Why Some Hospitals Lack the 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, particularly in India. Tens of thousands of people with Covid-19 are admitted to hospitals every day, driving the demand for oxygen far beyond supply.

Oxygen makes up 21 percent of the atmosphere. A handful of companies collect and clean it in bulk, but mostly sell it to industry. Many poorer parts of the world lack the infrastructure to deliver or use the medical supplies sold by the companies to be piped into hospital rooms.

Some hospitals and clinics have machines that produce purified oxygen on a much smaller scale, but they are in short supply. So many hospitals and patients in poor countries and remote areas are relying on the most expensive option: oxygen tanks, which have become scarce in the countries hardest hit by the virus.

The shortage affects patients with any type of respiratory disease that requires oxygen, not just patients with Covid.

The World Health Organization said in February that it would take $ 1.6 billion to correct the lack of oxygen for a year. Now that estimate is up to $ 6.5 billion. Efforts to raise this money have stalled, despite the fact that it is only a small part of spending on vaccines and financial aid to businesses and workers.

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

Given the enormous and obvious oxygen demand during a respiratory pandemic, the crisis should come as no surprise. But in a year where policymakers wavered from one pandemic challenge to the next – PPE shortages, lockdowns, threats of economic collapse, distance learning, therapeutics, vaccines – oxygen supplies never rose to the top of the list.

“Oxygen was not given adequate priority,” said Robert Matiru, program director at Unitaid, one of the global health groups working to address the shortage with the World Health Organization.

Some poorer regions were unable to ensure adequate supplies even before the pandemic. But it wasn’t until earlier this year, when deadly oxygen shortages occurred in northern Brazil, Mexico, and elsewhere, that it became clear that what had been viewed as a potential problem was becoming a dire emergency. The World Health Organization set up an emergency task force on oxygen starvation and asked for money to fix it.

Then the pandemic soared in India, where it was relatively limited, and put oxygenation at the center of world’s attention. India’s official number of new coronavirus infections rose from an average of 11,000 a day in mid-February to a daily average of more than 370,000 last week – and experts say the real number is far higher.

In the past two months, unmet global medical oxygen needs have more than tripled, from less than 9 million cubic meters per day to more than 28 million, according to a coalition of aid groups tracking the crisis.

India accounts for around half of this unmet need. And health lawyers warn that the disaster could repeat itself in other countries.

In affluent countries, hospitals generally rely on tank trucks to make bulk deliveries of liquid oxygen, which is far denser than normal air and stored in large containers. A system of pipes sucks the gas out, allows it to expand to normal density, and delivers it to each bed.

This is by far the most cost-effective form of oxygen delivery, and companies that supply oxygen in large quantities have enough manufacturing capacity to meet global medical needs. In the past few weeks, some of them have started to ramp up their medical gas production by diverting some from the industry whose gas has slightly different requirements.

The Indian government has ordered producers there to temporarily adjust all of their oxygen emissions to medical needs.

However, many hospitals around the world are not equipped to use liquid oxygen because of the lack of lines to distribute it to patients and there is no delivery system for many remote locations.

Oxygen can also be obtained in less dense gaseous form in bottles that need to be topped up more frequently. This is often the most expensive option – it can cost ten times as much as bulk liquid oxygen – but it is the only one available to many parts of the developing world.

Understand India’s Covid Crisis

In many countries, people have made an effort to buy or refill such cylinders for their family members, but the demand has far exceeded supply.

Some hospitals have their own equipment to remove oxygen from the air, a technology known as pressure swing absorption, or PSA. The systems are expensive, however, and a hospital that bought them would also have to install a system of pipes to deliver the oxygen to the beds.

There are also small devices called oxygen concentrators that can serve one or more patients. Although they can cost hundreds of dollars, a high hurdle in poorer countries, the demand for them has grown faster than manufacturers can produce them.

Money and time.

Public health advocates say hospitals should have PPE systems and associated piping, but in poor countries this solution can be prohibitive and only achievable with international help. The Indian government plans to install the equipment in hundreds of hospitals, but that could take months.

Companies that manufacture PSA systems and oxygen concentrators are increasing production worldwide, but that also takes time.

Mass oxygen producers and governments are still trying to adjust supply chains to get the life-saving gas where it is needed most. In India, the government uses trains and even military transport planes to provide oxygen to the sick.

If enough money was available, governments and international groups could pre-purchase contracts with bulk suppliers, and emergency oxygen stores could be stationed in different parts of the world and deployed when needed.

Last but not least, the last few months have made it clear how difficult it is to try to increase the oxygen supply at short notice in a crisis.

Instead, said Mr Matiru, the world should invest in preparation “so that if there is an increase, we can hit ‘go'”.