Coronavirus: Pakistan much deficient in machines designed to provide mechanical ventilation

ISLAMABAD: Pakistan’s government and private hospitals have a very small number of ventilators, which will be too deficient if there is a significant surge of new cases of coronavirus, data shows.

The key factor in mitigating strategy and effort of any country will be hospital capacity, and within such facilities two aspects are crucial – the number of beds available for patients who come with coronavirus complications and ventilators, which accompany those beds in intensive care units (ICUs).

The situation of ventilators which is a huge stress even on the health systems of developed and resource-rich countries is varied in Pakistan with picture varying from province to province.

Statistics shared by a health sector expert with The News reflects that public and private sectors of Khyber Pakhtunkhwa (KP) have around 150 ventilators. In Balochistan, all government hospitals put together have only 49 working ventilators.

According to the official record, Punjab’s public sector hospitals have nearly 1,300 ventilators, most of which were procured by the Shahbaz Sharif government in 2016-2018 when it had launched a project for revamping of tehsil and district hospitals.

In Lahore, the government hospitals have around 250 ventilators. However, the Punjab Kidney and Liver Institute (PKLI), which is a state-of-the-art facility and the brainchild of Shahbaz Sharif, alone has 100 brand new ventilators.

An official said the Punjab health department had done a stocktaking of ventilators in the private sector in Lahore and came to know that it has approximately 475 ventilators. However, the private hospitals of Lahore have 51 such machines. The previous government had provided 130 brand new ventilators to 25 district headquarter hospitals in 2017. It had planned to make available 140 ventilators to all tehsil level hospitals but the initiative was discontinued after 2018 by the new dispensation. The official said that private hospitals outside Lahore in large cities like Gujranwala, Faisalabad, Multan, Rawalpindi and Sialkot have some 150 ventilators in approximately 30 hospitals.

The health sector expert said in the light of these facts, one urgent step the government has to take is to purchase as many ventilators as possible in order to prepare for emergency situation. Both federal and provincial governments will have to allocate additional resources, he said.

However, another senior official, well conversant with development sector allocations, said that it was not only the issue of earmarking of resources but the capacity of health departments to procure ventilators and other much-needed equipment at top priority and expeditiously.

Reinforcing his claim with facts, the official said that the track record of the health ministry during the last two years is not very encouraging. The federal government for the second consecutive year is allocating hundreds of millions of rupees of funds to provide for every conceivable machine and equipment like MRI, ENT equipment, ophthalmology and nephrology and cardiology for the Pakistan Institute of Medical Sciences (PIMS) Islamabad but not a penny has been utilised.

Planning Minister Asad Umar, who was elected to the National Assembly from Islamabad and has keen interest in improvement of facilities at the PIMs, has expressed his displeasure over the state of affairs in the Health Ministry where concerned officers are again prepared to surrender the earmarked funds, unutilized, rather than purchasing the direly required medical equipment.

When this state of affairs was put to a senior bureaucrat, he recommended to get hold of young civil servants, who did emergency procurement in Punjab as the present health ministry and PIMs bureaucracy may not measure up to the challenge.

In 2016-2018, the Punjab government had procured ventilators at around $13,000 per instrument with built-in compressor. Price may be higher now with huge global demand in view of the spread of coronavirus. The United States, Sweden, Germany, Switzerland and Japan are major manufacturers of ventilators. A doctor explained that a ventilator is a machine designed to provide mechanical ventilation by moving breathable air into and out of the lungs, to deliver breaths to a patient who is physically unable to breathe, or breathing insufficiently. It is critical and essential equipment for any ICU. Major complication of coronavirus affected patient is breathing difficulty especially in old and infirm and people already suffering for underlying ailments, the doctor said.

All countries affected by coronavirus are doing an urgent stocktaking of ventilators that their health systems have. Even the well-resourced system like Italy is finding it challenging to provide ventilators in large numbers, which should be commensurate with the number of serious patients. It is stated that even the United States does not have enough ventilators and ICU beds if there’s a noteworthy surge of new cases. As with Italy, the health system could become overwhelmed.

Many experts are doubting the ability of existing health systems to absorb the shock, what is called the surge capacity, meaning ability to handle serious patients, who need intensive care especially through ventilators.

So, the million dollar question is: will there be enough ventilators as the pandemic spreads? As the coronavirus spreads, there are continuing concerns among hospitals, public health experts and government leaders that ICUs would be hard-pressed to handle a surge in seriously ill patients.

A key limiting factor to provide good care, experts say, is the number of ventilation machines, a hospital has on hand to help the most seriously ill patients breathe.

A pulmonary disease expert explains the coronavirus like many respiratory viruses can cause inflammation in the lungs. When the lungs become inflamed, the membranes that transfer oxygen from the air into the blood become blocked.

When patients develop this type of viral pneumonia, they often require bedside ventilators, which can supply higher levels of oxygen, help push air into the lungs to open them up, and afford more opportunity to get oxygen into the patient, he said.

Ventilators are generally a temporary bridge to recovery of patients in critical care, who need them to get better. These machines can be crucial to sustaining life in certain emergency situations. If there is a surge in seriously ill patients as COVID-19 spreads, ventilators could be in short supply from hospital to hospital or nationally.

The public health expert said if hospitals continue to be overwhelmed, at that point tough decisions would have to be made about who gets access to a ventilator and who does not. This could be left to the health professionals to choose who has chances to live and who is to be left. Experts say this scary scenario can only be avoided if prevention and containment protocols are immaculately followed.