Medical oxygen: why is it lacking in the world and how …

Faced with respiratory failure caused by coronavirus, the ranks of distressed patients are widening in India and other developing countries to try to obtain medical oxygen, which it is far from being sufficiently available on an industrial scale all over the world.

1 – Why are rows of oxygen tubes most often seen in developing countries?

– Oxygen shortages in the Democratic Republic of the Congo, lines in front of hospitals in Venezuela, price speculation in Peru, black markets in Brazil. For weeks, AFP journalists have reported from around the world that oxygen, essential to save people with respiratory problems, is in short supply in many so-called “low and middle income” countries, especially in America. Latin and Africa. .

Although vital for the effective treatment of COVID-19 patients, access to oxygen, relatively easy in Europe and North America, is limited in these countries due to cost, poor infrastructure and logistical barriers. , explains Unitaid, the international organization sponsored by the WHO. who is in charge of centralizing the acquisition of treatment.

According to the World Health Organization, one in five COVID-19 patients will need oxygen.

2 – What are the needs of these countries in the face of the pandemic?

In February, the WHO estimated that more than half a million people in those countries needed 1.2 million cylinders of oxygen a day.

Unitaid estimates its needs at 1.6 billion dollars for the purchase of bottles for the poorest countries this year: “A global emergency which requires a global response”.

According to the organization, some 20 countries, including Malawi, Nigeria and Afghanistan, will face major challenges.

3 – How is medical oxygen made?

There are two main types of oxygen production:

– Medical oxygen: It can be obtained by separating the gases contained in the air. This is composed of 78% nitrogen, 21% oxygen and 1% of various gases such as argon, carbon dioxide and helium among others, said Régis d’Hérouville, general manager of ‘Air Liquide Santé France.

The 02 (oxygen) is isolated from the air after compression, filtration and purification steps. Concentrated at more than 99.5%, it is a drug.

It is transported liquefied in large containers or tanks with insulating walls, which allows it to maintain its temperature below -182 ° C or in gaseous form in bottles of smaller volume.

“The supply of liquid oxygen is what makes it possible to meet the most important needs and variations in demand. One liter of liquid oxygen is equivalent to approximately 800 liters of gaseous oxygen. Oxygen can also be supplied in pressurized cylinders to allow patient mobility. In this case, one liter of gaseous oxygen at 200 bar corresponds to 200 liters of gaseous oxygen that can be used directly by a patient ”, explains Hérouville.

– Oxygen produced by concentrator: It is an oxygen concentrated at 93% in general. These are portable electrical equipment that extract and purify oxygen from the ambient air in real time, or larger production units that can power large entities such as hospitals.

“In the absence of liquid oxygen production infrastructure, concentrators are useful. But they are sized for a certain need, which makes it difficult to respond to a sudden and rapid increase in oxygen consumption multiplied by five or even six, as we saw in some French hospitals during the COVID-19 crisis. In addition, they consume a lot of energy and have a high maintenance cost, ”explains Hérouville.

4 – Who are the main producers?

Apart from China, the three main global suppliers of medical oxygen are: the German Linde, allied with the American group Praxair, the French Air Liquide and the US Air Products.

But medicinal oxygen is mainly produced by many local and regional players, because one of its main problems is that it is difficult to transport it over long distances.

For this reason, it is no longer available in industrialized countries. Production units have been built to supply sectors other than health, such as the steel and chemical industries.

5 – How much oxygen does India have?

In India, Air Force cargo planes began delivering large oxygen tankers last week to where needed. On April 22, a first “Oxygen Express” train was put into service.

The Indian Ministry of Defense also announced the import of 23 mobile oxygen production units from Germany.

France sent eight oxygen production units and liquefied oxygen containers to supply up to 10,000 patients in one day.