DAKAR, Senegal (AP) – A crisis over the supply of medical oxygen to coronavirus patients 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 set up an oxygen factory in the hospital and even less time to convert industrial oxygen manufacturing systems into a medical network. But in Brazil and Nigeria, as well as in sparsely populated countries, decisions to fully address inadequate supplies began to be made only last month, after hospitals were overwhelmed and patients began to die.
The gap in the availability of medical oxygen “is one of the defining issues of health equity, I think, in our time,” said Peter Piot, director of the London School of Hygiene & Tropical Medicine, who said he survived a severe coronavirus infection due to oxygen on who received it.
Nigerian doctors are eagerly monitoring traffic as oxygen supplies move on blocked streets in Lagos. There and in other countries, desperate families of patients sometimes turn to the black market. Governments only take action after hospitals are overwhelmed and infected people die by the dozens.
In the Brazilian state of Amazonas, scammers were caught reselling painted fire extinguishers to look like medical oxygen tanks. In Peru, people camped in rows to get bottles for sick relatives.
Only after the lack of oxygen was blamed for the death of four people at an Egyptian hospital in January and six at a Pakistani hospital in December, governments addressed the issues.
John Nkengasong, director of the African Centers for Disease Control and Prevention, said medical oxygen was a “critical need” across the continent of 1.3 billion people and is a major reason why patients with COVID-19 are more likely to die there during a wave of cases.
Even before the pandemic, the 2,600 oxygen concentrators in sub-Saharan Africa and 69 functional oxygen plants met less than half of their needs, leading to preventable deaths, especially from pneumonia, said Dr. John Adabie Appiah from the World Health Organization.
The number of concentrators has increased to about 6,000, mainly 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 is “struggling to find oxygen to handle cases” in January, said Chikwe Ihekweazu, head of its Center for Disease Control.
A major hospital in Lagos, a city of 14.3 million, has seen its January virus cases rise fivefold, with 75 medical workers infected in the first six weeks of 2021. Only then did President Muhammadu Buhari release 17 million. $ to set up another 38 oxygen plants and another $ 670,000 to repair plants in five hospitals.
Some oxygen providers have dramatically raised prices, according to a doctor at Lagos University Teaching Hospital, who spoke on condition of anonymity because he was not allowed to speak to reporters. This has increased the cost of a cylinder 10 times, to $ 260 – more than the average monthly salary – and a seriously ill patient may need up to four cylinders a day.
Money and influence do not always help.
Femi Odekunle, a Nigerian academician and 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 online newspaper Premium Times reported. The hospital blamed him for his severe infection.
In Malawi, the president has promised funding for protective equipment for health workers and the immediate purchase of 1,000 oxygen cylinders, adding that he will fly them if needed.
Corruption has been blamed on defects in a new oxygen plant at a hospital in Uganda’s capital, Kampala, the Daily Monitor reported in November. The workers had to rely on rusty oxygen cylinders, which were blamed for the deaths of at least two patients.
“While senior health officials collapsed in the oxygen of good publicity, patients were literally suffocating to death,” the newspaper said. “It seems that behind the delays and funding gaps, the corners have been cut.”
Leith Greenslade, coordinator of the Every Breath Counts Coalition, which advocates for wider access to medical oxygen, said the approaching deficits were 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 the lack of oxygen is becoming at crisis levels, ”she said.
The World Bank has set aside $ 50 billion for the world’s poorest countries alone, but only $ 30.8 billion has been committed, including $ 80 million for oxygen improvements, following requests from Afghanistan, Bangladesh, Benin , Central African Republic, Chad, Congo, Gambia, Ghana, Grenada, Kenya, Mali, Rwanda, Sierra Leone and Tajikistan. This leaves nearly $ 20 billion available so far by the June 2021 deadline to spend it, the World Bank said.
“We make money available to countries, but countries, governments, have to make a decision about how much they spend and what they spend,” said Dr. Mickey Chopra, who is helping the global response to the World Bank’s medical logistics.
Many countries view oxygen supply primarily as an industrial product for more profitable sectors, such as mining, not health care, and it has not been a goal of many international donors. Oxygen manufacturing facilities require technicians, good infrastructure and electricity – all of which are scarce in developing countries.
The main provider of medical oxygen for the Brazilian state of Amazonas, White Martins, operated at half capacity before the pandemic. The first infections hit the isolated city in March and led to 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 their oxygen supplies dwindled.
Brazil’s Supreme Court has launched a crisis management investigation after White Martins said an “unexpected increase 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.
Just after 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, who was affected by the virus, fell less than halfway through his oxygen tank. She was willing to wait as long as it took. “If not, my father will die,” Llamocca said.
WHO’s Appiah said countries with mining industries could, with little change, convert their systems to produce medical-grade oxygen.
The national trade body for gas producers in India suggested this in April 2020, when the number of virus cases was relatively low. Industrial storage tanks have been rebuilt in hospitals, said Surendra Singh, manager of the Indian division of the multinational corporation Linde.
“There is no science about missiles,” said Saket Tiku, president of the Indian Industrial Gas Producers 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; Contributing were 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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