Prohibitive cost and shortage of ventilators compound coronavirus crisis

0
27

By Chris Paul Otaigbe

Prohibitive cost of essential medical equipment needed in the global war against Coronavirus coupled with extortionist disposition of some equipment manufacturers are threatening to derail efforts to halt the spread of COVID-19 and end the pandemic.

Facing a bill of over $1 billion, the United States Government has pulled out of a proposal to get General Motors to mass produce the ventilators badly needed by patients struck down by the virus which has crossed 100,000 mark in the country.
And as the global pandemic continues its ravaging scourge across continents, healthcare systems are becoming overwhelmed with countless number of cases and deaths.

At over 600,000 cases, more 35, 000 deaths and close to 200,000 recoveries, the need to procure equipment and pharmaceutical products to meet the bludgeoning number of cases to decrease the virus mortality rate has become a desperate cry of Health officials in virtually all countries on the planet.
One of the major healthcare related equipment that is most needed at this time is the ventilator.

All developed and developing countries are in desperate search for the ventilators and other medical equipment to purchase at any cost just to save the lives of their citizens.
Scarcity and prohibitive cost of the respiration-assisting machines are the two reasons standing in the way of its procurement.

Few days ago, United States President Donald Trump had to pull the brakes off the deal that was to see General Motors and Ventec Life Systems embark on a massive production of ventilators to help out in the fight against the virus.
In a report published in the New York Times on March 26, 2020, the Trump administration is not comfortable with the price tag of more than $1 billion and the several hundred million dollars to be paid upfront to General Motors to retool a car parts plant in Kokomo, Ind., where the ventilators would be made with Ventec’s technology.

The joint venture which is expected to churn out, in short order, 20,000 out of the 80,000 ventilators it was earmarked to produce. Even the short order is said to have decreased to 7,500. According to the report, the US government contended that the $1.5 billion price tag comes to around $18,000 a ventilator, which is comparable to the cost of buying 18 F-35s, the Pentagon’s most advanced fighter jet.
Even if the money was available, meeting the urgency of the demand for the device by the many States that are in desperate need of it may not be possible immediately.

The BBC News website (March 26, 2020), reported that the UK government ordered 10,000 ventilators from Dyson to help deal with the coronavirus crisis. Currently, its National Health Service (NHS) said it is planning to add a minimum of 8, 000 Ventilators, from Local and foreign suppliers, to its existing 8, 000. Although, the government health agency is aiming at procuring about 30, 000 respiratory machines which it said is what would adequately manage an eventual surge of corona virus surge in its hospitals.

A ventilator is a machine that helps a person breathe by getting oxygen into the lungs and removing carbon dioxide and can be used to help a person breathe if they have lung disease or another condition that makes breathing difficult. They are also used during and post-surgery. The computerized, bedside machines can cost as much as $50,000.

A tube, connected to a ventilator machine, is placed in a person’s mouth, nose or through a small cut in the throat. That piece of device is called a tracheostomy.
Similarly, New York is also hoping to buy 30,000 required ventilators, even though it has a population one third the size of the UK’s.

The race to produce tens of thousands of ventilators to keep people with Coronavirus-related breathing difficulties alive, has been on for weeks.
Meanwhile, the consortium of medical, military and civil engineering companies – which includes Airbus, Meggit, GKN and others – is working to ramp up the production of an existing design. Usually, these processes would take months or even years.

It is a measure of the current emergency that the decision-making process has been reduced to days.
Grossly, insufficient ventilators and other medical equipment threaten to cripple the capacity of the United States to combat and contain the virus as it approaches its full bloom.

Unlike its European counterparts, the US is said to have been slow in its response to the attack of the virus and this is said to have affected the infrastructural capability of the country to push back the virus.
At over 136, 000 with more than 2000 deaths and counting, America stands as the country with the largest number of coronavirus cases in the world. This is the situation that has forced him to invoke Defense Production Act of 1950 to order mass production of desperately needed equipment and materials to combat the raging virus.

Despite his jerky discussion with GM and Ventec for the mass production of ventilators, the action is coming late in the day.
Clearly, production of the equipment cannot be accelerated enough to meet rising demand by European and US manufacturers. Meanwhile, some European governments are deploying wartime-mobilization tactics to get factories churning out more ventilators and to stop domestic companies from exporting them.

In an interview published by the New York Times on March 18, 2020 Andreas Wieland, the chief executive of Hamilton Medical in Switzerland, one of the world’s largest makers of ventilators said the reality is that available quantity of the machine is not enough to go around the countries needing them.
Even though Wieland is shipping machines as fast it can get them off the assembly line, moving administrative staff to the factory and hiring more employees, it is still not enough to keep up with the dizzying volume of orders for his ventilators. For instance, Italy ordered for 4,000, but he was only able to supply 400.

Chris Kiple, its chief executive of Ventec, a small ventilator company with headquarters near Seattle said the Ventilator manufacturing firm recently filled an order to sell 150 ventilators to Japan. Adding employees and increasing work hours, the company still finds it difficult to meet up with the orders it is inundated with.

According to the New York Times report, Hospitals in the United States have roughly 160,000 ventilators, in addition to a further 12,700 in the National Strategic Stockpile, a cache of medical supplies maintained by the federal government to respond to national emergencies.
About half of the intensive-care ventilators, in the United States, in use were made by foreign companies. Meanwhile, less than 12 American companies make ventilators and they are straining to meet demand.
Countries are forcing people to stay home to slow the spread of the virus as demand for the machine continue to skyrocket. To bring more workers into factories, companies first need to buy protective gear for staff and spend money on cleaning services.

The shortage of the bedside respiratory device is forcing doctors to make life-or-death decisions about who needs the machines most.
The rampaging spread of the pandemic made the leadership of Johns Hopkins University’s hospital system to buy some new ventilators a few weeks ago, while the Baltimore hospital network is desperately searching for more to buy. This emergency times is making the John Hopkins hospital to consider the extreme idea of working with the university’s engineering department to build its own ventilators.

China, which was the original epicenter of the coronavirus outbreak, gobbled up as many there was in the market for the assisted-breathing machines. When the disease spread to South Korea and Italy, hospitals in those countries put their orders in. Now manufacturers are getting flooded with orders from all over the world.
Getting drowned in the sea of coronavirus infected citizens, European countries are responding aggressively to swim her back to life’s surface by restraining domestic medical supply companies from fulling international orders.

With an estimated 25, 000 ventilators, Germany has ordered 10,000 from Drager, a domestic manufacturer to be produced over the next 12 months. Even though it has set about rushing to make the orders, Drager faces the challenge of safety testing and component availability.
At over 86,498 confirmed coronavirus cases and more than 9,100 deaths, Italy faces the severest shortage of ventilators. According to Local media, officials in Northeast region of Veneto are considering exploring the idea of using ventilators designed for animals on humans.

The Italian administration has sent about 25 engineers and other staff members from the defense ministry to assist with manufacture of ventilators at Siare Engineering, a manufacturer near Bologna. The company had to increase fourfold to attain a weekly production of 150 ventilators. In order to meet demands in Italy, it has delayed deliveries to other countries like India.

With 2,885 deaths and over 14,547 cases which include Boris Johnson, its Prime Minister and a couple of UK’s ruling elite including Queen Elizabeth II, who are all in self-isolation having tested positive to the virus, United Kingdom certainly needs more than the Over 5,000 ventilators are currently in British hospitals.
In a move reminiscent of the country’s mobilization to build Spitfire fighter planes during World War II, Boris Johnson recently called on car makers and other manufacturers to immediately begin helping make ventilators. Fortunately for the UK government it got over 400 calls from businesses offering to help build ventilators.

Capacity to power the machines poses another challenge as the question of finding enough trained personnel to staff the equipment is a problem confronting manufacturer and their hospital-based clients. Under normal circumstances, Dr. Martin said, physicians receive years of training before they are entrusted with operating ventilators in life-or-death situations. In the face of the overwhelming urgency the virus has plunged health officials, it is expected that governments and health policy makers may be forced to improvise crash courses for available personnel to develop the required capacity to use those machines.

But the machines are complicated, made up of hundreds of smaller parts produced by companies all over the world. There is no simple way to substantially increase the output.
In Nigeria, the local auto manufacturer Innoson said on Monday, March 24,2020, that it was ready to alter its assembly lines to commence production of needed medical equipment which in scarce supply as the nation combats the coronavirus pandemic.
In an interview published in the Premium Times of March 24, 2020, Cornel Osigwe, the company’s spokesperson said Innoson Motors is ready to assist the government in any way it can to produce ventilators and other equipment.

According to Osigwe, the motor manufacturer needs the guarantee of orders from government or other health institutions before it could take any step.
This intention has placed Innoson on a rising list of automobile companies who volunteered to convert their manufacturing plants to produce medical equipment across the world.
It is a surprise that where governments all over the world are desperately seeking for the supply of ventilators, which is prompting them to direct automobile manufacturers to help out with mass productions in order to save the Lives of their citizens, Nigerian government is yet to invite the firm for discussions.

With over 111 cases and one confirmed death, it is obvious that the virus has made its landfall on the Nigerian soil and has begun its viral journey across the country.
Working hard to prevent further spread of the virus at over 59 confirmed cases, Lagos State as the epicenter of the contagion, does not have enough ventilators to manage coronavirus patients who may present with breathing problems.
A report published in the March 24, 2020 edition of Punch, revealed that while some hospitals in Lagos State do not have ventilators at all, those who have do not have enough to take care of emergency situations such as posed by the COVID-19 pandemic.

The secondary health facility at Orile Agege General Hospital, Lagos, do not have a single ventilator as disclosed by a senior management health worker who pleaded anonymity. He informed that cases requiring ventilators are referred to the Lagos State Teaching Hospital (LASUTH).
The tertiary facility at the Lagos State University Teaching Hospital, Ikeja, has at least 15 ventilators which are distributed to the Critical Care Unit, Intensive Care Unit, Medical Emergency Unit, Surgical Emergency Unit, and Ayinke House; and   are all in good working condition.

The secondary health facility at the General Hospital, Ikorodu, had no ventilation machine.
At the Imo State University Teaching Hospital, Orlu, said there were two ventilators, but only one is functioning. Kaftan Post anonymous Source noted that a teaching hospital such as that is meant to have between 10 and 20 ventilators.
There are four ventilators at the hospital at the University of Benin Teaching Hospital but it is doubtful if they are all operational.
The management of Alimosho General Hospital, Igando, said the facility was equipped with about eight ventilators, comprising five in the wards and three in the theatre.

According to an anonymous senior management staff, the ventilators stationed in the wards and in the theatres, are fully functional and could work for up to six hours without power supply. Three are used in any of the Facility’s three theatres comprising three suites each and all functioning at optimal level.

According to him, the hospital has just restocked its oxygen supply and all the cylinders are stacked in a store.
The Federal Medical Centre in Ebute Metta, Lagos has acquired five ‘state-of-the-art’ ventilators. Three of the ventilators are always in use in the ICU, while the remaining two are in the storage center of the facility. Four of its anesthesia machines are reported to be equipped with ventilators. The machines are constantly in use virtually every day of the week.

In a situation where a patient has to stay on one for four months or years before he or she is discharged, how is such a facility expected to cope in the event of a deluge. Patients are also known to stay on ventilators for years or indefinitely.
The Lagos University Teaching Hospital, a federal government-owned tertiary healthcare facility, has only four ventilators while Gbagada General Hospital, a major secondary health facility in the state, does not have any.

Unfortunately, investigations revealed that the hospital and the Lagos State-owned Gbagada General Hospital are ill-equipped to steer the facility effectively through corona virus surge.
An anonymous Source who said basic equipment needed to manage patients admitted at the ICU is in short supply, including ventilators confirmed that there are only have four ventilators in the Intensive Care Unit. So, she contended that in an extreme covid-19 situation, there are no ventilators to manage Patients with respiratory crisis.

In a normal situation, a teaching hospital of the class of LUTH, located in a thickly populated state as Lagos and with large traffic of patients should have between 50 and 100 ventilators.
However, with less than 500 ventilators across all the States including the FCT, this issue is not peculiar to LUTH alone, other teaching hospitals in the country, owned by the federal and state governments, lack adequate number of ventilators.

Hospital Insiders disclosed that an aesthetic machine is what the hospital has and not a ventilator. Revealing further that there is no Intensive Care Unit for the management of patients with respiratory crisis. So, what happens is that whenever, the facility has such Patients, they area immediately referred to the Lagos State University Teaching Hospital, Ikeja; or LUTH.

Considering the number of available ventilators in the country, it is obvious that Nigeria is neither equipped nor prepared to manage the pandemic that is fast gaining ground across the nation.
What is worse is that even if, when and where the increasing urgency forces the Nigerian government to buy these machines, it is not likely that the country can get them when they would be needed as she would have to join the endless queues of countries waiting to procure the equipment from the same market and manufacturers.

Since this is a matter of life and death for the nation, the federal government would do well to throw the challenge to Inventors in the country and mobilize her medical Engineers from both the civil and military establishment, as done by the developed countries, to build the local version of these ventilators and other life-saving machines.

LEAVE A REPLY

Please enter your comment!
Please enter your name here