Why some hospitals lack oxygen to keep patients alive

The latest horror of the pandemic is that large numbers of people around the world are dying from lack of access to medical oxygen, especially in India. Every day, tens of thousands of people are admitted to hospitals with Covid-19, resulting in the demand for oxygen far beyond the supply.

Oxygen represents 21% of the atmosphere. A handful of companies capture it and purify it in bulk, but they sell most of it to industry. Many of the world’s poorest areas do not have the infrastructure to deliver or use the medical grade supplies sold by these companies, which are designed to be piped to hospital rooms.

Some hospitals and clinics have machines that produce purified oxygen on a much smaller scale, but these are rare. So many hospitals and patients in poor countries and remote areas rely on the more expensive option: oxygen reservoirs that have become scarce in countries hardest hit by the virus.

The shortages are affecting patients with all types of breathing disorders requiring oxygen, not just those with Covid.

The World Health Organization said in February that $ 1.6 billion would be needed to address the oxygen shortage for a year; now that estimate stands at $ 6.5 billion. Efforts to collect this money have failed, although it is only a small fraction of what has been spent on vaccines and financial support for businesses and workers.

Here are the answers to some of the questions asked about the oxygen crisis.

Given the huge and obvious oxygen needs during a pandemic affecting the respiratory system, the crisis shouldn’t have come as a surprise. But in a year when policymakers have shifted from one pandemic challenge to another – PPE shortages, lockdowns, threat of economic collapse, distance schooling, therapeutics, vaccines – the oxygen supply has never been in short supply. top of the list.

“Oxygen has not been prioritized enough,” said Robert Matiru, program director at Unitaid, one of the global public health groups working to address the shortage with the World Health Organization.

Even before the pandemic, some poorer areas were unable to ensure adequate supplies. But it wasn’t until early this year, when deadly oxygen shortages hit northern brazil, Mexico and elsewhere, that it became clear that what had been seen as a potential problem was becoming a terrible emergency. The World Health Organization has created an emergency task force on the oxygen shortage and called for funds to address it.

Then the pandemic has exploded in India, where it had been relatively contained, pushing oxygen supplies to the center of the world’s attention. India’s official tally of new coronavirus infections has risen from an average of around 11,000 a day in mid-February to a daily average of over 370,000 last week – and experts say the real figure is much higher.

In the past two months, the unmet global need for medical oxygen has more than tripled, from less than 9 million cubic meters per day to more than 28 million, according to a coalition of aid groups that are follow the crisis.

About half of this unmet need is in India. And health advocates warn the calamity could recur in other countries.

In wealthy countries, hospitals typically rely on tankers to make bulk deliveries of liquid oxygen, much denser than ordinary air, which is stored in large containers. A system of pipes draws in the gas, allows it to expand to ordinary density, and distributes it to each bedside.

It is by far the most cost effective way to supply oxygen, and companies that supply oxygen in bulk have sufficient production capacity to meet global medical demand. In the last few weeks only some of them have started speed up their production of medical gases by diverting some from the industry, whose gas has somewhat different requirements.

The Indian government has ordered producers to temporarily direct all of their oxygen production to medical needs.

But many hospitals around the world are not equipped to use liquid oxygen due to a lack of hoses to deliver it to patients, and there are no delivery systems in place for many remote locations.

Oxygen can also be obtained in a less dense gaseous form, in cylinders which must be filled more often. This is often the more expensive option – it can cost 10 times more than bulk liquid oxygen – but it is the only one available in many parts of the developing world.

In many countries, people have rushed to buy or refill such bottles for family members, but demand has far exceeded supply.

Some hospitals have their own factories to extract oxygen from the air, a technology known as variable pressure absorption, or PSA.But the systems are expensive, and a hospital that purchases one should also install a pipes to supply oxygen to the bedside. .

There are also small devices called oxygen concentrators that can serve a single patient or a few. While it can cost several hundred dollars, a major hurdle in poorer countries, demand for these products has grown faster than manufacturers can produce.

Money and time.

Public health advocates say hospitals should have PSA factories and the plumbing to go with them, but in poor countries this solution can be prohibitively expensive, achievable only with international help. The Indian government plans to install the equipment in hundreds of hospitals, but it could take months.

Companies that make PSA plants and oxygen concentrators are increasing production around the world, but that too takes time.

Bulk oxygen producers and governments are always trying to adjust supply chains to get vital gas to where it’s needed most. In India, the government uses trains and even military transport aircraft to bring oxygen to the sick.

If enough money was available, governments and international groups could enter into advance purchase agreements with bulk suppliers, and emergency oxygen supplies could be placed in various parts of the world and deployed as needed.

If nothing else, the past few months have shown the difficulty of trying to increase oxygen supplies on short notice, in the midst of a crisis.

Instead, said Mr. Matiru, the world should invest in readiness, “so that if there is a push, we can press ‘Go’.”

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