Oxygen supply crisis looms large at Islamabad's PIMS as COVID-19 cases surge

ISLAMABAD: With the third wave of the COVID-19 pandemic growing unchecked in Pakistan, major hospitals are faced with a looming crisis as they approach saturation.

The situation in the federal capital, Islamabad, seems to be particularly precarious as the largest medical facility here, the Pakistan Institute of Medical Sciences (PIMS), is struggling with low oxygen pressure amidst a tidal wave of COVID-19 patients.

A critical situation was reported at PIMS on April 18, when ventilators reserved for coronavirus patients started sounding alarms.

The ventilator alarms are triggered when the pressure of oxygen being supplied to a patient drops below the required level. On that day, it dropped from 100% to 70%.

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The incident sparked a panic at the facility as there were five patients on ventilators at the time in the coronavirus intensive care ward. At the time, there were 147 patients occupying the 183 beds allocated for Covid-19 patients at the hospital. A separate 30 patients were in the hospital's emergency ward.

The situation was serious as most of the patients affected were dependent on 'high flow oxygen' for survival -- a medical condition where they need more oxygen in comparison to ordinary patients as they suffer from acute breathing difficulties.

When contacted, Joint Executive Director PIMS Dr Minhaj-us-Siraj told Geo News that the drop in oxygen pressure was mainly attributable to the sharp increase in the number of coronavirus patients at the hospital and the need to continuously supply oxygen to them.

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The official said any unnecessary oxygen supply in the hospital was immediately halted as part of efforts to restore oxygen pressure in order that the required oxygen flow be maintained for Covid-19 patients.

Otherwise, the patients would have been at grave risk. 

The administration disclosed that the health facility's storage tank is in fact full of oxygen: it stores 10,000 cubic meters of the vital gas and is refilled every 15 hours. The real issue, the administration explained, is to maintain oxygen pressure as the oxygen supply lines running through the hospital are in excessive use owing to an unprecedented number of patients needing oxygen for life support.

The hospital administration sat down to review the situation but apparently there was no easy solution in sight. The administration feared that oxygen pipes might burst in case oxygen pressure was cranked up too high, as the pipes supplying oxygen are more than 35 years old.

The hospital explained that oxygen pressure is kept at 3 bars in normal conditions; the pressure has since been raised to first 5.5 bars, and then to 7 bars in a bid to maintain steady supply.

The administration said it had already taken a risk by kicking the pressure up to 7 bars, adding that it fears pushing the pressure beyond that level may prove dangerous.

The final solution the administration came up with was to stall all scheduled surgeries except emergency cases for the time being. They also discontinued oxygen supply to ICUs where there are no patients and diverted it to COVID-19 patients.

The next day, the administration decided that coronavirus patients on ventilators would be shifted to medical or surgical ICUs. The hospital management reopened the closed ICUs, including one at its Liver Transplant unit.

The administration has explained it cannot risk installing new pipes for oxygen supply as it remains in a state of emergency without any letup in the severe third wave.

It is worth asking that despite there being 16 hospitals in Islamabd set aside for treatment of coronavirus patients, why is PIMS under so much pressure?

Among the hospitals catering to the capital city, the Federal Government and Social Security hospitals do not have proper arrangements for high flow oxygen beds, according to the health ministry.

There is no ventilator available for COVID-19 patients at these facilities either.

As a result, there are only nine patients hospitalised on the 100 beds allotted for coronavirus patients in the Federal Government Hospital, according to statistics available with Geo News. The Social Security Hospital has no patients on 12 beds restricted for Covid-19 patients.

Patients who require high flow oxygen are not accepted at these two hospitals, according to sources. Such patients are referred to PIMS and other hospitals, which is creating pressure on those facilities.

Patients whose condition requires high flow oxygen are not admitted to a facility that lacks ventilators or high flow oxygen supply as their condition may deteriorate at any time and they may need to be immediately shifted to a ventilator, according to health officials.

As of April 21, three hospitals of the federal capital are under pressure with an increased number of coronavirus patients: PIMS Hospital has 149 patients on 183 beds, the Isolation Hospital and Infection Treatment Centre (IHITC) has 100 on 105 beds; and the Polyclinic Hospital is treating 30 Covid-19 patients on 47 beds kept for coronavirus positives.

Meanwhile, there are 42 patients on 58 beds at the CDA Hospital, according to sources. The CDA Hospital too has no ventilators.

It is clear that, before the situation worsens and snowballs into a full-blown crisis, other hospitals need to be equipped with necessary facilities so that the pressure can be taken off from the three main hospitals of the federal capital.

But is there enough time?