Reviewing some more COVID-19 related data and I'm more convinced that ventilators will not be the choke point to solve for in Nigeria. This is because of how poorly our systems are set up. The challenges will be further upstream.
My thoughts; Only about 5% of the Nigerian population is above 65. This means the profile of people needing critical care will be generally younger. This group usually tolerate illnesses for longer than older people so early recognition of at risk patients is key.
As such, what all Covid-19 treating hospitals need to institute as a matter of urgency is an early warning score system (EWS). This system measures the vitals of a patient and assigns a score. The higher the score, the higher the risk of a person getting sicker. 
To compute this score, vital signs must be done regularly. Do we have enough machines to facilitate this? If we have 200 people in hospital at once can we get all their vitals done every 4 hours and this score measured?
Not sure we can. Let's get more vitals measuring machines
Not sure we can. Let's get more vitals measuring machines
They are cheap but if there's no cash, even a simple pulse oximeter would be a good start. These cost less than N5,000 and tell you a heart rate and oxygen saturation. They are portable and can be battery operated. Let's get more pulse oximeters.
Younger people probably means one can get away without mechanical ventilation if we intervene early, this means using pulse oximeters regularly and if saturations are low, intervene early with oxygen.
Do we have enough oxygen and masks? Let's get more oxygen and masks.
Do we have enough oxygen and masks? Let's get more oxygen and masks.
High BMI's may be a poor predictor per early UK data. We generally have lower BMIs so should theoretically be ok to delay ventilation and trial other options. A step up from Oxygen via mask is high flow nasal oxygen (HFNO). This may delay or circumvent ventilation. Let's get HFNO
From HFNO, we can trial non-invasive ventilation (NIV). How many of these machines do we have? they are much cheaper and easier to operate than ventilators and could buy you a lot of time.
Once someone goes on NIV, they will need constant blood gas monitoring. Do we have enough blood gas machines well stocked with consumables and technicians to repair them should they breakdown with high volume?
Quick anecdote. I was once observing in a Nigerian hospital dept.
Quick anecdote. I was once observing in a Nigerian hospital dept.
Their machine that did potassium tests wasn't working for days. The emergencies they commonly managed needed a regular potassium measurement for treatment decisions to be made. They couldn't get results so just guessed. That people died as a result is not even up for debate.
So before we need ventilators we need:
An early warning score system
Mobile vitals measuring machines
Pulse oximeters
Oxygen and masks
High flow nasal oxygen
Non-invasive ventilation machines
Blood gas machines
Consumables and technicians for all of these
An early warning score system
Mobile vitals measuring machines
Pulse oximeters
Oxygen and masks
High flow nasal oxygen
Non-invasive ventilation machines
Blood gas machines
Consumables and technicians for all of these
We in healthcare have been shouting these things for a very long time. the evidence here:
Sad it took a pandemic but glad we finally have your attention. Now invest in healthcare as a whole not just looking for emergency ventilators that won't save us.
Sad it took a pandemic but glad we finally have your attention. Now invest in healthcare as a whole not just looking for emergency ventilators that won't save us.
