Breathing easy when the virus hits

 

Oxygen tanks lined up at the quarantine centre at MAEPS in Serdang. People can be prepared with oxygen concentrators or aerosols at home, if the need arises, say medical experts. (Bernama pic)

PETALING JAYA: With no let-up in the Covid-19 numbers, Malaysians are looking at a grim scenario, with patients parked on stretchers in car park lots, forced to wait outside emergency departments and even sleeping on hospital floors.

There is now a need for treatment and care for patients away from hospitals, or even in the comfort of their own homes. So, what do they do?

Ipoh-based senior consultant paediatrician Dr Amar Singh HSS suggests getting prepared for home quarantine, complete with oxygen support if they reach stage 3.

Besides keeping a thermometer, doctors, medical product suppliers and disaster management organisations suggest that those under home quarantine or waiting to be admitted get a pulse oximeter, a Covid-19 rapid home test kit and an oxygen concentrator.

Amar said a pulse oximeter was useful for measuring oxygen level.

“If the SaO2 (oxygen saturation) drops below 95%, the patient may need to be admitted to hospital or given supplemental oxygen,” he said in a webinar on the Covid-19 situation in Malaysia.

For that, he suggested investing in an oxygen concentrator, and one that can be used while being recharged.

However, he warned against rushing out to buy concentrators as it could lead to a shortage for those who really needed them.

Communities could buy for the poor or give or lend to hospitals or relevant NGOs so that they can be used optimally.

“Those with good business or NGO connections with other nations should help bring more oxygen concentrators into the country,” he said.

Universiti Malaya Medical Centre’s senior consultant respiratory physician Dr Pang Yong Kek said the function of the oxygen concentrator was to concentrate the oxygen in the air from 21% to above 85%.

It can be used at home with doctor’s recommendation but patients with a lower normal range of oxygen saturation of the haemoglobin (less than 95%) are at risk of deteriorating further and they should be hospitalised, he said.

However, during the recovery phase (three weeks after symptom onset), patients who are stable, but whose oxygen saturation remains less than 90% may be allowed to be discharged and use supplementary oxygen at home.

Patients with acute or chronic illnesses of the lung may not be able to exchange oxygen effectively to reach an oxygen saturation of at least 95% (pulse oximeter saturation reading above 90%), he explained.

An oxygen concentrator with an oxygen flow rate of 5 litres per minute (LPM) is adequate for home use but some patients may require 10 LPM.

Costing RM4,500 or more, oxygen concentrators are expensive but there is always an option to rent. Rental cost ranges from RM350 to RM600 a month, said Acucare Systems (M) Sdn Bhd director Teh Wei Haw.

An oxygen concentrator can be shared by another person in the same household by using different tubes. It can also be reused by another person, but the machine should be returned to the company to be sanitised and the nasal cannula and the humidifier (bottle) changed, said Teh.

The other necessary item is a disposable aerosol which works as an oxygen inhaler but with limited use.

GasWorld Sdn Bhd executive director Ang Eng Teck said each aerosol canister provides 600ml of oxygen which lasts three minutes.

Costing RM25 a can, it is economical. A Covid-19 positive person may want to keep a few cans of it, said Ang.

On the use of oxygen tank/cylinder, he said the set costing over RM1,000 (cylinder, regulator and trolley) is cheaper than the oxygen concentrators but due to Covid-19 contamination concerns and difficulties with refills, his company does not supply it to homes currently.

“We supply oxygen tanks to Covid-19 assessment centres (CAC), quarantine centres and hospitals which are equipped with staff members who can set up the system,” he said.

Oxygen concentrators do not require oxygen refills.

Another item the community can invest in is a Covid-19 rapid test kit, said Mercy Malaysia president Dr Ahmad Faizal Perdaus.

Three test kits have been approved by the Malaysian Device Authority.

They are the Salixium Covid-19 rapid antigen rapid test (saliva/nasal swab samples) made by Reszon Diagnostic International Sdn Bhd, the Gmate Covid-19 Ag saliva for home use by Philosys Co Ltd, Korea, and the Beright Covid-19 antigen rapid test device (oral fluid) made by Hangzhou Alltest Biotech Co Ltd.

Ahmad said there are many things that communities can do to empower themselves such as buying home self-assessment tools and working with NGOs to deliver the tools.

Mercy is currently assisting overwhelmed hospitals and quarantine centres and will collaborate with the private sector or NGOs to set up an oxygen centre to provide low-dose oxygen to patients when the need arises, he said.

Meanwhile, Crest Malaysia has started giving oximeters to home quarantine cases and is buying oxygen concentrators, said its director, Rev Dr Ng Swee Ming.

Ng, a doctor himself, said his church had bought 20 oxygen concentrators especially for its B40 community.

“We are not taking over the government’s job but supplying the tools only,” he said, adding that each community can build its own stock to serve its community.

The church had sent an oxygen concentrator to a recovering Covid-19 patient whose lungs were badly damaged and another two to Covid-19 positive students who had breathing difficulties but were turned away by hospitals, he said.

With the growing need for more help on the ground, Ng said Crest needs medical and non-medical volunteers to help run a tier 1 Covid-19 quarantine centre for the B40s once it gets the government’s approval.

International Disaster Response Network chairman Daron Tan said as the situation worsened, many people may have to care for the sick at home.

“We have been giving advisories and training people to provide care and give some non-prescription medicines with the support of doctors,” he said.

People should get themselves trained and be prepared for any eventuality, he said. - FMT