I’ve seen countless severe Covid-19 patients struggling to breathe. When they come into the emergency room, we immediately put an oxygen face mask on them and hook it to the wall. A quick turn of a bedside valve and oxygen rushes forward, quickly filling the patient’s lungs. In many cases, the improvement in the patient’s condition is immediate and dramatic.
In turning that valve, I never worry about the supply of oxygen running out. But my healthcare colleagues around the world aren’t so lucky. Despite oxygen being one of the most abundant substances on Earth, people around the world are dying due to a lack of it. The Covid-19 pandemic has made it markedly worse.
Why Medical Oxygen is Important
There are many illnesses that can cause the oxygen level in the blood to dip, a condition known as hypoxemia. Oxygen itself is often the only effective treatment.
Many of the most common causes of death in the world — including premature birth, sepsis, and malaria — could be avoided with oxygen treatment. For example, even though pneumonia is treatable with simple interventions like antibiotics and oxygen, it’s still the leading cause of death in children under five, killing more than 800,000 a year.
Recognizing oxygen’s critical role in the treatment of so many illnesses, the World Health Organization (WHO) recently added oxygen to its List of Essential Medicines. This list outlines the “minimum medicine needs for a basic health-care system” to which people should have reliable and sufficient access. But inclusion in a list doesn’t itself guarantee widespread availability.
Nearly half of hospitals in low- and middle-income countries have inconsistent or no oxygen supply. Despite oxygen’s critical role in treating patients and averting death, many people around the world don’t have reliable access to it.
Why There’s Such a Shortage
Infrastructure and cost constraints mostly explain the inequity in oxygen availability around the world. Producing and delivering oxygen is a surprisingly complex process. In the United States, oxygen is commonly produced at a large industrial plant. It is then transported as a liquid, which is cheaper to transport by volume than gas, to healthcare facilities, where it’s stored, converted into a gas, and transported through pipes to convenient bedside spouts.
Oxygen production facilities are much less common in low- and middle-income countries; when they do exist, they are usually located in urban centers. Oxygen is typically delivered to hospitals in heavy metal cylinders, and these cylinders incur significant transport costs, which are ultimately passed along to the patient. A report by the Bureau of Investigative Journalism found oxygen in sub-Saharan Africa “to be at least five times more expensive by volume than in Europe and North America.”
The cylinders also hold a limited amount of oxygen, which can be quickly extinguished by a single patient. And they require regular maintenance, which isn’t always available in rural clinics or places less experienced with their use.
There is an alternative to oxygen cylinders: oxygen concentrators. These suitcase-sized machines pull oxygen from the air and compress and purify it. The oxygen-rich air is then delivered to a patient in need. However, like cylinders, oxygen concentrators have significant limitations: There are large up-front costs for these machines, and they require access to regular electricity and ongoing maintenance.
The Impact of Covid-19
Around one in five patients with Covid-19 require hospitalization and treatment with supplemental oxygen. For many, it’s the only treatment they’ll need, and usually only for a short duration.
But the magnitude of the pandemic has made the demand for oxygen skyrocket. The WHO estimates that more than half a million Covid-19 patients in low- and middle-income countries need oxygen treatment every day. According to the Covid-19 Oxygen Needs Tracker, that amounts to 1.2 million oxygen cylinders per day. This estimate is just to treat Covid-19 — it doesn’t reflect the oxygen demand for non-Covid patients, for whom less than half the need was being met even before the pandemic.
The shortage has left many people around the world scrambling to find oxygen for their loved ones, many of whom are being treated at home as hospitals are stretched to capacity and unable to admit more patients.
This has led to price gouging and black markets, making oxygen even harder to access. In Mexico, the surge in demand and limited supply resulted in the price of an oxygen tank skyrocketing “more than $800, up to 10 times as much as in countries like the United States,” according to a recent New York Times story.
This struggle isn’t limited to patients treated at home. In Egypt, a viral video showed families panicking and health care providers sobbing as the hospital’s oxygen supply failed, leaving patients suffocating and at least three people dead.
Similar stories from South America, sub-Saharan Africa, and Southeast Asia all highlight the global nature of the problem. Covid-19 has placed an increased burden on health care facilities where oxygen supply was tenuous at best — and nonexistent at worst — even before the pandemic.
What’s Happening to Address the Problem
Prior to the pandemic, efforts were underway to deal with the global oxygen shortage. In 2017, the WHO, UNICEF, and the Bill and Melinda Gates Foundation launched the Oxygen Therapy Project with the goal of increasing oxygen delivery to low- and middle-income countries.
But the pandemic provided more urgency. As of February 2021, the WHO and its partners had distributed more than 30,000 oxygen concentrators and 40,000 pulse oximeters to 121 countries. And recently, the WHO, along with other global health agencies, including the Wellcome Trust, Unitaid, and many more, announced a Covid-19 Oxygen Emergency Taskforce to secure funding, identify oxygen needs, and provide oxygen supplies and technical support in the hardest-hit countries.
But even if the task force raises the $90 million it needs to fund an “immediate emergency response,” it warns that $1.6 billion will be needed over the coming year to expand the global availability of medical oxygen. Without that funding, many patients won’t have access to oxygen when they need it most.
Unlike many wealthy countries where rapid vaccine rollouts have put the end of the pandemic in sight, many low- and middle-income countries won’t achieve widespread vaccination until 2023. In those countries, Covid-19 will continue to spread. This will put more pressure on the existing oxygen supply and further limit the amount of oxygen available to non-Covid patients as well.
Urgent action is needed. Medical oxygen cannot remain a luxury available only to those in urban areas or wealthier countries. Until the global inequity in access to oxygen is addressed, many patients won’t receive the treatment they need. Their lives depend on it.
In the United States, the availability of oxygen is something we take for granted. I wish healthcare providers and patients around the world could say the same.
This piece was first published on Medium.