Oxygen shortages threaten ‘total collapse’ of dozens of health systems | Global development

Dozens of countries are facing severe oxygen shortages due to the surge in Covid-19 cases, threatening “total collapse” of health systems.

the Bureau of Investigative Journalism analyzed data provided by the Every Breath Counts Coalition, the NGO Path and the Clinton Health Access Initiative (CHAI) to find the countries most at risk of oxygen deficiency. He also studied data on global immunization rates.

Nineteen countries around the world – including India, Argentina, Iran, Nepal, Philippines, Malaysia, Pakistan, Costa Rica, Ecuador and South Africa – are considered as most at risk after seeing huge increases in demand since March – by at least 20%. – by having vaccinated less than 20% of their populations.

A man watches over his wife, suspected of having Covid-19, in a hospital in Argentina
A man watches for his wife, suspected of having Covid-19, at a hospital in Lomas de Zamora, Argentina. Photography: Natacha Pisarenko / AP

There are fears that other Asian countries like Laos are at risk, and African countries like Nigeria, Ethiopia, Malawi and Zimbabwe, which have less mature oxygen delivery systems, which means that a small increase in requirements could create big problems.

Many of these countries faced oxygen shortages before the pandemic, said Leith Greenslade, coordinator of the Every Breath Counts Coalition. The additional need pushes health systems to the brink of collapse.

“The situation last year, and again in January this year in Brazil and Peru, should have been the wake-up call,” she said. “But the world has not woken up. We should have known that India would arrive after seeing what happened in Latin America. And now looking at Asia, we have to know that this will happen in some of the big cities in Africa. “

Robert Matiru, who chairs the Covid-19 Emergency Oxygen Task Force, told the office: “We could see the total collapse of health systems, especially in countries with very fragile systems.”

Hospitals in India have reported severe oxygen shortages as the country battles its second wave. As of mid-May, India needed an additional 15.5 million cubic meters of oxygen per day just for Covid-19 patients, more than 14 times what it needed in March, according to the office analysis.

Oxygen provided by an NGO in Amritsar, India
Oxygen supplied by an NGO in Amritsar, India. Photograph: Narinder Nanu / AFP / Getty

In response, India has banned all exports of liquid and bottled oxygen.

But experts are worried about India’s neighbors – Pakistan, Nepal, Bangladesh, Sri Lanka and Myanmar – some of which depend on oxygen and equipment made in India.

“You imagine if they start to see peaks of the same degree, then it could be even worse, because India needs all the supplies,” said Zachary Katz, vice president of essential medicines at CHAI.

Office data shows Nepal now needs more than 100 times more oxygen than in March.

The demand for oxygen in Sri Lanka has increased sevenfold since mid-March. In Pakistan, which is suffering its third wave of cases, nearly 60% more patients are on oxygen in hospital than during the country’s previous peak last summer, according to a government minister, who warned in late April that the pressure on the oxygen supply was reaching dangerous levels.

“The atmosphere is extremely dark,” says Dr Fyezah Jehan, a doctor in Karachi. “I think we are very afraid of a situation similar to India. We hope a little magic happens, and this [current] lockdown can prevent further attack of cases. “

Truck loads oxygen cylinders to supply private hospitals in Karachi
A truck is loaded with oxygen cylinders to supply private hospitals in Karachi, Pakistan. Photograph: Fareed Khan / AP

“The increasing oxygen needs are putting pressure on the healthcare system that it cannot meet, and we are seeing patients dying,” said Greenslade. “And that will continue to happen week after week, month after month, if the vaccine rollout is slow, because at this point in many of these countries, it is only increases in immunization coverage that will tip the curve of the vaccine. transmission.”

The health systems of many poorer countries “could not be more ill-prepared,” said Greenslade. “From the Head of State, the Minister of Health, the Minister of Finance… these countries have not given priority to oxygen as an essential medicine. As we see in India, scores of people have died and continue to die every day from lack of oxygen. “

Several countries have required companies that produce liquid oxygen to divert products from their industrial customers to hospitals. Medical oxygen represents only 1% of the global production of liquid oxygen.

Newly installed oxygen tanks are filled at Ramlila Ground in New Delhi, India
Newly installed oxygen tanks are filled at Ramlila Ground in New Delhi, India. Photograph: Arun Sankar / AFP / Getty

However, data from Gasworld Business Intelligence, which analyzes the global industrial gas market, shows that many countries that need it most will still experience shortages, although all local oxygen production has been diverted to hospitals.

In Iraq, gas companies can produce around 64,000 cubic meters of liquid oxygen per day, a third of what the country’s Covid-19 patients need. In Colombia, the industry can only supply 450,000 cubic meters per day, less than two-thirds of what is needed.

In Peru, gas companies can only get 80% of the oxygen they need if all the oxygen is diverted to healthcare. “Currently, Peru is experiencing a decline [Covid] case, ”said Dr Jesús Valverde Huamán, who works in an intensive care unit in Lima. “However, we still need medical oxygen, especially for hospitals.” There has been a constant struggle to find enough oxygen for patients, he said, except for a short time in November and December of last year when cases declined.

In Peru, hundreds of people wait to fill their oxygen tanks
Hundreds of people in Peru wait to fill oxygen tanks outside a gas plant in San Juan de Lurigancho, Lima. Photograph: Gian Mazco / AFP / Getty Images

Greenslade said: “We have to ask a very critical question: why is such an essential resource as oxygen locked up in mining, steel, oil and gas when the poor public hospital system cannot provide enough? to keep babies, adults and the elderly? living.

“These countries need to carefully consider how they invest in medical oxygen in the healthcare system. If the oxygen capacity is there for mining companies to extract, the capacity has to be there for the health care system to save lives. “

Although liquid oxygen is a major source for physicians in many countries, it does not represent the entire supply. Hospitals can also obtain oxygen from on-site factories that convert ambient air into oxygen and in portable concentrators.

The World Health Organization, Unicef, the World Bank, and other donors and NGOs have shipped hundreds of thousands of concentrators to countries to help them cope with increasing oxygen requirements, but manufacturers run out of parts.

The World Bank has warned that many countries have not requested emergency loans available to help them upgrade oxygen systems. Last year, the World Bank made $ 160 billion (£ 113 billion) available to countries to prepare for Covid-19 and added an additional $ 12 billion this month. The money can be used to import oxygen or boost production.

Unitaid and Wellcome donated $ 20 million in emergency funding for oxygen in low-income countries. The Global Fund has also made $ 13.7 billion in grants available to countries for use in Covid-19 response programs, including purchasing oxygen concentrators and building public oxygen plants.

Campaigners want emergency and fast-track funding for oxygen supplies around the world.

Paramedics assess a Covid-19 patient in Lenasia, Johannesburg.
Paramedics from a community-run ambulance service assess a Covid-19 patient in Lenasia, Johannesburg. Photograph: Michele Spatari / AFP / Getty

But Mickey Chopra, a senior World Bank official, said countries have requested loans for ventilators and PPE but not for oxygen supplies. “The variations and sudden spikes that we’ve seen now took people by surprise, to a large extent, and the weakest point in the system turned out to be the oxygen supply system.

Going forward, Greenslade would like to see governments create comprehensive national medical oxygen strategies, with workers trained to deliver oxygen to patients safely and to maintain and repair equipment.

Countries must have plans in place to deal with unexpected increases in demand, she said. “What they’re doing right now is when a crisis hits, [governments] scrambling to get a group together to find a way to manage it. But they need to get ahead of the game. “

Additional reporting by Oksana Grytsenko, Anmol Irfan, Ivan Ruiz, Rizwan Shehzad, Natalie Vikhrov, Claudia Chavez and Ralph Zapata

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