Khan Modern Medical College Hospital, have that facility.

Dr Mazharul Haque, a WHO doctor in Bangladesh, said it is necessary to develop a central oxygen storage system in all hospitals dedicated for Covid-19 patients in Bangladesh. "Or else, ventilators in these hospitals will never be effective."

When asked if developing such a facility needs much time, the doctor said the system is not complex and can be developed quickly.

Dr Nazrul Islam Khan, member of the government's Covid-19 specialist taskforce and former vice chancellor of BSMMU, said they will discuss the issue on an emergency basis in the taskforce meeting.

A high official of Linde Bangladesh, on condition of anonymity, said developing a central oxygen storage facility is costly and time-consuming. "But there is no alternative to developing it if we want to treat Covid-19 patients."

Health specialists said a normal human takes in 11,000-12,000 litres of oxygen per day, but the gas use rises when he is infected with the coronavirus. And a standard-sized cylinder can usually supply that volume of oxygen for 15-20 minutes.

Linde Bangladesh now supplies 35 tonnes of oxygen per day, but it has the capacity to produce and supply 90-100 tonnes per day.