Why some hospitals lack oxygen to save patients

NEW YORK.- The most recent horror of the pandemic is the sheer number of people around the world, especially India, who is dying poor availability of medical oxygen. Thousands of people with Covid-19 are admitted to hospitals every day, and the demand for oxygen far exceeds the supply of this essential medical supply.

21% of the earth’s atmosphere is made up of oxygen. There are a handful of companies that purify it, wholesale it, and sell it, mostly to the healthcare industry. But in many poor parts of the world, the infrastructure to distribute and use the medical oxygen sold by these companies does not exist, as it is designed to flow through pipelines to hospital wards.

Some hospitals and clinics have their own small-scale purified oxygen production equipment, but such equipment is not currently available. So many hospitals and patients in poor countries and remote areas have to turn to the more expensive option: oxygen tubes, which in countries hardest hit by the virus are now scarce.

And this shortage affects not only Covid patients, but also patients with any type of respiratory disease requiring oxygen..

In February, the World Health Organization (WHO) said it would take $ 1.6 billion to solve a shortage of medical oxygen for a year. Now that estimate stands at $ 6.5 billion. Attempts to collect this money have failed, although it represents only a tiny fraction of what has been spent on vaccines and financial support for businesses and workers.

Here are some answers to the questions posed by the medical oxygen crisis.

How did it all get worse so quickly?

Given the huge and obvious need for oxygen during a pandemic of a disease that primarily affects the respiratory system, the increase in demand should not have come as a surprise to anyone. But in a year when political leaders and senior officials of institutions have gone from problem to problem – shortage of personal protective equipment, containment, threat of economic collapse, distance education, variety of treatments, vaccines – the provision of oxygen has never succeeded. at the top of the changing list of priorities.

“Oxygen was not the priority it should have been,” says Robert Matiru, program director of Unitaid, one of the global public health groups working to tackle oxygen shortages with the ‘WHO.

In many poor areas, shortages of basic inputs predate the pandemic. But it wasn’t until this year, with deadly oxygen shortages in northern Brazil, Mexico and other countries, that it became clear that the potential problem had turned into a serious emergency. WHO has created an emergency task force to deal with the oxygen shortage and has asked for money to address it.

Then the pandemic hit India, where it was previously relatively contained, and the problem of oxygen supply suddenly came to the center of global attention. In India, the official tally of new coronavirus cases has skyrocketed from around 11,000 daily infections in mid-February to a daily average of over 370,000 new cases in the past week, and experts say that the real number is much higher.

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

Almost half of this unmet demand is in India. And public health groups warn the disaster could reoccur in other countries.

How is oxygen produced and distributed?

In wealthier countries, hospitals often receive bulk shipments of tankers containing liquid oxygen – much denser than air – that health centers store in large containers. The hospital’s plumbing system extracts the gas, allows it to expand to its normal density, and distributes it to each bed.

It is by far the cheapest way to deliver oxygen to a patient, and companies that supply oxygen in bulk have sufficient production capacity to meet general medical demand. It is only in the last few weeks that some of these companies have started to increase their production of medical oxygen by diverting some of what they previously used to general industry, whose gas demands somewhat. little different.

The Indian government has ordered all oxygen producers in the country to devote themselves exclusively to the production of oxygen for medical use. But many hospitals around the world are not equipped to receive liquid oxygen because they do not have the hoses to distribute it to patients., as well as a distribution mechanism for remote sites.

Oxygen can also be found in a less dense gaseous form, in tubes that need to be recharged more frequently. This is often the more expensive option – it can cost 10 times more than wholesale liquid oxygen – but it is the only one available in many parts of the developing world.

In many countries where demand far exceeds supply, people are scrambling to buy or refill these tubes and thus care for their sick relatives.

Some hospitals have their own generators to extract oxygen from the air, a technology known as variable pressure absorption, or PSA, for its acronym in English. But the system is expensive, and the hospital that buys it must also install a plumbing system to deliver oxygen to the beds.

There are also small devices called oxygen concentrators, which can power a few patients. Although they can cost several hundred dollars – an obstacle for the poorest countries – the demand for such equipment has already completely exceeded the production capacity of manufacturers.

What does it take to resolve this crisis?

Money and time. Public health groups say hospitals should have PSA generators and accompanying hoses, which is prohibitive for poor countries, and only achievable with international financial assistance. The Indian government plans to install such equipment in hundreds of hospitals, but the process could take months.

Manufacturers of PSA oxygen generators and oxygen concentrators are increasing production around the world, but that too is taking time. Wholesale oxygen producers and governments are adjusting supply chains to get oxygen where it’s needed most. In India, the government uses trains and even military transport planes to provide oxygen to the sick.

With enough money, governments and international groups could enter into advance purchase agreements with wholesale suppliers.and set up emergency oxygen tanks in various parts of the world and use them when needed. In recent months, it has become clear how difficult it is to increase oxygen supply on the fly, in the midst of a crisis.

Matiru says the world should invest in prevention instead. “So if there is an increase in oxygen demand somewhere, we can cover it right away,” says Unitaid’s program director.

Translation of Jaime Arrambide

The New York Times

The New York Times