Our attention has been drawn to an article titled: “Dying with dignity” published by The Sunday Monitor on November 29th 2020, which makes a number of allegations on the COVID-19 response in the country including among others that two patients died from a faulty Oxygen Plant at Mulago National Referral Hospital, fake masks for Doctors and unfounded doubt on the country’s capacity to respond the pandemic.
Therefore, Mulago National Referral Hospital would like to respond to the various allegations contained in the article as follows:
Background: Mulago National Referral Hospital opened a COVID-19 Treatment Unit (CTU) early in March following the confirmation of the first COVID-19 patient in March this year. The center provides the following services;
- Clinical and supportive treatment for confirmed COVID-19 patients.
- Psycho-social support to COVID-19 patients.
- Clinical and supportive treatment for presumptive patients (these are patients with COVID-19 like symptoms pending laboratory tests).
- Post COVID-19 follow up care (this clinic runs on Thursdays).
- There is a help desk which attends to the concerns of the relatives as well as the public.
The center is currently running at a capacity of 500 beds but may be expanded depending on the need. Of these Intensive Care Unit (27), High Dependence Unit (200) and the rest general care 3.
As of 30th November 2020, Mulago National Referral Hospital had a cumulative admission of 2,456 patients, with a total discharge of 2,137 and the current admission stands at 160 (of these 95 severe cases in HDU, 5 critical cases in ICU and 60 in general ward).
The total fatalities currently stand at 150. Self-requested transfers out of Mulago to other units five (5) in total. The cumulative admission into High Dependency Unit and ICU is 605.
It is important to note that almost all patients are referred to Mulago Hospital from other hospitals in critical conditions, some arriving from ICUs of other hospitals with late stage of the disease.
Most of the patients are referred when in critical conditions (with multi-organ failure). We would like to inform the public that Mulago National Referral Hospital is doing whatever it takes to ensure that services required for COVID-19 treatment are made available.
Other services Mulago National Referral Hospital continues to provide surgical, medical Paediatric and diagnostic services. The hospital being the highest level of care continues to provide specialised health services, for instance recently we separated Siamese twins in a multi-disciplinary surgical operation that lasted 24 hours, the babies are currently recovering and doing well.
The hospital has also recently successfully handled casualties with traumatic injuries from the riots. All other services are running normally in various departments. We wish to clarify on the allegations made in the aforementioned article carried in the Sunday Monitor of November 29th 2020.
DEATH OF TWO PATIENTS
The article alleges that two patients died from Mulago Hospital’s Intensive Care Unit (ICU) in August this year due to lack of oxygen.
However, this is not true and we would like to categorically state as follows: The patients, who include a 70-year-old referral from Rubaga Hospital ICU, a 27 year-old case referred from Hoima Regional Referral Hospital and 46 year-old case, all died of severe COVID-19 with multi-organ dysfunction.
It is therefore not true that the patients died due to lack oxygen.
During this period, the Mulago Hospital ICU had other patients who posted better outcomes. COVID 19 causes mild to moderately severe disease which in majority of cases, can be self-limiting.
About 20% of cases progress to very severe disease leading to multiple organs in the body failing to function. Depending on the severity of the organ dysfunction, the outcome is usually bad with most patients who progress to this stage succumbing to the disease.
As at March to April 2020 Covid19 was the 3rd leading cause of death in USA after Heart diseases and Cancer. It is important note that admission into the Intensive Care Unit (ICU) is meant to offer life support for critically ill patients.
Life support includes the use of machines such as ventilators and other high end medications as the patients’ body fights the disease thus the death rate tends to be high.
Italy’s ICU death rates during this pandemic were at 51% and a good number discharged from ICU still remained incapacitated in one way or the other.
ICU care and use of ventilators is last resort because it means that your body has failed to function and it’s a machine doing this for the patient.
Given the current stage of the pandemic, where there is wide spread community infection, patients are presenting to the hospital rather late as they delay at home trying to treat this as common flu that has similar symptoms with COVID-19.
We therefore appeal to the general public to test for COVID-19 whenever they present with flu-like symptoms, fever, headache, high temperature, chest pain and difficulty in breathing. OXYGEN PLANT Currently, Mulago National Referral Hospital has four (4) new fully functioning Oxygen Plants which are supplying Oxygen to where it is required in optimal amounts and purity levels.
The newly installed 4 oxygen plants at the Hospital makes it the largest Oxygen plant in the country that is able to generate 2,083 liters of oxygen per minute. In 24 hours the Mulago, the plant can generate about 2,999,520 liters of oxygen which in normal circumstances can serve about 900 patients.
The four are part of the seven plants procured by the Ministry of Health to meet the oxygen needs in the country. The article makes a comparison of the cost price of the new plants with the old ones installed 10 years ago which is misleading.
The cost drivers for the current plants include;
- Higher specifications due to demand for high flow and high purity oxygen necessary for treating COVID-19 patients.
- High production capacity of 125 cubic meters for plant as compared the old ones which are of a lower production of 20 cubic meters.
- The global demand for oxygen plants.
- Global travel restrictions amidst COVID-19 and the urgency of oxygen plants made air lifting of the plant as the only available quick option.
- The brand of equipment is also high end and durable.
Furthermore, the allegation that Oxygen supplied to patients dropped from 90% to 20% is not true.
We would like to clarify that Oxygen is delivered to the user wards through pipes when its purity is ranging between 93% and 100 %. The currently installed plants are automated and cannot generate oxygen when its purity levels go below 90%.
All patients in need of oxygen are connected to a supply of medical grade oxygen which is always above 90%. This is contrary to what the authors alleged that patients are supplied with “hot air”.
The allegation on fake medical masks is not true.
The Hospital would like to state that all medical masks used by health workers countrywide meet both local and international standards.
Indeed, no health worker in ICU at Mulago has contracted COVID19.
This is attributed to the training and strict adherence to Personal Protective Equipment (PPE) use which is highly protective, including the alleged fake masks. Uganda ranked best in Africa on the COVID-19 Response In August, the Lancet Commission in its report to the 75th United Nations General Assembly ranked Uganda as the best performing country on the African Continent as far as suppressing the spread of the COVID- 19 infection is concerned.
This achievement was not by mere accident but was as a result of a resilient health care system that has a track record of dealing with emerging and remerging epidemics.
However, our health care system like any other across the globe, may get challenges as a result of the upsurge of the community infections.
That is why we continue to urge all Ugandans to avoid death from Covid-19 by strictly abiding with preventive measures instituted by the Ministry of Health and the World Health Organisation(WHO) These include:
- Regular hand washing with water and soap or using an alcohol-based hand sanitizer • Proper wearing of face masks
- Ensuring there is social distancing of at least 2 meters on both sides whenever in public gatherings.
We advise authors to always reach out to the Ministry and its institutions like Mulago National Referral Hospital for information to avoid misrepresentation of facts that cause anxiety to the public.
In conclusion therefore, Mulago National Referral Hospital would like to state that every individual holds the responsibility to protect themselves against COVID-19.
At the same time, the Ministry continues to make available all the necessary requirements to enable patriotic health workers save lives.
We commend our health workers for their determination to save lives even when the number of new infections is on the rise.
Thank you. Executive Director Mulago National Referral Hospital
01st December, 2020