Vaccine 4. Prevention is better than cure

The Covid-19 satellite hospital at Bardai, a  re-purposed police station. 

Cast your minds back to April 2020, the first lockdown had begun on 23rd March, but despite this the deaths  due to Covid-19 were still rising at an  alarming rate.What could be done to stem the tide of the pandemic? 

 

Hopes were already being pinned on a vaccine, but would it be possible to make one? How much would it cost?  And more importantly how long would it take? According to the Welcome Trust, in normal circumstances $500 million over 10 years. The quickest ever was 5 years for a mumps vaccine. However fortunately there were new technologies, mRNA and adenovirus vectors, and so Sir Patrick Vallance, UK Chief Scientific Officer, was suggesting 12-18 months. There were grounds for hope but a long and anxious wait was just beginning.  

Meanwhile what could be done to help people before a vaccine would become available? The first response was already in place, an unprecedented lockdown to slow the rate of transmission, the second was to boost the capacity of the NHS to cope with the number of patients needing hospital treatment especially lifesaving oxygen treatment.

On the 3rd of April, 11 days into the first UK lockdown, to prevent the risk of NHS hospitals being overwhelmed, NHS Nightingale London was declared operational. The Excel conference centre had been converted into a hospital in  less than 2 weeks. The  initial capacity was 500 hospital beds with  the possibility of 4000.  More complex equipment was harder to come by,  innovative manufacturing was needed and in the meantime some came from surprising places, such as working ventilators given by the BBC's Holby City film set. The cost of the conversion and equipment was £57 million and 6 more provincial centres were to follow. 

In Bardai, at the hospital, we were trying to respond to the situation, by delivering health education messages on hand washing, mask wearing and social distancing in the community and improving hospital hygiene and infection control. Our ADP linguist colleagues made a health education film in Teda that passed from phone to phone.

We also realised that our small hospital was at risk of being overwhelmed by even a small number of cases due to  inadequate separation of Covid and non-Covid patients and uncontrolled visiting fuelling any epidemic. The local authorities offered a very good solution; the disused police station with a perimeter wall could be transformed into a separate Covid satellite hospital. Help from the WHO and Ministry of Health would eventually arrive but in the meantime BMS supported the rapid organisation of a water supply, triage area and other changes. The main  hospital had basic equipment such as beds and trolleys in storage and so within a couple of weeks we had a unit. We even had a small quantity of disposable PPE that had arrived by chance 6 months before, that was initially supplemented by surgical gowns and scrubs made in town and eventually further supplies from the Ministry. 

Orders for plenty of oxygen masks and other essential medical equipment were made from the UK and these eventually arrived along with essential medicines such as dexamethasone, paracetamol and antibiotics from N'Djamena.  

 

Rather like the UK Nightingale hospitals, our satellite hospital has been little used, although we did have a handful of highly probable cases in the town (we had no tests to confirm them). Thankfully we didn’t get sustained transmission, but having seen the scenes from the UK, Europe and the US we were right to prepare as much as possible. Despite all our preparations the day a more transmissible variant arrives in Bardai we will be at risk and  still would have difficulty coping. The reason for this is the same as one of the drivers of the unfolding tragedy in Nepal and India, a lack of oxygen.

From the outset we were aware that this was a major weakness. In the UK we assume that nearly every bed in a hospital has a piped oxygen supply, and if not, there is a full oxygen cylinder nearby. There is no chance of replenishing our empty oxygen cylinders in Bardai, but we do have four individual patient oxygen concentrators, an amazingly high number for such a small hospital but only two were working. Fortunately, one was repaired by missionary colleagues from Germany and the Ministry of Health sent us another one. BMS bought 2 small generators that could run 6 hours on, 6 hours off to supply the necessary electricity 24 hours a day.  Large numbers of oxygen concentrators have been given by the WHO and other donors to Chad, and hundreds of thousands throughout the world but as an article in today’s Guardian shows, once an epidemic strikes there is usually not enough oxygen to meet the 10 to 100 fold increase in demand. As a consequence  Covid is no longer a disease predominantly affecting the older population, many people of all ages die. We must of course help in any way we can to get oxygen and supplies  to everyone  that need it, but the volume of equipment and the training and skill required to do anything other than the simplest oxygen mask treatments means that this can never be the best solution for most of the population in low and low middle-income countries. Building Nightingale hospitals in advance all around the world is just not possible.

What is needed is a vaccine freely and equitably available for all, after all prevention is better than cure.  

CAMPAIGN FOR A COVID FREE World Click for news 

JOIN THE GLOBAL CHRISTIAN MOVEMENT FOR EQUITABLE VACCINE ACCESS