Dr. Asad Naveed: Sierra Leone telegraph: 19 March 2020:
The novel coronavirus (COVID-19) continues to wreak havoc around the globe. Africa was initially thought to be a safe zone for the disease, but now has 14 countries infected.
Even though Sierra Leone is yet to detect a COVID-19 case, the country only has one ventilator, a device required to treat critically ill patients with shortness of breath or respiratory failure due to COVID-19 pneumonia.
All neighbouring countries around Sierra Leone have reported new coronavirus cases and if the disease was to spread in Sierra Leone, the country will have limited capacity to treat critically ill patients.
According to a WHO report, based on a study sample of 55,924 COVID-19 confirmed cases in China, 6.1% patients became critically ill and developed symptoms such as respiratory failure, septic shock, and/or multiple organ failure.
This means that, approximately for every 100 people infected with coronavirus, 6 people will need a ventilator to support their breathing.
The only ventilator available in Sierra Leone is at a private hospital named Choithram Memorial Hospital. (Independently verified)
Another private facility – Aspen Medical- has two portable ventilators but these are only used for patients who are guaranteed to get off from them after 48-72 hours or someone who is being evacuated. Hence, they won’t be very useful for COVID-19 patients who require long-term ventilation. (Independently verified)
There are 17 government civilian hospitals in Sierra Leone but none of them has a ventilator in their ICUs. Ventilators used during surgery were not counted as COVID-19 patients would require continuous long term use of ventilators.
Coronavirus manifests itself with symptoms such as dry cough, sore throat, fever, fatigue, and runny nose. In extreme cases, it leads to shortness of breath.
The disease has a high survival rate among the young but can be fatal in elderly and immunocompromised people.
Italy – a country with a much stronger health system- faced a sharp rise in cases this week. There are now 17,660 reported cases, and doctors are no longer able to provide ventilation support for all patients needing them.
A ventilator is a machine which provides mechanical ventilation and delivers breaths to a patient who is physically unable to breathe. The average cost of a ventilator is $6,182. Sierra Leone’s annual health budget for 2020 is 12% of the GDP but purchasing ventilators have never been prioritized.
As a junior doctor in Sierra Leone, we always had to scramble around when treating patients with breathing difficulties. At the Ola During Children’s Hospital, the best treatment we had were oxygen concentrators and a few makeshift CPAP (Continuous Airway Pressure) devices. These are supportive but inadequate to care for patients undergoing respiratory failure.
Even the oxygen concentrators were few in number and one machine was used to support multiple patients at times. Connaught Hospital, also faces a significant shortage of oxygen concentrators. The King’s Sierra Leone Partnership helped in installing an oxygen house/ tank at Connaught but its supply limit stops at the ICU. Oxygen can be transferred to other wards in oxygen cylinders but there aren’t many cylinders.
Dr. Eva Hanciles, a leading Sierra Leonean Anesthesiologist and head of the Connaught ICU suggests that the country should ramp up production of oxygen and storage capacity. She also noted the need for more supplies of oxygen consumables such as venturi masks, tubing, nasal prongs and pulse oximeters.
Sierra Leone already has one of the weakest health systems in the world with an average life expectancy of 51.84 years. Only 7.46% of the population is 55 years or older. This is a vulnerable population.
Sierra Leone has a tropical warm climate which may have helped in preventing the spread of coronavirus. However, according to a Harvard epidemiologist, warmer, wetter weathers are not enough to limit containment of the disease. He suggests that best policy to eradicate the disease would be isolation of cases, quarantining their contacts, a measure of “social distancing,” among other intensive efforts.
It is highly recommended that the country invests significantly in testing, radical contact tracing, border control and health communication. It is also high-time the country starts to invest in sophisticated medical equipment such as ventilators and dialysis machines.
As Sierra Leone has limited capacity to treat critically ill COVID-19 cases, the country must do all it can to prevent infections from moving into the country.
It’s very sad to hear how difficult Dr. Naveed and others are struggling to save lives in the country without adequate and proper Medical Equipment in place. Thank you very much Dr Naveed and all our health professionals who are working very hard to save people’s lives all over the country. Now to the point of the ventilators. It’s really unacceptable for a country like Sierra Leone not to have any ventilators in any of the country’s Government hospitals. This is a very big disgrace. SAD. We hear huge sums of money being wasted in organizing no fit for purpose events whilst our country lacks vital equipment to save lives. Ridiculous in my view.
Let’s say each Ventilator costs $10,000. What is wrong buying hundreds if not thousands of such units for our hospitals? Well, Coronavirus is here. Let’s see if President Bio and his Administration will sit down, seeing Sierra Leoneans dying, God forbids, without having ventilators. If that happens, he would go down in history as the worst leader Sierra Leone ever had. Let me repeat again. The Bio Administration must start sourcing Ventilators, protective gears for health professionals who would be in the forefront of this fight, constructing equipped isolation centres throughout the country, Coronavirus test kits and a system to track Coronavirus patients. No time waiting for outside help because, it will not come. Countries that normally help are diverting all their resources in fighting Coronavirus.
Some are depending on help from other countries whilst everyone is fighting this messy and deadly disease in their backyard. Is the Bio Administration going to wait till we get aid from China, UK, USA etc? These countries are very busy at the moment trying to prevent their citizens from catching Coronavirus. They have directed huge sums of money in combating Coronavirus. Do people talking about help from other countries know the impact Coronavirus is having on their economies?
If it was not for Dr. Naveed’s bravery, no one would have known the ventilator status of government hospitals in the Republic of Sierra Leone. Land of Diamonds and Gold with a “PAOPA ADMINISTRATION” in charge. God bless Dr. Naveed and all the health professionals- Doctors, Nurses etc.
Hopefully the government, donors partners especially China that has already made tremendous progress in fighting the disease will help the people of Sierra Leone to tackle this problem. Even benevolent Sierra Leoneans or Organisations can come to our rescue but at the moment we have to improvise and work with what is available and according to news from credible channels, there is also a short supply of this equipment in the USA. I also hope that the government will make all necessary preparations to safeguard and protect our health workers this time around.
The other reality is most Africans in the diaspora especially Sierra Leoneans are in the medical field and they always return home everyday to their respective families, so lets hope and pray for God speed for the scientists to manufacture the vaccine which will be the best solution.