Health-care providers suggest switch from oxygen-focused careTuesday, September 07, 2021
BY ALICIA DUNKLEY-WILLIS
A group of independent public health providers who say they have treated some 300 COVID-19 patients between the ages of 18 and 104, without any dying, is urging the Government to lay off what they call oxygen-centric care which they argue is unsustainable amidst surging caseloads and fatalities.
Panic heightened in the island last week when public health-care facilities ran out of medical-grade oxygen with unconfirmed reports of individuals dying because of the absence of the precious commodity.
The country's sole supplier of medical oxygen, IGL, indicated that it was running out of the product due to the increased demand from COVID-19 patients. Several countries worldwide have faced the same dilemma.
But, according to the group of practitioners, while oxygen-based treatment has its place, it has not been used correctly in the current crisis.
Consultant neurosurgeon and spinal surgeon Dr Roger Hunter, speaking during a recent conference hosted by Medical Strategies AO Limited, said more focus should be placed on unblocking the airways rather than blowing oxygen down airways that are partially blocked.
“COVID patients are now lying on mattresses on the floor and COVID patients are now lying right bedside non-COVID patients on general wards in government hospitals. Sadly, oxygen has run out and patients have died, and this is largely because [doctors] have used oxygen-centric care, which we decided not to apply, so that when oxygen runs out the patient really feels like a fish out of water and is gasping,” said Dr Hunter, the lead presenter and president-elect nominee of the Medical Association of Jamaica.
“We apply a principle of permissive relative hypoxia. In other words, seeing a saturation of 80 per cent we do not start oxygen, not until they are down in the 70 per cent, and I daresay even 60 per cent. By so doing you condition the patient to tolerate a much lower oxygen tension and so you are reducing your oxygen requirement, reducing the stress and the expense on your system, and your system, which is already limited, is now better able to deal with the demands placed on it,” Dr Hunter said.
“We therefore strongly recommend to the Government that they should now focus their attention on relative hypoxia and not on oxygen-focused care,” he added.
“We are waiting for the Government of Jamaica to come to independent public health providers and ask us for our experiences to see how the successes we have gained from early home-based treatment can be configured and shaped and how that would work in a government health system,” he added.
According to Dr Hunter, many COVID-19-positive Jamaicans are now treated by independent public health providers who are “COVID-competent and COVID-enabled”. Noting that some 300 people have been treated in the home-based care approach, all of whom have lived, he said, “The question must be asked why are our 20-year-olds, 30-year-olds, 40-year-olds dying from COVID when [people over 100 years of age] are living after being treated at home?”
Furthermore, the physicians, who are batting for early home-based care with medical supervision, are contending that the advice given to Jamaicans by the health authorities from the onset has been incorrect and has contributed to the state of overflow in public facilities.
“Patients are presenting too late to the hospital, and that's largely because the Government has said stay home and watch rather than stay home and treat,” Dr Hunter said, arguing that people have stayed home and waited until it is too late when their oxygen levels are in peril.
“Start treatment the moment you have symptoms, even if you are asymptomatic, you have no symptoms but you have been exposed to someone who has COVID. Do not rely on a positive test…all must steam and pay attention to oral hygiene,” Dr Hunter urged.
Steaming, he said, is part of an “algorithm” which has been proven and tested by the practitioners who are also all in favour of individuals getting vaccinated.
“For our algorithm to work, all homes and public spaces must have a pulse oximeter (which measures heart rate and oxygen level), an infrared thermometer. All homes with diabetics must have a glucometer,” Dr Hunter explained. The algorithm, he said, also involves steaming and cupping the chest to unblock airways. Steaming must be done for 30 minutes, three to five times a day, preferably after meals. Sun baths, vitamins, prescribed antibiotics as well as a strict oral hygiene regime form part of the treatment.
“Everyone must practice regimental oral hygiene. Floss, brush, gargle with mouthwash for a minimum of two minutes. The virus loves the mouth, it loves to replicate inside the mouth and therefore if we constantly sanitise the mouth, it reduces our viral load,” Dr Hunter said.
The group also appealed to the Government to remove all taxes and fees from the importation of oximeters, while calling for the price of the infrared thermometer (which ranges from $8,000 upwards) to be subsidised so that the cost is not too much more than $3,000 to ordinary Jamaicans.
He said the early home-based treatment approach in the context of the rampant spread of the virus is the country's best hope.
“Jamaica now has a 50 per cent positivity rate, which means that every other person in a line — be it a line for the vaccination or a line to get scarce resources — has COVID. This is very sobering. All our measures to stop the spread of this tiny virus have failed. We recognise, therefore, that we should not spend billions more isolating coronavirus, but we should spend money trying to get 200,000 children back in school because, at the end of the day, a third or a little more of children being left out of school is a far greater public health problem than locking down and preventing COVID spread,” he argued.
“COVID spread is here, it is in every household, it is in every community, so now we have a concept of existing with this endemic rather than trying to block this pandemic,” he added.
Jamaica recorded 687 new COVID-19 cases and 26 deaths on Saturday, bringing the infection total to 71,344, and virus death toll to 1,619 since the first case was reported in March last year. The Ministry of Health and Wellness reported that the new cases comprised 417 females and 270 males ranging in age from 68 days to 92 years.
As of Sunday, there were 643 new confirmed cases, 18 deaths and a total 699 people hospitalised. The positivity rate, the ministry said, was now 43.7 per cent.
A total of 48,921 patients have recovered from the virus.
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