DAKAR, Senegal (AP) – A crisis over the supply of medical oxygen to coronavirus patients has affected nations in Africa and Latin America, where warnings were ignored at the start of the pandemic and doctors say shortage has caused unnecessary deaths.
It takes about 12 weeks to install a hospital oxygen plant and even less time to turn industrial oxygen manufacturing systems into a medical quality network. But in Brazil and Nigeria, as well as in less populated nations, decisions to fully address inadequate supplies only began to be made last month, after hospitals were overwhelmed and patients began to die.
I think the gap in medical oxygen availability “is one of the definitive health equity issues of our age,” said Peter Piot, director of the London School of Hygiene & Tropical Medicine, who said he survived. to a serious coronavirus infection thanks to the oxygen he was receiving.
Nigerian doctors are anxiously monitoring traffic as the oxygen supply moves through the blocked streets of Lagos. There and in other countries, desperate families of patients sometimes turn to the black market. Governments take action only after hospitals are overwhelmed and the infected die by the dozens.
In the Brazilian state of the Amazon, scammers were caught selling fire extinguishers painted to look like medical oxygen tanks. In Peru, people camped in a row to get chocolates for sick relatives.
Only after blaming the lack of oxygen for the deaths of four people in an Egyptian hospital in January and six people in one in Pakistan in December, governments addressed the issues.
John Nkengasong, director of the African Centers for Disease Control and Prevention, said medical oxygen is a “huge critical need” across the continent of 1.3 billion people and is one of the main reasons 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 the 69 oxygen plants in operation met less than half of the need, resulting in preventable deaths, mostly from pneumonia. say Dr. John Adabie Appiah of the World Health Organization.
The number of concentrators has grown to about 6,000, mostly from international donations, but the oxygen produced is not pure enough for critically ill patients. The number of plants that can generate higher concentrations is now 119.
Nigeria was “struggling to find oxygen to handle the cases” in January, said Chikwe Ihekweazu, head of its Disease Control Center.
A major hospital in Lagos, a city of 14.3 million, saw its January virus cases multiply by five, with 75 medical workers infected during the first six weeks of 2021. Only then did President Muhammadu Buhari release 17 million of dollars to install 38 more oxygen plants and another $ 670,000 to repair plants at five hospitals.
Some oxygen suppliers have drastically raised prices, according to a doctor at the University of Lagos Teaching Hospital who spoke on condition of anonymity because he was not allowed to speak to journalists. This has raised the cost of a cylinder tenfold, to $ 260, more than the average monthly salary, and a critically ill patient could need up to four cylinders a day.
Money and influence do not always help.
Femi Odekunle, a Nigerian academic and close ally of the president, was without adequate oxygen for nearly 12 days at the Abuja University Teaching Hospital until two state governors and Ministry of Health officials intervened. He also died and family and friends blamed the lack of oxygen, the online newspaper Premium Times reported. The hospital attributed his death to his serious infection.
In Malawi, the president promised funding for protective equipment for medical workers and the immediate purchase of 1,000 oxygen cylinders, adding that he would fly them, if necessary.
Corruption was blamed for defects at a new oxygen plant at a hospital in Uganda’s capital, Kampala, the Daily Monitor reported in November. Workers had to rely on rusty oxygen cylinders that were blamed for the deaths of at least two patients.
“While senior health officials were taking oxygen from good publicity, patients were literally drowning to death,” the newspaper said. “It looks like corners are being cut behind delays and funding gaps.”
Leith Greenslade, coordinator of the Every Breath Counts coalition, which advocates wider access to medical oxygen, said the next shortage was evident last spring.
“It simply came to our notice then. Now you have a second wave, not only in Africa, but also in Latin America and Asia, and oxygen shortages are turning into crisis levels, ”he said.
The World Bank has set aside $ 50 billion for the world’s poorest countries alone, but only $ 30.8 billion has been pledged, including $ 80 million for oxygen-related upgrades following requests from Afghanistan , Bangladesh, Benin, Central African Republic, Chad, Congo and Gambia. , Ghana, Granada, Kenya, Mali, Rwanda, Sierra Leone and Tajikistan. That leaves nearly $ 20 billion available by June 2021 to spend them, the World Bank said.
“We make money available to countries, but it is the countries, the governments, that have to make a decision about how much they spend and where they spend it,” said Dr. Mickey Chopra, who helps with the global response of the World Bank’s medical logistics.
Many countries view oxygen supply primarily as an industrial product for more lucrative sectors such as mining, not health care, and it has not been a focus of many international donors. Oxygen manufacturing plants require technicians, good infrastructure and electricity, all in developing nations.
The main provider of medical oxygen in the Amazon state of Brazil, White Martins, was operating at half capacity before the pandemic. The first infections affected the isolated city in March and caused so many deaths that a jungle cemetery was cut down.
Doctors in his capital Manaus were forced last month to choose which patients to treat as their oxygen supplies dwindled.
Brazil’s Supreme Court began an investigation into crisis management after White Martins said an “unexpected increase in demand” caused shortages.
“There was a lack of planning on behalf of the government,” said Newton de Oliveira, president of Industria Brasileira de Gases, a major oxygen supplier.
Just after making an average of 50 deaths a day, the government said it would build 73 oxygen plants in the state. Within a month, 26 were in operation.
The shortage remains critical in Peru, where Dani Luz Llamocca waited five days outside a distribution center in Lima, saying her father affected by the virus had dropped to less than half a tank of oxygen. She was willing to wait the time it took. “If not, my father will die,” Llamocca said.
The WHO Appiah said countries with mining industries could, with few changes, convert their systems to produce medical-grade oxygen.
India’s national trade body for gas manufacturers suggested precisely this in April 2020, when the number of cases of the virus was relatively low. Industrial storage tanks were reused in hospitals, said Surendra Singh, manager of the Indian division of multinational Linde.
“It’s not rocket science,” said Saket Tiku, president of the Association of Industrial Gas Manufacturers all over India. “The decision saved thousands of lives.”
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Hinnant reported from Paris. Aniruddha Ghosal to New Delhi, Franklin Briceño to Lima, Peru; Contributed by 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.
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