An employee filling oxygen tanks as a free service provided by the government in Iztapalapa, Mexico. Over the past two months, global unmet needs in medical oxygen have more than tripled. Credit ... Luis Antonio Rojas for Hfrance.fr
How did it becomeso bad, so fast?
Considering the enormous and obvious need for oxygen during a pandemic affecting the respiratory system, the crisis should not have come as a surprise. But in a year where the decision maker moves from one pandemic challenge to another - P.P.E. shortages, lockdowns, threat of economic collapse, distance schooling, therapeutics, vaccines - the oxygen supply has never reached the top of the list.
given enough priority, "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 that deadly oxygen shortages hit northern Brazil , Mexico and elsewhere, that it became clear that what had been considered a potential problem became an emergency. The World Health Organization has created an emergency oxygen shortage task force 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 novel coronavirus infections is notFrom 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 number is much higher.
Over the past two months, the global unmet need for medical oxygen has more than tripled from less than 9 million cubic meters per day to over 28 million, according to a coalition of aid groups that are crisis monitoring .
About half of this unmet need is in India. And health advocates warn the calamity could recur in other countries. Image Liquid oxygen tanks in an El Paso hospital. Credit ... Joel Angel Juarez for Hfrance.fr
How is oxygen made and supplied?
In wealthy countries, hospitals usually rely on tankers to perform bulk deliveries of liquid oxygen, much denser than ordinary air, which is stored in large containers. A system of pipes sucks the gas, allows it to expand to ordinary density and distributes it to each bedside.
This 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.first weeks, some of them started accelerate their production of medical equipment by diverting part of the industry , whose gas has somewhat different requirements.
The Indian government has ordered producers to temporarily direct all their oxygen production medical needs.
But many hospitals around the world are not equipped to use liquid oxygen, lack hoses to distribute it to patients, and there is no delivery system in place for many remote locations.
Oxygen can also be obtained in gaseous form less dense, in bottles that need to be refilled more often.It is often the more expensive option - it can cost 10 times more than bulk liquid oxygen - but it is the only one available to humans in parts of the developing world. Understanding the Covid crisis in India
In many countries people rushed to buy or refill such bottles for their family members, but the demand far exceeded the supply.
Some hospitals have their own factories to extract oxygen from the air, a technology known as pressure swing absorption or PSA But the systems are expensive, and a hospital that purchases one would also have to install a tubing system to deliver oxygen to the bedside.
There are also small devices called oxygen concentrators that can serve a single patient orsome. Although they can cost several hundred dollars, a major obstacle in poorer countries, the demand for them has soared faster than manufacturers can produce them. Image A pharmacy in the Tuscan village of Castellina in Chianti, Italy, lines up empty oxygen cans at the back of the pharmacy. Supplying oxygen in cans is 10 times more expensive than delivering it in bulk. Credit ... Nadia Shira Cohen for Hfrance.fr
What does it take to resolve this crisis?
Money and time.
Public health advocates sayhospitals should have PSA facilities and accompanying piping, 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 manufacture PSA factories and oxygen concentrators are ramping up production all over 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 is needed most. In India, the government uses trains and even military transport planes to bring oxygene to the sick.
If enough money was available, governments and international groups could have advance purchase agreements with bulk suppliers, and stockpiles of Emergency oxygen could be installed in various parts of the world and deployed as needed.
If nothing else, the past few months have clearly shown the difficulty of trying to increase oxygen supplies on short notice, in the midst of 'a crisis.
Instead, Mr. Matiru said: the world should invest in preparedness, "so that in the event of a power surge, we can support on "Go ".