According to the World Health Organization, more than half a million Covid-19 patients in low- and middle-income countries (LMICs) require oxygen every day. Recent calculations show that approximately 20 countries need an immediate cash infusion of $90 million to ensure an adequate level of medical care. 20 million will be provided by Unitaid and Wellcome, two international agencies dealing with health issues, scientific development and research.
Since the beginning of the pandemic, ventilators, tests and personal protective equipment have all been in acute shortage since the start of the coronavirus pandemic. To address this issue, the COVID-19 Oxygen Emergency Taskforce was established under the auspices of the WHO to deal exclusively with oxygen-related issues – its shortage, supply, distribution and technical support to the most vulnerable countries. Ultimately, according to the group’s experts, its main mission is to prevent unnecessary deaths.
The problem is particularly acute in Latin America, but experts say oxygen deprivation is also threatening Eastern European countries. According to the international charity PATH, the demand for oxygen increased five to seven times in several countries during the pandemic. These are low-income countries, as defined by the World Bank, or countries with below-average income levels. “The problem of adequate access to oxygen exists in many countries,” explains Lisa Smith, senior expert in market dynamics at PATH. “We have never seen a respiratory disease epidemic of this magnitude.” “But in countries where access to medical oxygen has always been a problem, the impact is greater. We see that the shortage of oxygen is much greater in low- and middle-income countries,” she adds.
Since mid-January, almost every country in Latin America, Africa and Israel has been facing a shortage of medical oxygen. In recent months, local authorities from Lagos in Nigeria to Laghman Province in Afghanistan have announced plans to increase their medical oxygen production capacity. Ukraine is also at risk. According to Ekaterina Gamazina, head of the PATH office in Ukraine, if the infection rate in the country reaches the level of October-November last year, there will not be enough oxygen. According to PATH, Brazil is currently experiencing the most severe shortage of medical oxygen. The shortage there is more than two million cubic meters a day. This means that 334,000 seven-liter canisters are missing from patients in the country every day.
In January, the city of Manaus, the capital of the Brazilian state of Amazonas, became a terrible example of what can happen when medical oxygen is in short supply. The second wave of the virus caught the city off guard. Since mid-December, the city’s excess mortality and infection rates have been rising. Hospitals are overcrowded.
In Manaus, the surge in infection rates has caused an acute shortage of oxygen. In January, three thousand people were buried in the city. The photo shows work to expand the city cemetery. We explain quickly, simply, and clearly what happened, why it matters, and what happens next. The number of offers should remain: episodes. The end of the story: Promotional Podcasts Manaus, like many other cities in Latin America, had already experienced the first wave of the pandemic. According to a recent study published in The Lancet, antibodies were present in at least 52% of the population when the new wave of the epidemic began. In theory, this would have slowed the spread of the virus, but infectivity and excess mortality increased severalfold in January compared to December. The likely reason is the more virulent “Brazilian” strain of the coronavirus. Against this backdrop, the isolated city’s oxygen supply problems have become a disaster. On January 21, Médecins Sans Frontières declared that “the health system in Manaus has collapsed for the second time in a row. “The amount of oxygen produced by the city’s hospitals meets only one-third of patients’ needs. This means that hospitals are unable to ventilate patients and there are reports of people dying of asphyxiation,” the organization wrote.
The Battle for Oxygen in the Amazon. The second wave of coronavirus in Brazil. One of the dead was the 60-year-old mother-in-law of Manaus resident Talita Rocha. On January 14, at the height of the city’s infection wave, Rocha was in the intensive care unit of one of the city’s hospitals. Roja says she witnessed people dying from lack of oxygen. “It was a disaster. Many elderly patients started to deteriorate before our eyes – they turned blue,” she said emotionally in a video on social media. Speaking to the BBC, Roja said her mother-in-law ran out of an oxygen tank after the level of oxygen in her blood suddenly dropped. In Latin America, it has become standard practice to treat coronavirus patients at home. These patients require oxygen. For Mexicans, long lines of people with oxygen tanks have become commonplace in recent months. Today, a small oxygen tank can cost up to $800 in Mexico, and filling one with gas costs $10, according to the New York Times.
Typical situation in Mexico: The country’s hospitals are so overcrowded that, like in Brazil, oxygen tanks are used at home. This is happening against a backdrop of equipment shortages in hospitals and declining confidence in the healthcare system as a whole. In addition, the black market is flourishing – online and offline fraudsters are raising the price of oxygen cylinders and selling industrial gas as medical gas. In January, several hospitals were robbed and at least one truck carrying cylinders was stolen.
Even before the pandemic, the lack of oxygen in hospitals in developing countries was a problem that WHO, UNICEF and charities were trying to solve. Last June, the WHO announced the procurement of 14,000 oxygen concentrators for 120 developing countries. But even then, it was not enough, and now, with the pandemic, it is even less.
Oxygen is cheaper in developed countries. Long-term contracts are signed with suppliers for large volumes of production and transportation, including covering the additional costs of serving remote and hard-to-reach hospitals. “Liquid gas can be produced in one place and transported to another. This is what happens in Senegal, for example, where Air Liquide imports large quantities of oxygen from its plant in Antwerp. The question always lies elsewhere – whether the country is ready to use liquid oxygen effectively, whether it has the necessary infrastructure and specialists,” says Lisa Smith of PATH.
While in developed countries oxygen is purchased and stored in liquid form, converted to gas in the hospital and delivered to beds through special tubes, in developing countries the infrastructure is different. In a rural hospital in Africa, a liter of oxygen can cost 5-10 times more than in a hospital in London because it is purchased in smaller quantities and is more expensive to transport. At the same time, the infrastructure problem has different characteristics in different countries.
In December-January, African countries faced a second wave of the coronavirus, which was much more devastating than the first. “We were facing a national shortage of oxygen,” recalls Akin Abayomi, Nigeria’s Minister of Health, in an interview with Reuters. In Lagos, the demand for oxygen increased from 70 to 500 cylinders per day from November last year. Prices skyrocketed and shortages began. In addition, logistics became such a serious problem that the authorities had to call in the military to help deliver the cylinders to the regions.
Logistics are also a problem for Ukrainian hospitals. As the Ukrainian service of the BBC discovered in December last year, hospitals often lack oxygen stations. It takes at least 30 days to get a project for an oxygen station approved. And then it takes at least the same amount of time to install it. As a result, volunteers are helping to find oxygen. “In Ukraine, patients’ access to oxygen was limited at the beginning of the epidemic,” says Ekaterina Gamazina, PATH’s country director. “The government made this a priority, and thanks to their joint efforts with international partners (WHO and UNICEF) and private oxygen producers, all patients in hospitals now have access to gas.” “Today this is enough, but if there is an increase in infection in the country, say to the level of October-November, then oxygen will not be available for everyone,” she warns. “Many pieces of the puzzle need to come together to achieve an adequate oxygen supply for the country – not only infrastructure and keeping the plants running, but also prices, personnel and government policies. There is no one-size-fits-all approach that will work in every country in the world. Approaches need to be tailored to specific countries,” says Lisa Smith of PATH.
Can a lack of oxygen in developing countries affect the global market and affect developed countries? “Under normal circumstances, access to oxygen is not a problem in most developed countries,” says Smith. “In a situation where all countries are facing a sharp increase in demand at the same time, there may be problems with underproduction, but even if that happens, there are alternative sources, such as concentrators,” she adds.
There are several ways to produce medical oxygen. For example, it can be produced directly in the hospital using concentrators. However, this is an expensive method. According to PATH, only 5-10 percent of the oxygen produced worldwide today is used for medical purposes. The rest is used in the industrial sectors of mining, chemical and pharmaceutical industries. The problem of oxygen shortages can be solved by reprofiling industrial capacity, but for developing countries, logistics and delivery systems are more important. “We need to think about oxygen the same way we think about electricity, water, and other things we need,” says PATH’s Lisa Smith. “We cannot think about it only when it starts to run out. Because when it starts to run out – people die”.
A second wave of coronavirus has hit Manaus, the largest city on the Amazon River in Brazil. Hospitals are overwhelmed, and many people are leaving their loved ones at home to get sick.