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Doctors working in hospitals across the country say they are being told to limit the amount of oxygen they use as the UK approaches a peak in coronavirus cases.
In multiple posts on online discussion forums and in interviews with BuzzFeed News, frontline medics describe wards unable to admit further patients, surgical wards being repurposed into COVID-19 wards because of oxygen issues on medical wards, oxygen saturation targets for patients being lowered, and staff being told to ration oxygen for patients on ventilators.
“We only have enough oxygen for 50 beds to be on high flow,” one hospital doctor treating coronavirus patients told BuzzFeed News. “We don’t have any way to get more, they’re rationing it instead.”
NHS England said oxygen tanks were “fuller than normal” and that there was “sufficient oxygen supply available”.
But Simon Walsh, the British Medical Association’s lead on emergency medicine, told BuzzFeed News that the issue is likely not the total amount of oxygen available, but each hospital’s capacity to deliver it to the patients who need it.
“There are a few things which basically limit the supply of oxygen,” he said. “One is the total amount — if it runs out and it hasn’t been resupplied then all the oxygen supply will stop at that point.
“The other part, that’s slightly more difficult to understand, is that even when the tank has got oxygen in it, there’s a maximum flow rate, which cannot be exceeded by the valves that control delivery into the system. If you do exceed that flow rate then the entire oxygen supply fails, and has to be reset by engineers.”
While Walsh said he was unaware of specific situations in individual hospitals, he told BuzzFeed News that health service leaders must address the doctors’ concerns.
“I think we need to take these reports seriously,” he said. “We need to find out why people are being told these things if, as NHS England says, oxygen supplies are not a problem. I think their explanation that the tanks are full doesn’t address the potential issues with oxygen supply that we’ve been talking about.
“The tanks may be full, but it may be that some hospitals are reaching the limits of the amount of oxygen they can supply at any one time, and if that is the case and if it’s effectively resulting in rationing of oxygen, then that urgently needs to be addressed by NHS England, ensuring that the numbers of patients in these hospitals is reduced to a level where they can deliver what the patients need.”
The doctor treating coronavirus patients, who spoke to BuzzFeed News on condition of anonymity, said that normally the target oxygen saturation level for patients would be between 94 and 98%, but they had been told by senior hospital staff that targets had been decreased.
“Now they’re saying 90% and above — it keeps changing,” they said. “They’re saying they’re rationing it, so palliative people won’t get oxygen.
“They’re just trying to do everything they can to cut down oxygen. They’re not using nasal high flow oxygen, but they're mostly talking about rationing oxygen.”
Normally, intensive care units account for a significant amount of hospitals’ oxygen usage, and with ICU capacity increased to prepare for an influx of coronavirus patients, so has demand for oxygen.
“Now, basically everyone that’s going to be in there is going to be needing oxygen,” the doctor added. “If you’ve got COVID and you don’t need oxygen, then you don’t need to be in hospital.”
Walsh said that the reasons for lowering oxygen saturation targets could be clinical, because “particularly over long periods of time, high oxygen concentrations can be harmful to patients”, adding that there were “plenty of good clinical reasons to aim for saturations in the low 90s rather than 94 or above, in certain groups of patients”.
However, he said he would be “extremely concerned” if oxygen was being rationed because hospitals don’t have enough of it.
“Certainly, not giving oxygen to palliative patients, we’d all have a lot of difficulty with that ethically,” he said. “We normally give oxygen to patients who have low oxygen levels because it’s an uncomfortable feeling, and even if the treatment is palliative and the patient is not expected to recover, oxygen is often part of that treatment.”
While doctors may decide not to give oxygen to palliative patients because the treatment can be uncomfortable, he said, “that’s different from limiting it because of a lack of supply, and myself and the BMA would be concerned to hear about stories where clinicians are told to ration oxygen to those patients because there isn’t sufficient” supply.
He added: “We would be concerned if there was any instruction to withhold [nasal high flow oxygen] from patients who might benefit from it because of an inadequate oxygen supply. We would encourage people absolutely to escalate that, flag that and report it, because if this is something that is not driven by the clinical need of the patient but by resources then the government needs to ensure that the patients are in the right place where the resources are available.
“They’ve made a lot of publicity about opening these new Nightingale Hospitals, and the capacity that’s there, and if oxygen supplies are limiting patient care in any way in the existing NHS trusts, then these patients need to be moved, or some patients need to be moved, to allow them to deliver the highest quality care to all patients.”
On Saturday, Watford general hospital declared a critical incident involving its oxygen supply and told people not to attend. Oxygen use there has doubled in recent weeks, due to additional ventilators and CPAP (continuous positive airway pressure) machines used to treat patients with COVID-19.
In a statement, the hospital said: "As a result of a technical issue with our individual hospital's oxygen equipment, which does not pose any risk to our patients, West Herts Hospitals NHS Trust declared a critical incident on Saturday April 4 and has asked that people do not attend Watford General Hospital.”
BuzzFeed News asked what specifically had been the issue with oxygen supply, but a spokesperson said they were not able to provide any further details. Walsh said that while he does not know what caused the issue in Watford, one possible explanation is that the flow rate had been exceeded and the system had to be reset.
A spokesperson NHS Estates said: “Hospital oxygen tanks are fuller than normal, having been filled more frequently in recent weeks as part of preparations for patients with coronavirus, so there is sufficient oxygen supply available. Individual hospitals received guidance in February and again this week on how to safely manage engineering and their increased oxygen usage."