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. Desperate patient families around the world 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, two con artists were caught reselling painted fire extinguishers 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 during outbreaks.
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.
However, without formal requests from governments, nearly $ 20 billion in World Bank funds for coronavirus for the poorest countries in the world have remained unspent so far, the organization told the Associated Press.
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 rise 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 plants 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 relatives and friends blame the lack of oxygen, the Premium Times reported. The hospital attributed his death to the serious infection.
In Malawi, the president promised funding for protective equipment for medical workers and the immediate purchase of 1,000 oxygen cylinders.
Corruption was blamed for defects in a new oxygen plant at a hospital in the Ugandan capital, Kampala, the Daily Monitor newspaper reported. The workers had to rely on rusted oxygen cylinders, blamed 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.
Leith Greenslade of the Every Breath Counts Coalition, which advocates wider 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 oxygen scarcity is reaching crisis levels, ”she said.
The World Bank set aside $ 50 billion for the poorest countries in the world only during the pandemic, and $ 30.8 billion was allocated, including $ 80 million for oxygen-related updates.
“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.
A global oxygen-focused task force was formally announced on Thursday and will include the World Health Organization and the World Bank, among others. $ 90 million in immediate oxygen financing needs has already been identified for 20 developing countries, including Nigeria and Malawi.
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 oxygen shortage remains critical in Peru, where Dani Luz Llamocca waited five days outside a distribution center in Lima, saying that her virus-infected father had less than half a tank of oxygen. She was willing to wait as long as necessary. “Otherwise, my father will die,” said Llamocca.
Altogether, health experts estimate that 500,000 patients in developing countries currently need 1.1 million oxygen cylinders per day.
WHO’s Appiah said countries with mining industries could convert their systems to produce medical-grade oxygen. India’s national trade body for gas manufacturers suggested that industrial storage tanks be reused in hospitals last April, said Surendra Singh, manager of the 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. Sam Olukoya and Lekan Oyekanmi in Lagos, Nigeria, Aniruddha Ghosal in New Delhi, Franklin Briceño in Lima, Peru; Sam Magdy in Cairo, Diane Jeantet in Rio de Janeiro, Cara Anna in Nairobi, Kenya, Riaz Khan in Peshawar, Pakistan, and Rodney Muhumuza in Kampala, Uganda, contributed.
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