Covid-19 & Oxygen in LMICs

[Wim Van Damme]

Oxygen for covid-patients

 

Dear members of Google Group Covid-19 in SSA,

 

I am trying to make sense of this unfolding epidemic worldwide, being based in Kinshasa.

A lot of the attention here is focused on the "epidemic curve" (not exponential yet, from what we can know from the confirmed cases), on the treatment (new medicines!!!, including "Covid organic"), and obviously on the lockdown and its huge collateral effects.

 

But, one issue which I think is being rather neglected: oxygen!!!

 

As far as I understand treatment of covid-19 disease, the most essential commodity is oxygen, even in cases that are relatively mild. There seems to be some strange dissociation between "not feeling dyspnoeic" but “already having low oxygen saturation” (as easily measured by a pulse oximeter).

In lay terms, I tend to explain low oxygen saturation as follows: If there is low oxygen saturation, the body cannot easily burn its fuel for all body organs and systems. With low oxygen body systems cannot function optimally while the immune system is fighting the virus. When lungs are diseased, oxygen has difficulty entering the body, so it helps if the air entering the lungs has a higher oxygen concentration than normal. One can easily measure whether enough oxygen enters the body with a pulse oximeter on a fingertip.

 

So, I think that providing oxygen to covid-19 patients, aiming for optimal oxygen saturation early is a good way to support the body. (something similar to making sure fluid balance is OK in any sick patient). This is in fact the only proven (“evidence-based”) treatment for covid-19; all the other treatments remain unproven.

 

And, as all of you know, oxygen supplies (and masks and tubes for patients) are very insufficient in countries like DRC.

So, when people ask me what I recommend as priority for patient care here in DRC, I recommend 3 things: #1 oxygen; #2 oxygen; #3 oxygen; even in health centres (with oxygen concentrators). This is easily said, but quite complex; it involves

-        supplying lots of pulse oximeters (rarely available);

-        making sure there are enough oxygen concentrators (which need electricity to function);

-        finding enough gas bottles for oxygen (“bombonnes”), which once filled don’t need electricity and can provide much more oxygen;

-        boosting oxygen “production” to fill these bottles;

-        plus all the masks and tubes to administer the oxygen to patients; and

-        make sure all patients get it, continuously, frequently monitored with the oximeter.

In short: there is a need to assure the whole “oxygen production and supply chain”.

 

When I insist on oxygen, many people then think I recommend flying in ventilators. But obviously, that is not my intention. (I think focusing on ventilators for LMICs is a very-very bad idea, but that is not the point I want to make here).

 

But I have a hard time convincing; much more attention goes to chloroquine and other medicines.

 

Hence my question to this group: Why is it so difficult to get attention to oxygen? And to boost decisive action to boost the whole oxygen supply chain, so that oxygen will be available and utilised at the frontlines. (once the number of covid-19 rises rapidly, also in rural areas).

 

I can think of a few reasons:

-        Oxygen is considered something “logistic” rather than “medicine” …

-        Oxygen requires a different supply chain, not involving pharmaceutical companies, pharmacies, &c.

-        Oxygen can not be ordered abroad, but requires local “production” … Boosting availability of oxygen may require investing in some production unit, with technicians and engineers, &c …

-        There are no scientific papers or clinical trials on oxygen …

-        ….

 

What do you think?

[Robert Colebunders]

You are right Wim

This should be the priority concerning treatment

 

Robert (Bob) Colebunders

International citizen project COVID-19 (ICPCovid)

NSETHIO project

Campus drie Eiken

Gouverneur Kinsbergen Centrum

Doornstraat 331, 2610 Wilrijk

+3232651804

+32486920149

Skype name Robert colebunders

robert.co...@uantwerpen.be

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[Willem]

You have convinced me, but I am easy prey; and I fear that the simplicity of your advice makes it hard to convince those impressed by high-tech, international, pharmacy related avenues.

Have a good day!

Willem van de Put

On 6 May 2020, at 09:16, Robert Colebunders <robert.co...@uantwerpen.be> wrote:



You are right Wim

This should be the priority concerning treatment

 

Robert (Bob) Colebunders

International citizen project COVID-19 (ICPCovid)

NSETHIO project

<image001.png>

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[Guido Vanham]

Dear Wim,

 

I couldn’t agree more on oxygen and for your last remark: I guess there are no trials on oxygen, because it is so self-evident and it would seem completely unethical NOT to provide oxygen in a control group, which shows desaturation.

 

I also agree that the attention for chloroquine and other drugs with unproven activity should be countered in LMIC, because it deviates from the most important point: provide oxygen to people who are in dire need for it.  Wait until placebo-controlled trials have shown an effect or not, but even if there is an effect, it will not help if you do not provide oxygen. 

 

So, it will be very useful if the ITM GROUP makes a clear statement on the URGENCY TO PRODUCE OXYGEN.   It is fine that we have discussion groups amongst us and it is even fine that we disagree on particular points, but people expect that we provide clear advice, based on evidence.

 

Best wishes,

 

Guido

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[Charles Ssemugabo]

Thank you for sharing your thoughts on this.

The 52 cases that have recovered in Uganda so far have not needed oxygen. Much as I agree with the oxygen recommendation, there is also need to look at what has worked among the cases that have recovered in that setting say Kinshasha.

Stay safe,

Charles

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[Gerry Bloom]

At the moment the  focus is on technologies to reduce mortality in countries with relatively strong health systems and a push to make these technologies available in other countries. Efforts to identify effective treatments are also driven by the same pressure.

 

The comments about oxygen point to the need to identify factors leading to excess mortality in the context of COVID in countries with weak health systems. Much of this excess mortality will be outside hospitals and related to diversion of resources from primary health care services and to disruption of livelihoods due to both measures to slow the spread of the epidemic and economic downturn. In hospital, deaths are likely to be related to common failures in hospital management and to shortages of common technologies, such as oxygen. The other issue will be the spread of infection to health workers and non-COVID patients.

 

Gerry

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[Kalk, Andreas GIZ CD]

Dear Guido,

I cannot agree more !

Best regards,

 

Dr Andreas Kalk MS (Gen Surg) MCommH

Directeur Résident

Bureau GIZ à Kinshasa

(Rep. Dém. du Congo, Rép. du Congo)

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De : covid...@googlegroups.com <covid...@googlegroups.com> De la part de Guido Vanham
Envoyé : mercredi 6 mai 2020 08:33
À : Robert Colebunders <robert.co...@uantwerpen.be>; Wim Van Damme <WVD...@itg.be>; Covid-19 in SSA <covid...@googlegroups.com>
Objet : RE: Covid-19 & Oxygen in LMICs

To view this discussion on the web visit https://groups.google.com/d/msgid/covid19SSA/AM0PR05MB6724C0CD8C9A73DACC0368FB94A40%40AM0PR05MB6724.eurprd05.prod.outlook.com.

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[Carina King]

Agree! There are several initiatives currently working to increase oxygen and oximetry access, rather than ventilators and some nice commentaries around this, in LMICs as part of COVID19 response. UNICEFs first shipment of concentrators have already arrived in the DRC as I understand (and I'm sure Stefan can add a lot more here!!). There are a range of training/maintenance/installation resources for this being coordinated through the Every Breath Counts coalition. 

Also...there is an on-going trial comparing oxygen for children with sats <80% versus <92%, so assessing whether oxygen is an effective treatment is/was happening, but its not COVID19 specific. 

https://www.unicef.org/supply/stories/fundamental-and-sustainable-response-covid-19-improving-local-oxygen-systems  

To view this discussion on the web visit https://groups.google.com/d/msgid/covid19SSA/c475b27dbb1148ff98e393886753ea63%40giz.de.

[Wim Van Damme]

Thanks for that.

I hope UNICEF can convince all partners in LMICs to give priority to your brilliant "oxygen systems", and that worldwide supply systems can follow (esp. for oxygen concentrators & oximeters).

As many decision makers involved in the corona response where once MDs, maybe a state-of-the-art medical paper can convince them (about the exceptional nature of the covid-19 pneumonia).

I found this synthesis (in Le Monde) excellent, for once in French (I presume also exists in English).

https://www.lemonde.fr/blog/realitesbiomedicales/2020/05/05/covid-19-une-pneumonie-pas-comme-les-autres/

[Kristof Decoster]

Dear all,

 

For a somewhat related read, see also this CGD blog   https://www.cgdev.org/publication/covid-19-and-oxygen-selecting-supply-options-lmics-balance-immediate-needs-long-term    

 

Best,

 

Kristof

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[Marc Wajnsztok]

Dear Wim,

As we have discussed the issue yesterday, I will make sur to pass the message in our Technical Focal Point for the UN System.

Cannot agree more.

 

Marc

 

Marc Wajnsztok

Principal Coordinator Post Ebola Transition 

Office of the Deputy Special Representative of the Secretary General

Resident Coordinator & Humanitarian Coordinator Monusco Kinshasa

+243 (0) 827 763 302

+ 243 (0) 840 310 460

All Mobile accessible via WhattsApp 

 

 

 

De : covid...@googlegroups.com <covid...@googlegroups.com> De la part de Wim Van Damme
Envoyé : mercredi 6 mai 2020 09:12
À : Covid-19 in SSA <covid...@googlegroups.com>
Objet : Re: Covid-19 & Oxygen in LMICs

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[Luc Bonneux]

As mentioned earlier to Wim, I agree wholeheartedly. In Dutch nursing homes, we rarely if ever send our people to the hospital. It is not abnormal to die when you are (very) old and frail. We use often oxygen concentrators with good results for quality of life.

I don't find results of invasive ventilation in intensive care elsewhere. In the Netherlands, they don't have too many IC beds: you only get there when needed. Of the first 32 sars-2 patients on invasive ventilation, one (1) survived. You survive with neurological damage.

I can't find  cumulative data of IC admissions for sars-2 in Belgium, but there were 15678 admissions attributed to sars-2 and 3678 deaths in hospital attributed to sars-2, or a case fatality rate of 23%. Now, 21% of patients in hospital are in an IC bed.

Are we really knowing what we are doing? Admission to IC for sars-2 in real life is obviously not a succesfull episode of ER.

Being 65+ and active nursing home doctor, my risk is not nil, but my wife and I decided we refuse invasive ventilation. I'd love oxygen, oxygen under pressure (I don't know how easy that is to organise in LMIC), but if ventilation is needed, I will go for the morphine.

Luc Bonneux

Op wo 6 mei 2020 om 10:12 schreef Wim Van Damme <wvd...@itg.be>:

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[Rene Loewenson]

Hello

Id be interested to hear more from the experience of those working in the frontline/district services in the region on the clinical experience.

Generally I agree that the focus of much attention and funding has been on the R&D of medicines and vaccines, while issues like widening coverage of safe water, diagnostics and time between test and result through distributing test production and lab capacities (still 2 weeks between test and result in some places!), the best ways of organising community outreach for case tracing is getting much less profile. In the meantime our sense is that there is work in the ESA region to widen the local production and supply of CPAP not mechanical ventilation requiring intubation – see examples below pasted from EQUINET Information sheet 3 on COVID-19 (EQUINET COVID brief3 15April2020.pdf) and of course this calls for secure oxygen supplies, also produced locally. So perhaps useful to connect these two aspects of feasible local production (oxygen and CPAP equipment) that can ensure distributed supply to district / local level. , Rene

 

 

Enterprises at different scales and universities are producing CPAP equipment: Severe hospital cases require care ranging from Level 1 with basic oxygen therapy to Level 3 to support two or more organs or mechanical ventilation to aid breathing. CPAP equipment is less complex than mechanical ventilators used with intubation. It eases respiratory distress and reduces the amount of oxygen needed and the need for intubation and mechanical ventilation. CPAP can be assembled from locally available equipment and thus produced locally and there have been initiatives in Uganda and South Africa to do so.

 

Uganda’s Makerere University College of Health Sciences announced the release on April,10th of prototypes of a low-cost CPAP ventilator designed at  the University to support coronavirus patients, providing the image shown adjacent. . 

South Africa's National Ventilator Project is now evaluating submissions from producers who can help to manufacture 10000 CPAP ventilators before end June, and up to 50 000 more for export, using only components locally made or readily available in SA. As shown adjacent, “the proposed design is of a hood, with a seal around the neck or shoulders and straps that run under each arm. The hood's supply system can be hooked up either to a free-standing oxygen bottle or the piped oxygen supply of a hospital. Exhaled air will be filtered for viruses, to prevent the further spread of the novel coronavirus in medical facilities. Ideally the system will not require electricity”. 

 

R Loewenson

TARSC/EQUINET

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[Thetard, Rudi]

Thanks for initiating this interesting track

I have been involved with the expansion of access to oxygen for the last few years in Malawi. The intervention that drove an increased interest in Malawi was the introduction of the emergency triage and treatment approach (ETAT) under the leadership of the MoH and supported by Prof Liz Molyneux. ETAT is an emergency care approach for children who present to OPDs with severe childhood conditions. A few projects were able to support the procurement and installation of oxygen concentrators in district hospitals (we procured 100 in 2011 with USAID funding). We promoted the expansion of this approach to health centers and this has been an ongoing process for the last few years - more recently we procured about 200 concentrators that were widely distributed to a number of districts including hospitals and health centers. It is rare to walk into a pediatric ward and not see or hear an oxygen concentrator somewhere. We have also been pushing to expand the use of oxygen to areas such as maternity units in health centers. Previously people understood the use of oxygen to be a harbinger of death - we hope this perception is slowly changing. Oxygen use has increased tremendously in neonatal units in hospitals especially after the introduction of bubble CPAP (Baylor University).

Of course there are challenges - maintenance, infection control, etc. We have however seen a substantial increase in access to oxygen which may become very important during the era of COVID-19. COVID-19 may be a real opportunity to further institutionalise the use of oxygen and even promote and intensify the use of pulse oximeters.

Best

Rudi

 

Dr RCH Thetard

Chief of Party

USAID's ONSE Health Activity

Tel     +265991200025

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[Thetard, Rudi]

Apologies for another message . It is Rice University who developed the bubble CPAP (Pumani model)

https://unconventional.rice.edu/bubblecpap  

Best

Rudi

Dr RCH Thetard

Chief of Party

USAID's ONSE Health Activity

Tel     +265991200025

On Wed, May 6, 2020 at 11:29 AM Rene Loewenson <re...@tarsc.org> wrote:

To view this discussion on the web visit https://groups.google.com/d/msgid/covid19SSA/00c301d62388%24d83143c0%248893cb40%24%40tarsc.org.

[Jordan Kyongo]

In Kenya, there has been some early assessment and discussion about this (see paper attached) with the conclusion that "Additional investments will however need to be strategically prioritized to focus on strengthening essential services first, such as oxygen availability before higher cost investments such as ICU beds and ventilators"

However, as someone else mentioned, noting the that fact should health systems get overwhelmed, investment in things like ventilators will not add value and may actually prove detrimental without proper training, there has been a greater focus on more 'upstream' prevention factors where there is a greater chance of impact as well as on mitigating secondary effects of the pandemic and pandemic control measures such as (partial)lockdowns that can be harsher than the pandemic itself.

Regards,

Jordan

[Vincent De Brouwere]

Dear Wim and colleagues,

As the other colleagues, I found also oxygen a priority. I translate below a comment from my pneumologist colleague A. Mehdaoui:

"Yes, Oxygen is crucial, but:

- finger monitoring of saturation: it is an imprecise estimate; due to the dissociation curve, the same level of saturation may correspond to quite different PO2 figures; also the quality of the measurement devices varies. Finally, be careful of the color of the skin (lower level for a black compared to a white skin) and of the nail polish.

- in case of fever peak: saturation may temporarily decrease, therefore do not conclude on the basis on only one measurement

- don't forget the clinical examination: breath frequency, anxiety, dyspnea are not necessarily the major signs/symptoms but the most important is the work of your respiratory muscles. In about all the western countries, patients have been intubated based only on saturation level although patients felt good and asked why they were going to be intubated. Either there was a neurologic disturbance that reduced the feeling that patients had dyspnea or actually the pulmonary compliance was not reduced and hypoxy was due to other mechanisms

- there is a potential risk of virus spreading and contamination of the carers when oxygen is given, mainly when the flow is higher than 6 L and it is important to give a mask to all the patients receiving O2 (virus will go laterally rather than in front of the carer).

Although Oxygen is not a treatment as such (curing the disease), it gives time to wait until the body self-repairs"

He also sent me an article about oxygen and COVID-19-19 (I attached it)

best wishes

Vincent

[Anna Mia Ekström]

Dear Jordan

I entirely agree with this analysis. I expect the financial and social consequences of the lockdowns will have much more severe health effects than  covid-19 itself in SSA and needs urgent mitigation measures in terms of securing antibiotics, hiv/malaria/TB drugs, contraceptives, not to mention the imminent risk of hunger/unemployment, gender-based violence and girls being taken out of school. This is something I have tried to clearly communicate to the Swedish Sida and other agencies.

Best wishes

Anna Mia

Anna Mia Ekström 

Professor, MD, MPH, PhD
Senior Infectious Disease Consultant
Research group leader

Global & Sexual Health Research group (GloSH)
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Karolinska University Hospital &
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[Jordan Kyongo]

Dear Anna,

Thanks a lot for your communication of those pertinent points to the relevant agencies. Definitely something that we need to make sure someone keeps an eye on. We wouldn't want pull our heads up when this pandemic is over on to realise that the losses experienced in these other sectors have set us back considerably on gains that have taken years to make. I understand that it's complicated because of the interaction with COVID19 and the mitigation measures put in place but we have to keep sight of that. In Kenya, for example, there are anecdotal reports of reduced numbers of hospital visits (for many reasons) yet the systems at community level are not being effectively utilised to capture indicators that would help us flag things to act on before its too late - GBV, MNH, missed immunisations etc.

Kind regards,

Jordan

[Regine Unkels]

Hello Wim,

you could ask the same question for the silent epidemic of pneumonia deaths in the same settings. I think oxygen is seen as a health technology and also as amanagement for intensive care units, rather than a medicine and as such, needs the presence of biomedical technicians or engineers and their advocacy, a cadre that is very rare, e.g. in Tanzania, where I am and I figure even rarer in DRC. Usually the health care technology department of MoH is sidelined and not considered important. I agree with you that oxygen has different supply chains and supply ways and this may contribute. I think the article by Tim Baker highlights the issue fir COVID well and maybe that one can convince your colleagues. Here in Tanzania, we have a donor organization group trying to support MoH in sclae up of oxygen, where biomedical technicians from MoH take part. I am sure they are most happy to share their plans and strategy.

Best regards, Regine

[Stefaan Van derBorght]

Dear Members,

Following up on the discusssion about the importance of oxygen supplementation in the treatment of COVID patients I would like to draw some attention to a South African initiave by doctors and mining engineers to increase respiratory treatment capacity to respond to Covid-19. The action plan and progress made by these volunteers can be found in attached documents . The group is currently running a trial in a 17 bed ward and has submitted a request for approval to the South African Health Products Authority (SAHPRA). The partnership is looking for additional partners and potential implementation locations. On the website www.umoya.org.za you can find more information and submit a request for additional information. A working, low-tech solution can certainly contribute to a stronger clinical response.

dr Stefaan Van der Borght

Op woensdag 6 mei 2020 09:11:12 UTC+2 schreef Wim Van Damme:

[Daniela Garone]

Dear Stefaan,

 

I am Dr Daniela Garone, working for MSF Belgium and following Sothernafrica countries including covid epidemic. Would be possible to be added in the group?

 

Regards,

 

Thanks a lot and have a nice day

 

Daniela Garone ID specialist and DTM&H  |  Operations Department  Cell 5 | Malawi, Mozambique, South Africa, Zimbabwe, India, Venezuela, Bolivia and Brazil  |  Medical Deputy Coordinator of Operations

 

Médecins Sans Frontières | Doctors Without Borders | أطباء بلا حدود

Rue de l'Arbre Bénit - Gewijde-Boomstraat 46  | 1050 Brussels | Belgium

Phone and whatsapp: +32 (0) 478720385

Skype: danielagarone

Daniela...@brussels.msf.org | www.msf.org

 

From: Marc Biot
Sent: dimanche 7 juin 2020 22:57
To: Kristel Eerdekens <Kristel....@brussels.msf.org>; Daniela Garone <Daniela...@brussels.msf.org>
Subject: FW: Covid-19 & Oxygen in South Africa

 

From Wim Vandamme’s google discussion group…

See website on local oxygen device production:  https://umoya.org.za

 

Xx

Marc

 

 

De: Stefaan Van derBorght <borg...@gmail.com>

Objet: Rép : Covid-19 & Oxygen in LMICs

Date: 25 mai 2020 à 10:56:23 UTC+2

À: Covid-19 in SSA <covid...@googlegroups.com>

 

Dear Members,

 

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[Wim Van Damme]

An interesting paper in BMJ Global Health on Oxygen provision to fight COVID-19 in SSA.

On Wednesday, May 6, 2020 at 8:11:12 AM UTC+1, Wim Van Damme wrote:

[Wim Van Damme]

Non-invasive oxygen therapy has better results, in the US!!!

(study not specific for Covid-19; but very relevant for the current epidemic).

What about Africa?

Wim Van Damme

On Wednesday, May 6, 2020 at 8:11:12 AM UTC+1, Wim Van Damme wrote:

[Gerry Bloom]

Hello,

My name is Tabitha Hrynick, and I am a researcher at the Institute of Development Studies (IDS) at the University of Sussex. My colleague Santi Ripoll and I are preparing a brief focused on the secondary health impacts of official responses to COVID-19 for the Social Science and Humanitarian Action Platform (SSHAP). SSHAP briefs provide key considerations and social science intelligence for policy actors and implementers so that they may design, adapt and carry out emergency response in more effective and equitable ways.  

 

This particular brief is aimed at policy makers and health actors at various levels from global and regional health organisations, to national and local governments, and people working in and across health systems. It aims to:

• highlight existing evidence and potential risks and drivers of secondary health impacts (such as postponed or cancelled treatments, vaccinations, prenatal appointments etc..) resulting from disruptions to health systems (such as closure of clinics) stemming from COVID-19 responses

 

AND

 

• to highlight positive examples and make suggestions and recommendations as to how these actors might better support areas of health beyond COVID-19 infection, particularly in low-resource contexts where other health issues may present greater threats both in the short, and medium to long-term.

 

As these processes are unfolding in real time and there is little ‘hard’ data out there, we are keen to engage with people ‘on the ground’ to get a better sense of what may be going on in various contexts, and in different areas of health.

 

We would very much welcome any reports, literature or further contacts that you think might be relevant to our aims. Additionally, if you have any comments, experiences or views on these issues that you would like to share, feel free to send us an email or alternatively we would be happy to have a conversation with you at your convenience. We would of course acknowledge any contributions in the brief. If you would like to contribute to this effort, please get in touch with me by Friday, July 3^rd, 2020.  

 

Many thanks in advance.

 

Warmly,

Tabitha Hrynick

t.hry...@ids.ac.uk

 

[Kalk, Andreas GIZ CD]

Corona was in Italy already in December 2019

 

https://www.reuters.com/article/us-health-coronavirus-italy-sewage/italy-sewage-study-suggests-covid-19-was-there-in-december-2019-idUSKBN23Q1J9

 

and the seroprevalence in Ischgl, an Austrian ski resort and Corona hotspot is a mere 42 %:

 

https://www.meinbezirk.at/landeck/c-lokales/424-prozent-der-ischgler-bevoelkerung-bildete-anitkoerper_a4120176

 

Most of them did not have any symptom…

The researches still struggle with the fact that this is no ‘herd immunity’. I continue to believe that Corona is not infectious enough for this phenomenon. It seems to me that it will continue to move around in waves like influenza.

 

Dr Andreas Kalk MS (Gen Surg) MCommH

Directeur Résident

Bureau GIZ à Kinshasa

(Rep. Dém. du Congo, Rép. du Congo)

7, av. Comité Urbain

B. P. 7555, Gombe, Kinshasa

République Démocratique du Congo

 

Tel. : +243-810 844 577

GSM : +243-811 600 455

GSM Allemagne/Germany : +49-151-7189 0706    Nouveau numéro ! New number !

Skype : andreas-kalk

 

E-Mail : andrea...@giz.de

Internet : www.giz.de

 

De : covid...@googlegroups.com <covid...@googlegroups.com> De la part de Gerry Bloom
Envoyé : jeudi 25 juin 2020 10:06

À : Covid-19 in SSA <covid...@googlegroups.com>

Cc : Tabitha Hrynick <T.Hry...@ids.ac.uk>
Objet : RE: Covid-19 & Oxygen in LMICs

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[Ermias]

Dear Wim

Thank you for starting this forum and sharing ideas and evidences.

With regards to oxygen therapy, I wanted to share what I came across when looking for evidences. They have summarized it very well.

https://www.cebm.net/covid-19/is-oxygen-an-effective-treatment-option-to-alleviate-the-symptoms-of-breathlessness-for-patients-dying-with-covid-19-and-what-are-the-potential-harms/

 

What is clear is oxygen is useful in a state of hypoxia. We do not know yet how oxygen therapy can be useful in Covid-19. From the preliminary remdesivir trial, patient with non-invasive oxygen therapy did better. Probably those who required invasive oxygen therapy (mechanical ventilators) are too sick and/or optimization of the MV therapy and its complication is affecting them.

 

I agree with investing on oxygen and non-invasive oxygen delivery systems at this stage than on mechanical ventilators for places where the experience with MV was limited.

 

Best regards

Ermias

 

 

From: covid...@googlegroups.com <covid...@googlegroups.com> On Behalf Of Wim Van Damme
Sent: Saturday, June 13, 2020 22:13
To: Covid-19 in SSA <covid...@googlegroups.com>

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[Luc Bonneux]

For the Netherlands, case fatality rates of ICU are available. 32% left ICU dead, 68% alive, but, as all things covid, the results are so heavily age and risk dependent that averages are meaningless. Among the 75+, 70% left ICU dead.

The added value of mechanical ventilation is limited. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30163-2/fulltext (but observational, hence confounding by indication).

We receive now ICU survivors in our revalidation units. Some are living wrecks. For elderly people, palliative care had been the better option.

Nursing home patients with hypoxia love oxygen. The effect might partially be a placebo - but oxygen certainly enhances quality of life.

Luc B

Op ma 29 jun. 2020 om 06:35 schreef Ermias <ermi...@gmail.com>:

To view this discussion on the web visit https://groups.google.com/d/msgid/covid19SSA/002701d64dce%24c12d1fd0%2443875f70%24%40gmail.com.

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Luc Bonneux

lucbonneux.blogspot.com

[Elisabeth Paul]

Dear all,

In case you missed it:

Improving Hospital Oxygen Systems for COVID-19 in Low-Resource Settings: Lessons From the Field

 https://www.ghspjournal.org/content/early/2020/09/28/GHSP-D-20-00224

 Best,

Elisabeth

To view this discussion on the web visit https://groups.google.com/d/msgid/covid19SSA/CAPCaCucaoBsNqBcEOFVkWgZ364Rkz-hs1T2p72n-V0%3D5%3D%2Bp0Cg%40mail.gmail.com.