Why some Covid-hit countries are struggling for oxygen

As new waves of Covid sweep across the globe, severe oxygen shortages in many developing countries are costing countless lives.

Shortfalls of medical oxygen are being reported at hospitals across India, where relatives of Covid patients are making desperate appeals on social media for oxygen cylinders and other vital medical supplies.

Other countries that have faced similar crises during the pandemic include Brazil, the Democratic Republic of Congo, Peru, and Venezuela, says ABC News in Australia. The specific reasons for oxygen shortages in each country vary, but ultimately it comes down to the same core issues: cost, limited infrastructure and logistical difficulties.

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Why is oxygen important in the treatment of Covid-19?

Severe cases of Covid-19 can cause pneumonia and a lack of oxygen in the blood, called hypoxaemia. This is a major cause of death in patients who have the virus, explains Professor Trevor Duke, editor of the World Health Organization (WHO) guidelines, in an article on The Conversation.

While some antiviral drugs can be administered to fight off the infection, oxygen is needed to relieve hypoxaemia, giving time for the patient’s lungs to recover.

“For many people affected by Covid, oxygen is lifesaving,” says Duke.

What are some of the challenges in getting oxygen to patients?

In many countries, proper systems for supplying oxygen have been “neglected for decades”, writes Duke.

Some governments have simply failed to recognise oxygen’s vital role in saving the life of patients, while others “have been unprepared to invest in a properly functioning oxygen system”, he explains.

Proper oxygen systems involve a range of technical equipment, as well as vital infrastructure such as a power supply, trained health workers, technicians and maintenance staff. Countries without effective oxygen systems are usually under-resourced in other essential services needed to safely run a hospital too, like an adequate water supply and sanitation and infection controls, further hampering medical care.

“The neglect of oxygen systems has been partly market failure, partly lack of knowledge and anticipation, partly inertia,” says Duke.

What has happened in India?

Shortages in India are largely down to “logistical challenges and bureaucratic mismanagement, with supplies in some parts of the country not reaching areas that are more in need”, says the Financial Times (FT).

Unlike hospitals in developed countries that often produce their own oxygen, India relies on special oxygen tankers that travel long distances to replenish liquified oxygen tanks or cylinders.

India has found itself with a shortage of special cryogenic tankers needed to store liquified oxygen at low temperatures. These tankers, when filled, “have to be transported by road and not by air for safety reasons”, Al Jazeera reports.

The coronavirus pandemic has greatly increased the need for medical oxygen. “Normally, about 5% of hospital inpatients require oxygen support. The majority of hospitalised Covid-19 patients need oxygen, requiring hospitals to replenish far more frequently,” the FT adds.

Pre-pandemic, demand for medical oxygen was around 700 tonnes per day, says Inox Air Products, one of India’s biggest suppliers. “That rose to 2,800 during the first wave and has soared past 5,000 in recent days”, says the FT, as the pandemic reaches new heights in the country.

Could the shortages have been avoided?

Many experts, at least in the case of India, argue yes.

For one, India is a “significant” oxygen producer, reports the FT, “turning out roughly 7,000 metric tons a day”. But most of its oxygen plants are located in eastern industrial states, far from the biggest population centres like Delhi and Mumbai. Most oxygen is used for industry purposes, with only a small proportion for healthcare. More could have been diverted for hospital use, but “bottlenecks” in transport and storage have added to the problems, reports Al Jazeera.

The Indian government has also been accused of “wasting valuable time” in improving India’s oxygen infrastructure, after ministers mistakenly concluded that the worst of the pandemic was over, the FT reports.

Last year, the government announced plans to build more than 150 “pressure swing adsorption” generators at hospitals. “These are small production units that are relatively quick to install,” says the paper.

But just 33 have been completed, according to the health ministry last week. A total of 80 are due to be finished by the end of May, while there are plans to build a further 551 using money from a fund set up last year by the prime minister, Narendra Modi.