DAKAR, Senegal (AP) – A crisis over the supply of medical oxygen for coronavirus patients has hit countries in Africa and Latin America, which were ignored at the start of the pandemic and doctors say the shortage has led to unnecessary deaths.
It takes about 12 weeks to install an oxygen plant in a hospital and even less time to convert industrial oxygen production systems into a medical-grade network. But in Brazil and Nigeria, as well as in less populated countries, decisions were made to fully address inadequate supplies only last month, after hospitals were overwhelmed and patients began to die.
The medical oxygen availability gap “is one of the defining health issues of our age, I think,” said Peter Piot, director of the London School of Hygiene & Tropical Medicine, who said he survived a serious coronavirus infection thanks to the oxygen provided. he received.
Doctors in Nigeria keep a close eye on traffic as oxygen flows through the streets of Lagos at the touch of a button. There and in other countries, desperate families of patients sometimes turn to the black market. Governments are only taking action after hospitals have been overwhelmed and those infected have died with dozens dead.
In the Brazilian state of Amazonas, scammers were caught reselling fire extinguishers that were painted to look like medical oxygen tanks. In Peru people camped in rows to get cylinders for sick relatives.
Only after the lack of oxygen was blamed for the deaths of four people in an Egyptian hospital in January and six people in a hospital in Pakistan in December, the governments addressed the problems.
John Nkengasong, director of the Africa Centers for Disease Control and Prevention, said medical oxygen is a “huge critical need” on the continent of 1.3 billion people and this is one of the main reasons why COVID-19 patients are more likely to die there in a wave of cases.
Even before the pandemic, the 2,600 oxygen concentrators and 69 functioning oxygen plants in sub-Saharan Africa met less than half the need, leading to avoidable deaths, especially from pneumonia, said Dr. John Adabie Appiah of the World Health Organization.
The number of concentrators has grown to about 6,000, mainly through international donations, but the oxygen produced is not pure enough for the critically ill. The number of plants that can generate higher concentrations is now at 119.
Nigeria “struggled to find oxygen to treat cases” in January, said Chikwe Ihekweazu, head of the Center for Disease Control.
A main hospital in Lagos, a city of 14.3 million inhabitants, saw the number of virus cases increase fivefold in January, with 75 medical workers infected in the first six weeks of 2021. Only then did President Muhammadu Buhari release $ 17 million to raise an additional 38 set up oxygen factories and an additional $ 670,000 to repair factories in five hospitals.
Some oxygen suppliers have drastically increased prices, according to a doctor at Lagos University Teaching Hospital who spoke on the condition of anonymity because he was not allowed to speak to reporters. That has pushed the cost of a cylinder 10-fold, to $ 260 – more than the average monthly wage – and a critically ill patient may need as much as four cylinders a day.
Money and influence don’t always help.
Femi Odekunle, a Nigerian academic and close ally of the president, was without adequate oxygen at Abuja University Teaching Hospital for nearly 12 days until two state governors and officials from the Ministry of Health intervened. He died anyway, and relatives and friends blame the oxygen deficiency, the online Premium Times newspaper reported. The hospital attributed his death to his severe infection.
In Malawi, the president pledged funding for protective equipment for medical personnel and the immediate purchase of 1,000 oxygen bottles, adding that he would fly them in if necessary.
Corruption has been blamed for malfunctions at a new oxygen plant in a hospital in the Ugandan capital Kampala, the Daily Monitor newspaper reported in November. Workers had to rely on rusty oxygen bottles blamed for the deaths of at least two patients.
“While top health officials basked in the oxygen of good publicity, patients were literally suffocating,” the paper said. “It seems that behind the delays and the funding gaps, there have been cuts.”
Leith Greenslade, coordinator of the Every Breath Counts Coalition, which advocates wider access to medical oxygen, said the impending shortages were clear last spring.
“Very little has been done. Now you have a second wave, not only in Africa but also in Latin America and Asia, and the oxygen deficit is increasing at a crisis level, ”she said.
The World Bank alone has set aside $ 50 billion for the world’s poorest countries, but only $ 30.8 billion has been committed, including $ 80 million for oxygen-related upgrades at the request of Afghanistan, Bangladesh, Benin, Central African Republic, Chad, Congo, Gambia, Ghana, Grenada, Kenya, Mali, Rwanda, Sierra Leone and Tajikistan. That leaves nearly $ 20 billion between now and June 2021 to be spent, the World Bank said.
“We make money available to countries, but it is countries and governments that have to make a decision about how much to spend and what to spend it on,” said Dr. Mickey Chopra, who helps with the World Bank’s global medical logistics response.
Many countries see oxygen supply primarily as an industrial product for more lucrative sectors such as mining, not healthcare, and it has not been the focus of many international donors. Oxygen factories need technicians, good infrastructure and electricity – all of which are scarce in developing countries.
The main supplier of medical oxygen to the Brazilian state of Amazonas, White Martins, was operating at half its capacity before the pandemic. The first infections hit the isolated city in March and caused so many deaths that a burial ground was carved out of the jungle.
Doctors in the capital, Manaus, were forced to choose which patients to treat last month because the oxygen supply decreased.
Brazil’s Supreme Court began an investigation into the management of the crisis after White Martins said an “unexpected surge in demand” led to shortages.
“There was a lack of planning on behalf of the government,” said Newton de Oliveira, president of Indústria Brasileira de Gases, a major oxygen supplier.
Only after an average of 50 deaths per day did the government say it would build 73 oxygen factories in the state. Within a month, 26 were in use.
The shortages remain critical in Peru, where Dani Luz Llamocca waited five days outside a distribution center in Lima and said her virus-stricken father had less than half a tank of oxygen. She was willing to wait as long as it took. “If not, my father will die,” said Llamocca.
WHO’s Appiah said mining countries could, with little change, convert their systems to produce medical-grade oxygen.
India’s national trade association for gas producers suggested exactly that in April 2020, when the virus load was relatively low. Industrial storage tanks were being reused in hospitals, said Surendra Singh, a manager of the Indian division of the multinational Linde.
“It’s not rocket science,” said Saket Tiku, president of the All India Industrial Gases Manufacturers Association. “The decision has saved thousands of lives.”
Hinnant reported from Paris. Aniruddha Ghosal in New Delhi, Franklin Briceño in Lima, Peru; Sam Magdy in Cairo, Diane Jeantet in Rio de Janeiro, Sam Olukoya and Lekan Oyekanmi in Lagos, Nigeria, Cara Anna in Nairobi, Kenya, Riaz Khan in Peshawar, Pakistan, and Rodney Muhumuza in Kampala, Uganda contributed.
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