Editorial | Why oxygen shortage after March crisis?

The arrival of a shipment from abroad may have eased the shortage of oxygen at Jamaica’s public hospitals. But the island’s health officials, including the minister, Christopher Tufton, owe the public an explanation of how they allowed this crisis to occur and how they will prevent it in the future. It won’t be enough for them to merely point to the growing numbers of severely ill COVID-19 patients.

We, of course, are not intending to discount the August spike, Jamaica’s so-called third wave, of the coronavirus epidemic and its impact on healthcare resources. This newspaper – including in these columns – has been highlighting the growing magnitude, and increasing deadliness, of this illness.

Indeed, during the first 29 days of August, 14,165 new cases of COVID-19 were confirmed in Jamaica, an increase of 27 per cent since the end of July. In those 29 days, too, there were over three and half times (361 per cent) more cases than for the 31 days of July. Also during that review period, 314 people were killed by the virus, a jump of 171 per cent when compared to the deaths for all of July.

Additionally, at the end of July, 187 patients were hospitalised with COVID-19. Twenty-nine of them were categorised as seriously ill, which meant that they had to receive oxygen and required specialised nursing care. None were labelled severely ill.

FOUR PER CENT OVER CAPACITY

Up to Sunday, 728 cases of COVID-19 were being treated in hospitals, which meant that the institutions were four per cent over capacity, measured against the total number of hospital beds allocated for the treatment of the coronavirus. Of these patients, 62 were categorised as critically ill and 62 severely so. Both groups are administered oxygen, but the former doesn’t require round-the-clock specialised nursing. Over the past fortnight, the daily average of patients in the critically ill category has been nearly 55.

So, we get it. The situation is bad. That, though, without more, doesn’t explain the current oxygen crisis. The epidemiologists and the health statisticians at the health ministry ought to have done their modelling on the trajectory of COVID-19 in various circumstances and what would be required of the health system in the various scenarios. And with respect to oxygen, there should have been no surprises, having already been faced with the problem, or a situation similar thereto.

One weekend in mid-March, the health ministry, similar to what it did last Friday, announced a suspension of elective surgeries and a halt on admissions but for emergencies, in order to conserve oxygen for use in critical cases. That was during the epidemic’s second wave.

At the time – the increased demand for medical oxygen notwithstanding – the island’s sole manufacturer/supplier of medical oxygen, IGL Ltd, said the problem wasn’t output, but how the product was delivered and stored. Some hospitals were without on-site storage facilities and internal transmission pipes. So, they received their oxygen in ready-to-use cylinders, which were in short supply. More cylinders were to be imported.

Peter Graham, IGL’s CEO, also reported at the time that his company was working with hospitals to “modify supply configurations to cope with increasing demands”. This would include, where possible, improved storage capacity/facility.

That was five months ago – a long time for things to happen. Especially at a time of crisis. It would be useful, therefore, to know what happened with those projects and how these new supply configurations fared in the current situation.

POLICY HESITANCY

Assuming that IGL’s production capacity and output are not below demand (which no one has said they are), it would help if people were told how, in the current circumstances, these logistical challenges informed delivery schedules. Indeed, just-in-time supply arrangements are unlikely to be the most efficacious in this environment. Was there, for instance, a build-up of inventory?

There is something in the oxygen crisis that is reminiscent of the last-minute invitation to retired doctors and nurses and private healthcare providers to administer COVID-19 vaccines, when months ago the health authorities had a good idea when vaccine supplies were likely to be available.

If they were proactive, these agreements would have long been settled, training done and private contractors set to work as soon as the vaccines were delivered. Instead, they will be slow off the mark.

If we didn’t know better, we might equate the approach to policy hesitancy. Which, on reflection, is perhaps a good summary of the approach of Jamaican governments to most matters, except at elections.