A video from inside a public hospital showing a number of COVID-19 patients dying from what appears to be a lack of oxygen went viral on social media last week, sparking a public outcry and shining a spotlight on Egypt’s health care system as it struggles to cope with a renewed surge of coronavirus cases.
Shot by Ahmed Mamdouh, a relative of one of the four who died, the dramatic footage shows patients dead in their beds in the intensive care unit of Hussainiya Central Hospital in Sharqiya. “Everyone in the ICU is dead,” Mamdouh can be heard repeating in the video, which also shows a nurse sitting in a corner hugging her knees, clearly overwhelmed. “There’s no oxygen,” he says.
Mamdouh and family members of other patients told Mada Masr that an interruption in the oxygen supply at the hospital caused the deaths. Yet the Health Ministry and the governor of Sharqiya denied the claims and said the patients died because they suffered chronic diseases in addition to the virus. The Sharqiya prosecutor’s office opened an investigation into the deaths and Mamdouh was detained for 24 hours and questioned before being released.
The deaths follow similar allegations by relatives of two COVID-19 patients who died in the ICU at Zefta General Hospital because of what they said was a lack of oxygen. Health Minister Hala Zayed similarly denied those claims, saying that all hospitals designated for the treatment of COVID-19 patients were well supplied with oxygen. Nevertheless, two days after the Hussainiya video was posted online, Zayed decreed that an electronic system be put in place to monitor oxygen stocks at public hospitals — especially COVID-19 isolation hospitals. Under the new system, each administrator would be required to take pictures of the oxygen tank regulators at their hospital at different points during the day and submit them to a central control room.
However, the crisis appears to go deeper than a lack of oxygen or other medical supplies. According to the accounts of medical staff and patients’ family members, what happened at the Hussainiya hospital is a stark example of a health care system that has been stretched too thin by a surge in coronavirus cases, resulting in gross levels of mismanagement and neglect that can have deadly consequences.
On the morning of January 1, supplies of oxygen at the Hussainiya hospital were already running low, according to Ahmed Nour Eddin, whose 67-year-old mother, Mariam Ahmed, died in the ICU. She had been admitted to the hospital for treatment just two days earlier and Nour Eddin had taken to camping outside the hospital, along with other patients’ family members, to follow their care and purchase any medication or supplies requested by doctors for treatment.
Nour Eddin says that he and other family members overheard an altercation in the early morning of January 1 between a doctor from the isolation ward and a hospital worker charged with monitoring the oxygen tank regulator, which is stationed near the hospital entrance. The worker had reduced the oxygen pressure flowing to patients’ rooms by half, leading to the death of a patient in the ICU, according to Nour Eddin. “The doctor was yelling at the worker. It escalated into a physical altercation and the doctor almost beat him up,” Nour Eddin says. “From the yelling, we pieced together that he had reduced the supply of oxygen because the tank was running low and he was worried it would empty before the arrival of the refill truck, which was still several hours away.”
That worker’s job is to monitor the gauge on the oxygen tank, according to a nurse who works at the Hussainiya hospital’s isolation ward, and report the oxygen stock levels to a technician who oversees the grid, as well as to the head of the ICU and the hospital administrator. By monitoring oxygen levels, hospital officials should be able to alert their relevant health directorate to send a refill truck before the hospital tank runs out.
According to the nurse, who spoke to Mada Masr on condition of anonymity, oxygen is pumped from the main tank through pipes that lead to patients’ rooms in the designated isolation ward. Sometimes, when the tank is empty, the line is hooked to a number of backup oxygen cylinders. The hospital also has several cylinders connected to a separate grid, which supplies another building where non-critical cases are treated.
Following the altercation, Nour Eddin says, patients’ families started looking in on the oxygen gauge once an hour to see how many liters were left. At around 6 pm the following day, January 2, the deputy hospital administrator came down to check on the oxygen levels himself. Patients’ family members crowded around him to ask whether they needed to acquire their own oxygen cylinders if the hospital’s supply was running low. The deputy assured them that the hospital had an emergency reserve that could cover more than 12 hours and that he would order staff to immediately tap into it. However, it turned out the emergency reserve would only last a few minutes.
Shortly after speaking with the deputy administrator, Nour Eddin was called to the ICU ward by a doctor who asked him to purchase a Solu-Medrol injection for his mother. He returned with the injection at 8:30 pm and handed it to the doctor who reassured him his mother was doing well and asked him to get her some food.
At the time, Nour Eddin was unaware that a crisis was brewing. According to another nurse who spoke to Mada Masr on condition of anonymity, the entire staff knew that the hospital was about to run out of oxygen though they were repeatedly assured by the hospital administration that the oxygen truck would arrive shortly.
Nour Eddin arrived back at the ICU with the food for his mother at 9:30 pm to find a chaotic scene. The oxygen supply had indeed run out and doctors and nurses were dashing through the halls in a desperate scramble to try and save patients using hand-held bag valve masks.
“I walked in on my mother as she was gasping for her last breaths. The ventilator was off and she couldn’t breathe. She clutched onto my neck, pleading to me to save her. The doctor tried to pump air into her lungs, but she was dead within moments,” he says. “I crumpled to the ground in shock, but the doctor and nursing staff were in a desperate situation so I stood back up and held a bag valve mask for one of them. The doctor eventually brought in an oxygen cylinder and managed to save two patients.”
A policeman posted outside the ICU noticed Nour Eddin had been inside for a while. “He opened the door and forced me out. I kept screaming at him, ‘My mother just died.’ But he just escorted me downstairs,” Nour Eddin says. “There, I told the other families that patients in the ICU were dying. Another police officer standing nearby harshly reprimanded me and said, ‘Nothing happened.’”
Upon hearing the news, the other families tried to rush upstairs to check on their relatives in the ICU. Only Ahmed Mamdouh managed to get in and he quickly began filming the tragic scene on his cell phone which he would later post on Facebook. The oxygen truck finally arrived at 10 pm, just minutes after the four patients died, Mamdouh told Mada Masr the following day.
His account of what happened closely mirrors Nour Eddin’s. “I complained about the hospital’s oxygen tank emptying at 10 am. At 1 pm, they told us that there are 28 backup oxygen cylinders in the hospital and that they would deliver them to ICU rooms if the oxygen truck was delayed,” Mamdouh says. He says he tried to bring an oxygen cylinder for his aunt but officials at the hospital assured him that there were backup cylinders for emergencies and that the oxygen truck would arrive before the tank was empty.
“I was sitting next to my aunt. Her pulse and breathing were fine until 9:30 pm. I left her and went down to ask if the oxygen truck had arrived. I found someone coming down from the hospital screaming and saying that people are dying. I went upstairs and found that my aunt and everyone in the isolation ward had died,” Mamdouh says.
A nurse who works in the neonatal intensive care unit says that the Hussainiya hospital was first designated as a COVID-19 isolation hospital when the first coronavirus wave hit before summer. It was removed from the list of hospitals in September before being put back on the list on December 25. However, the hospital received no forewarning or preparation before being designated an isolation hospital a second time and the facility was quickly overwhelmed with cases.
“The oxygen shortage issue can be resolved by implementing a better supply process. The real dilemma is that we’re unable to provide patients with proper care,” the nurse says, pointing out that the hospital was inundated and forced to work under enormous pressure. The nurse said that she and more than a dozen of her colleagues had not been part of the hospital staff during the first wave. She says when the ministry again designated it an isolation hospital in December, “it was like we were all suddenly dropped on the frontline.”
Initially, the nurse worked in the COVID-19 isolation ward. But on December 31 she found out she was pregnant and asked to be transferred to the neonatal ICU ward where she mistakenly assumed there would be less work pressure and less risk of infection to COVID-19.
On January 2, just hours before the death of the four patients, three newborns were brought into the neonatal ICU. The infants — aged five, seven, and 10 months old — had all contracted COVID-19 yet were sent to the neonatal ICU because the isolation ward was at full capacity. The head doctor at the neonatal ICU refused to admit them for fear they might transmit the virus to the other children in the unit. He instructed the parents to isolate them at home. “The doctor knew, as did we, that these kids would die within hours. But there was nothing we could do about it,” the nurse said.
An official at Abbasseya Fever Hospital, who spoke to Mada Masr on condition of anonymity, says that, unlike the first wave, the primary issue is not a shortage of medical supplies, but that public hospitals simply do not have the capacity to provide proper medical care amid a new spike in cases.
Doctors Syndicate board member Karim Musbah also says that the availability of oxygen supplies is not the main issue — but rather that government officials are reluctant to acknowledge how strained the healthcare system actually is.
A case in point is how officials initially dealt with Mamdouh after he posted the video on social media where it quickly went viral, sparking public outrage. The following day, the Hussainiya Prosecution ordered Mamdouh be taken into custody for questioning. The head of the facility had accused Mamdouh of barging into the ICU, distracting doctors and filming without permission. A number of government officials claimed in the media that he had fabricated the video in service of the interests of groups hostile to the country.
Mamdouh’s lawyer, Said Ashmawy, says the Hussainiya investigative unit did not buy into the narrative presented by officials. The governor of Sharqiya, the hospital administrator, and other Health Ministry officials all considered the main issue to be Mamdouh’s filming of the incident, as opposed to the mismanaged care at the hospital. However, the detective came to the same conclusion as the families, nurses and doctors, and Mamdouh was freed after 24 hours.
“Had it been any other detective working at the investigative police unit in Hussainiya, he would have toed the line and affirmed the claim that Mamdouh was a member of the Muslim Brotherhood and he would have been done for,” Ashmawy says.
Mamdouh told Mada Masr after his release that the only way to safeguard against similar failings at other hospitals is to shine a spotlight on the medical negligence at the Hussainiya hospital and to hold those responsible to account.
Ashmawy — who was one of several lawyers representing Mamdouh during the hearing — filed a petition with the Hussainiya Prosecution on behalf of three members of the victims’ families accusing the health minister, the governor of Sharqiya, and officials in the Hussainiya hospital of criminal negligence, and demanding financial and moral restitution. The investigation is underway, and the prosecution has set up a technical committee to ascertain what happened.
Yet the problems appear to be widespread. One day after the Hussainiya incident, the administrator of Kafr El Sheikh’s Al-Hamoul Hospital made a desperate appeal on Facebook to residents to provide oxygen cylinders. The supply terminal had experienced a malfunction and the administrator was concerned that the hospital’s tank might empty before the refill truck arrived. People flocked to the facility with oxygen cylinders, helping to bridge the gap. In response, the administrator was suspended and referred to an investigative committee by the Health Ministry. However, a public backlash and interventions by several members of Parliament forced the ministry to back down.
While the health minister did issue a decree to implement a centralized system to monitor oxygen supplies at hospitals, she also banned any filming inside health care facilities. From now on, patients in the ICU will no longer be allowed to have their phones.