Tuesday, May 11, 2021

Oxygen shortages sting in poorest countries struggling with Covid

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Global demand for medical oxygen to treat patients with Covid-19 has risen sharply in recent months, quickly outstripping supplies and raising fears that thousands of patients in low- and middle-income countries are not receiving life-saving treatment.

Demand has increased by more than a fifth in the past three months, with many countries seeing larger increases. Manufacturers are diverting oxygen from industrial uses such as welding to healthcare, but funding and focus have been limited, and the capacity of hospitals and clinics is insufficient to cope with the surge in patient numbers. intensive care, according to companies and health experts.

“Supplies are very tight everywhere. In Africa, Europe and North America, needs have exploded with this second wave. The issue is not so much the availability of molecules as people, logistics [and] connect to hospital networks and facilities, ”said Jean-Marc de Royere, senior vice-president of Air Liquide in France, one of the world’s largest producers.

NGOs and medical staff are calling for more support and action on the issue from multilateral organizations, businesses and donors, urging them to step up production and distribution of oxygen alongside the deployment of vaccines and drugs.

“The international community and many governments have been appallingly slow to respond. Until Covid-19 vaccines are available, oxygen is the most important lifesaving weapon in the medical arsenal. We are heading towards a region-wide humanitarian crisis, ”said Kevin Watkins, head of the charity Save the Children UK.

Estimates of Monitoring of Covid-19 oxygen needs, compiled by a group of health charities, suggest that middle-income and low-income countries need more than 10.2 million cubic meters of oxygen per day – compared to 8.5 million cubic meters per day. day in November – with increasing demand in countries like Brazil, Nigeria and Peru.

One of the problems is that the global oxygen production market is complex and fragmented – shared between large manufacturers like Air Liquide and the British company Linde, and local hospital production – while data on medical capacity and utilization are limited.

Janet Diaz, Head of Clinical Care at the World Health Organization, said: “The challenges are very serious. Oxygen is a free molecule in the air, but to use it as medical oxygen you need technology. “

Many smaller and poorer countries are increasingly desperate. In Malawi, where two cabinet ministers and other senior officials have died of infections in recent weeks, the president has turned to local banks and online crowdfunding to purchase oxygen cylinders.

In Manaus, Brazil, doctors have resorted to manual ventilation due to cylinder shortages. Oxygen cylinders are brought to the remote town by the Air Force, while celebrities have paid for the shipments and Venezuela has also sent supplies.

Covid-19 patient undergoes physical therapy at his home, where he has set up his own emergency department with air tanks due to lack of oxygen in the public health system in Manaus, Brazil © Bruno Kelly / Reuters

Babajide Sanwo-Olu, governor of Lagos State, the center of the pandemic in Nigeria, said oxygen demand had quintupled in recent weeks at the main hospital treating Covid patients and would double again soon. “That in itself is a huge [burden],” he said.

Richer countries, including the United States and most of Europe, are scrambling to access scarce vaccine stocks to protect their populations, but these are unlikely to be available to any scale in low-income countries for many months.

A growing number of political leaders and doctors in Latin America and Africa are warning that they will not be able to provide enough oxygen to patients overwhelming hospitals, without whom life-saving treatments such as the cheap steroid dexamethasone cannot. will have little effect.

Line graph showing new cases of Covid-19 and daily oxygen requirements in millions of cubic meters for 2020

“Vaccines alone won’t do that. We could do a better job of saving lives by providing more of what we can currently offer. In many places the constraint is oxygen, ”said Peter Sands, head of the Global Fund to Fight AIDS, Tuberculosis and Malaria, the multilateral agency.

Leith Greenslade, coordinator of the Coalition Every breath counts, who calls for better oxygen delivery, said the World Bank and donor response had been fragmented and inadequate. “The amount of oxygen needed by Covid-19 patients is so great that larger emergency solutions are now needed.”

The World Bank has so far disbursed only half of a $ 6 billion coronavirus grant and a low-interest pandemic response loan program implemented in the last year. He says few countries have officially requested oxygen support and he’s stepping up work to coordinate increased funding.

Lack of coordination compounds the problem, with individual health systems purchasing their own supplies and suppliers worrying about non-payment from overburdened authorities. “The market is disorganized,” said Zachary Katz, vice president of Chai, a health charity.

The supply of oxygen is complicated by the difficulties of transportation, production, safety oversight and regular maintenance of equipment. Even before the pandemic, supplies were limited in much of the developing world.

Muhammad Pate, Global Director of Health, Nutrition and Population at the World Bank, said: “Countries with weakest health systems are hit hardest by this crisis.”

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