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Medical Specialists: Only 28 hospitals have liquid oxygen tanks

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Noting that the best way to deliver oxygen to a patient’s bedside is to have piped oxygen distributed from a central liquid oxygen tank, rather than using cylinders, the Association of Medical Specialists (AMS) has said that Sri Lanka only has 28 such liquid oxygen tanks installed in hospitals.

Dr A J A L Fernando, President, AMS, yesterday said, in a media statement, that the sizes of those tanks ranged from 3,000 to 20,000 litres, but only two had 20,000 litre tanks. One was the National Hospital and the other the Peradeniya Teaching Hospital, the AMS has said.

“The others are relatively smaller. With the current coronavirus being highly transmissible, taking patients to hospitals with larger tanks may not be an option as many of these hospitals mainly cater to non-Covid patients. Spreading the disease within a hospital could also result in disaster. With this, the system will still have to largely depend on jumbo cylinders where each can carry 47 liquid litres that produce 7,050 gas litres of oxygen.”

Dr. Fernando added that although the jumbo cylinders were heavy enough to need more than a couple of people to move them, each of them might not last for more than a few hours as regards a highly oxygen dependant patient. Managing oxygen between hospitals and delivering it to the individual patient would certainly need intelligent planning and extreme coordination of production, storage and efficient delivery, he said.

Dr Fernando added that his association did not see any pragmatic strategy on the part of the government in place to face eventualities that could arise given the spike in COVID-19 cases. “The number of Covid-19 patients is on the rise in Sri Lanka. It has exceeded 1,000 a day and is still rising. We know that our existing capacity to treat patients (intensive care and high dependency beds) has reached its threshold. Experts have clearly mentioned the higher infectivity and virulence of the current strain warranting and increased need for oxygen dependency and intensive care.”

Excerpts of the AMS statement: “Since there is no firmly established cure for this disease, symptomatic treatment is the mainstay till the recovery is reached. However, oxygen and ICU care play a crucial role in critical cases and we should ensure that there will be a constant and uninterrupted availability of oxygen supplied beds if we are to avert disaster. Apparently, being a financially stronger regional giant, India is facing immense hardships due to shortage of oxygen right now.

“As oxygen is considered the most important medical need and likely to be in short supply, all necessary steps must be taken to avoid a crisis.

“To the best of our knowledge there are two companies that supply oxygen to healthcare facilities and these manufacturers can easily increase their production almost three-fold. Together they now produce around 75 tons of oxygen per day of which a portion is supplied for industrial use. They can divert all their oxygen production to health if the need arises and Sri Lanka has sufficient source of supply. However, the more important issue is the delivery of this oxygen to patient’s bedside. The best way to do this is to have piped oxygen distributed from a central liquid oxygen tank rather than using cylinders. Unfortunately, the whole country only has 28 such liquid oxygen tanks installed in hospitals. The sizes range from 3000 to 20000 litres, but there are only two 20,000 size tanks one each at National Hospital and Peradeniya and others are relatively smaller. With the current Covid being highly transmissible, taking patients to hospitals with larger tanks may not be an option as many of these hospitals mainly cater to non-covid patients. Spreading the disease within a hospital could also result in disaster. With this the system will still have to largely depend on jumbo cylinders where each can carry 47 liquid litres that produce 7050 gas litres of oxygen. Though heavy enough to need more than a couple of people to move them, each jumbo cylinder may not last for more than few hours in a highly oxygen dependant patient. Managing oxygen between hospitals and delivering to the individual patient will certainly need intelligent planning and extreme coordination of production, storage and efficient delivery.

“For this, we need to utilize the services of relevant experts in these fields to design and implement the best national plan and it should be kept strictly apolitical. If such action is not taken in this crucial juncture, we will be another nation who has “planned to fail” as we have “failed to plan”.

“It is also important that we take a serious note of the high rate of disease spread in spite of the present prevention strategies. A degree of complacency and overconfidence can take Sri Lanka to a critical point faster as it has happened in some countries. Out of all, Prevention is THE best strategy and we need to do everything possible to prevent and slow down the spread. Even if a lockdown is needed, it is best to foresee and think ahead and be prepared to do it if it is essential.

“Only the authorities who have the real information and data, can make that decision. It should not be a political decision, but a decision to save the country and its people based on scientific principles both for today and tomorrow. It is very evident now that the countries can go up or down in the success of Covid control based on the wisdom they demonstrate during decision making. Moreover, while appreciating all the positive moves the government has taken towards Covid control, we believe it is the duty of the health authorities to submit the correct information and data to the political authorities without any delay. We urge the authorities to consider all above facts and make prompt decisions based on scientific facts and rational thinking to face the present Covid 19 situation. The AMS is ready to provide the government and health authorities its maximum support at this hour of need.”



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Facilities for infected pregnant women inadequate – SLCOG

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By Rathindra Kuruwita

The distribution and availability of high-flow oxygen machines to treat Covid-19 infected pregnant women were not adequate, President of the Sri Lanka College of Obstetricians & Gynaecologists (SLCOG,) Dr. Pradeep de Silva said yesterday.

Dr. de Silva said that while they had not yet faced any lack of oxygen in treating Covid-19 infected pregnant mothers, things could change rapidly given the limited availability of equipment. “Having an adequate supply of oxygen alone is not enough. You need high flow oxygen machines, and 50 litres of oxygen per minute is needed to operate a high flow oxygen machine. I do not know how many machines we have in this country but where I work, Castle Street Maternity Hospital has about four. We need to estimate the number of these machines we require and how much oxygen we want. From my understanding, the distribution and availability of high flow oxygen machines to treat Covid-19 infected pregnant mothers is not adequate.”

Dr de Silva said that Sri Lanka needed about 50–200 high-dependency unit (HDU) beds per district, based on the population, 10–50 high flow oxygen machines per district, four for ten ICU beds and two dedicated Extracorporeal Membrane Oxygenation (ECMO) machines.

“If we get this, we will be able to deal with pregnant women who develop complications from COVID-19 for the next four to five years,” he said.

Dr de Silva said that currently one pregnant woman who has been infected with COVID-19 is receiving ECMO treatment. There is also a shortage of beds at the Mulleriyawa Base Hospital, which has the largest ward dedicated to COVID-19 infected pregnant women. On Thursday, Obstetrician & Gynaecologist, Dr Mayuramana Dewolage, who heads the ward that treats COVID-19 infected pregnant women at the Mulleriyawa Base Hospital, said that they only had 37 beds were dedicated to pregnant women with COVID-19. They didn’t have any HDU or ICU beds dedicated for their use, he said.

“We share HDU and ICU beds with other patients at Mulleriyawa Base Hospital,” Dr Dewolage said.

The President of the SLCOG also urged all hospitals to find a separate space for pregnant women who were receiving treatment at their institutions. When COVID-19 pandemic started, the Health Ministry instructed all hospitals to do so but it was now obvious that those instructions had not been followed, he said.

“When the second wave started people got ready but later, they just stopped getting ready and now we are unprepared to meet the challenges of the third wave. We need to find a way to manage this. If the Ministry of Health has not prepared a plan, we are ready to help formulate one,” the President of the SLCOG said.

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Those who had AstraZeneca first jab, should take Sputnik V with adenovirus 26 – Specialist

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By Rathindra Kuruwita

If those who have taken the first dose of AstraZeneca are to receive a second jab of Sputnik V, they should take the first Sputnik V vaccine with adenovirus 26 (Ad26), Consultant Immunologist and head of the department of Immunology-MRI, Dr Nihan Rajiva de Silva says.

Dr. de Silva said that the first dose of Sputnik had Ad 26 and the second had adenovirus-5. “Adenovirus-5 is common. We may have been exposed to that and we may have developed antibodies. Adenovirus-26 is rarer and we will better respond to that. That is why the vaccine-maker has used adenovirus-26 in the first vaccine. So, if you had a first jab of AstraZeneca and you are to get the second dose from Sputnik-V remember to get the first jab,” Dr. de Silva said.

He added that any vaccine has the chance of reducing the severity of the virus and that the general public should get vaccinated when the opportunity is available.

Dr. de Silva said that there was a shortage of AstraZeneca vaccines because the Serum Institute of India could not deliver shipments as promised.

“However, we are now getting Sputnik V vaccines and we are looking at mixing them. There is a study in Russia about the efficiency of mixing Sputnik V with AstraZeneca and the results should be out soon. I can say that theoretically mixing the two vaccines should work,” he said.

Dr. de Silva added that the AstraZeneca vaccine should work against the new variant spreading in the country.

Consultant Cardiologist at the National Hospital of Sri Lanka, Dr. Gotabaya Ranasinghe said that those with heart issues, non-communicable diseases and were obese must get vaccinated to minimise the complications of Covid-19.

Dr. Ranasinghe said that those in the above-mentioned categories were at risk of contracting, getting complications and dying of COVID-19 and research had proven that vaccination would reduce the chance of such eventualities.

“If you worry about getting vaccinated, talk to your doctor. Don’t seek advice from friends and family,” he said.

Dr. Ranasinghe added that they had limited the number of heart surgeries they do due to COVID-19. ICU beds used for heart patients too were being now allocated for COVID-19 patients. “We only do the most pressing cases. But this means that the waiting list keeps on growing. Now, the waiting list is over eight months. If we limit the surgeries more and keep taking away ICU beds available for those who have had heart surgeries, the waiting list will grow further,” he said.

The Consultant Cardiologist also advised the public to eat healthy food and engage in moderate exercises, at least five days a week. This will reduce the mental stress as well as boost the immune system. ‘We recommend moderate exercises like jogging and brisk walking, for 30 minutes, five days a week. Being healthy is as important as wearing masks or adhering to physical distancing,” he said.

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STF raids narcotics distribution centre close to Bloemendhal police station

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Acting on information received from the Organised Crime Fighting Unit of the elite Special Task Force (STF), police commandos, on Thursday (6), arrested a person running a narcotic distributing network, 1.5 km away from the Bloemendhal police station.

The STF identified the suspect as Thawasidevan Pradeep Kumar, 21, a key associate of one Suresh with links to a criminal outfit run by Kimbulaele Guna, now absconding in India.

DIG (Legal) Ajith Rohana said that the raiding party had recovered 2 kg, 22 g and 88mg of ‘ICE,’ with a street value of Rs 25 mn in addition to 4kg, 2 g and 527 mg of substance known as ‘hash,’ as well as Rs 400,000 in cash and a mobile phone.

Kimbulaele Guna is believed to have sought refuge following an LTTE attempt to assassinate President Chandrika Bandaranaike Kumaratunga at the final PA presidential election rally at the Town Hall in December 1999.

DIG Rohana said that Guna’s brother Suresh was a major heroin distributor in Colombo. The STF later handed over the suspect, along with contraband and locally made ‘hash,’ and his phone to the Police Narcotics Bureau (PNB). The raid on the heroin distribution centre situated in Aluth Mawatha, Colombo 15, followed specific information received as regards the ‘operation’ conducted with impunity (SF)

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