DAKAR, Senegal (AP) – A crisis in the supply of medicinal oxygen to patients with coronavirus has hit nations in Africa and Latin America, where warnings 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 a hospital oxygen plant and even less time to convert industrial oxygen manufacturing systems to a medical grade network. But in Brazil and Nigeria, as well as in less populous nations, decisions to deal fully with inadequate supplies began to be made last month, after hospitals were overbooked and patients began to die.
The gap in the availability of medical oxygen “is one of the defining issues of health equity, I think, of our time,” said Peter Piot, director of the London School of Hygiene & Tropical Medicine, who said he survived a serious coronavirus infection thanks to the oxygen he received.
Doctors in Nigeria anxiously monitor traffic as oxygen supplies move through the congested streets of Lagos. There and in other countries, desperate families of patients sometimes turn to the black market. Governments act only after hospitals are overburdened and those infected die by the dozens.
In the state of Amazonas, Brazil, swindlers were caught reselling extinguishers painted to look like medical oxygen tanks. In Peru, people camped in lines in search of cylinders for sick relatives.
Only after the lack of oxygen was responsible for the death of four people at an Egyptian hospital in January and six people at a hospital in Pakistan in December, governments solved the problems.
John Nkengasong, director of the African Centers for Disease Control and Prevention, said that medical oxygen is a “huge critical need” across the continent of 1.3 billion people and is the main reason why patients with COVID-19 are more likely to die there during an increase in cases.
Even before the pandemic, the 2,600 oxygen concentrators in sub-Saharan Africa and 69 functioning oxygen plants met less than half the need, leading to preventable 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 from 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 119.
Nigeria was “struggling to find oxygen to manage cases” in January, said Chikwe Ihekweazu, head of the Center for Disease Control.
A main hospital in Lagos, a city of 14.3 million, saw its virus cases in January increase fivefold, with 75 medical professionals infected in the first six weeks of 2021. Only then did President Muhammadu Buhari release $ 17 million to install 38 more oxygen plants and another $ 670,000 to repair factories in five hospitals.
Some oxygen suppliers have drastically increased prices, according to a doctor at the University Hospital in Lagos who spoke on condition of anonymity because he was not allowed to speak to reporters. This increased the cost of a cylinder by 10 times, to $ 260 – more than the average monthly salary – and a critically ill patient may need up to four cylinders per day.
Money and influence don’t always help.
Femi Odekunle, a Nigerian academic and a close ally of the president, was left without adequate oxygen for nearly 12 days at Abuja University Hospital until two state governors and Ministry of Health officials intervened. He died anyway, and family and friends blame the lack of oxygen, reported the online newspaper Premium Times. The hospital attributed his death to the serious infection.
In Malawi, the president promised financing for protective equipment for medical workers and the immediate purchase of 1,000 oxygen cylinders, adding that he would transport them if necessary.
Corruption was blamed for defects in a new oxygen plant at a hospital in the Ugandan capital, Kampala, the Daily Monitor newspaper reported in November. The workers had to rely on rusted oxygen cylinders that were responsible for the deaths of at least two patients.
“While the top health officials reveled in the oxygen of good publicity, patients literally died of suffocation,” the newspaper said. “It seems that behind the delays and funding gaps, difficulties were being cut.”
Leith Greenslade, coordinator of the Every Breath Counts Coalition, which advocates broader access to medical oxygen, said the shortage became apparent last spring.
“Very little has been done. Now you have a second wave, not just in Africa, but in Latin America and Asia, and the lack of oxygen is reaching crisis levels, ”she said.
The World Bank has set aside $ 50 billion for the poorest countries in the world only, but only $ 30.8 billion has been committed, including $ 80 million for oxygen-related updates after requests from Afghanistan, Bangladesh, Benin, Central-Republic Africa, Chad, Congo, Gambia, Ghana, Grenada, Kenya, Mali, Rwanda, Sierra Leone and Tajikistan. That leaves almost $ 20 billion available by June 2021 to spend it, the World Bank said.
“We make money available to countries, but it is countries, governments that need to make a decision on how much they spend and what they spend 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 profitable sectors, such as mining, not health, and it has not been the focus of many international donors. Oxygen factories require technicians, good infrastructure and electricity – all of which are lacking in developing nations.
The main supplier of medicinal oxygen to the state of Amazonas in Brazil, White Martins, operated at half capacity before the pandemic. The first infections affect the isolated city in March and caused so many deaths that a cemetery was dug in the jungle.
Doctors in his capital, Manaus, were forced last month to choose which patients to treat, as the oxygen supply has declined.
The Supreme Federal Court of Brazil initiated an investigation into crisis management after White Martins said that an “unexpected increase in demand” led to shortages.
“The government lacked planning,” said Newton de Oliveira, president of the Brazilian Gas Industry, an important oxygen supplier.
Only after the deaths reached an average of 50 per day did the government announce that it would build 73 oxygen plants in the state. Within a month, 26 were up and running.
The scarcity remains critical in Peru, where Dani Luz Llamocca waited five days outside a distribution center in Lima, saying her father, infected with the virus, had less than half a tank of oxygen. She was willing to wait as long as necessary. “Otherwise, my father will die,” said Llamocca.
WHO’s Appiah said that countries with mining industries could, with little change, convert their systems to produce medical grade oxygen.
India’s national trade body for gas manufacturers suggested just that in April 2020, when the number of virus cases was relatively low. Industrial storage tanks have been reused in hospitals, said Surendra Singh, manager of the Indian division of multinational Linde.
“It is not rocket science,” said Saket Tiku, president of the All India Industrial Gases Manufacturers Association. “The decision saved thousands of lives.”
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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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