World The pandemic has exposed a shortage of medical oxygen around the world. So what is it? And why is it lacking?

07:36  29 april  2021
07:36  29 april  2021 Source:   abc.net.au

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Harrowing scenes of people begging for oxygen have become firmly etched in the global consciousness, as India's health system struggles under the weight of surging coronavirus cases.

Difficulty breathing is one of the most common severe COVID-19 symptoms.

But as photos of people waiting in long lines for oxygen canisters attest, supplies of medical oxygen are far from adequate everywhere in the world.

So how did we get here? And what's being done to help those most vulnerable?

Wait, how is oxygen even made?

In severe cases of COVID-19, oxygen levels in the body can drop. So, in order to keep them within a normal range, medical oxygen is required.

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"If the oxygen levels are low, if they're low for a long time, if it's not treated … your organs, they'll start to malfunction," said Dr Janet Diaz from the World Health Organization (WHO).

"The lifesaving treatment here then is medical oxygen."

Medical oxygen is made by separating the oxygen from other gases and impurities found in air by repeated steps of compression, filtration and purification.

Such medical oxygen reaches more than 99.5 per cent purity and is rigorously tested.

"[That] oxygen you take in — let's say, for example, from a cylinder — you’re now breathing in almost pure oxygen," Dr Diaz said.

It can be highly compressed into a liquid form, but has to be maintained below -182 degrees Celsius.

That's to help meet variations in demand, as one litre of liquid oxygen is the equivalent to around 800 litres when it is in normal gas form.

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So why the long wait?

India is the latest country to confront a lack of medical oxygen supplies.

Earlier in the pandemic there were similar scenes of long lines in countries such as Brazil, the Democratic Republic of Congo, Peru and Venezuela.

Unitaid, a global initiative that helps low and middle-income countries confront public health challenges, puts the lack of supplies of medical oxygen down to its cost, limited infrastructure and logistical difficulties.

According to the WHO, one person in five suffering from COVID-19 needs medical oxygen to ensure that the level of oxygen in their blood is sufficient.

"About 21 per cent of the air is oxygen. But we have to concentrate it into medical oxygen and that requires technology," Dr Diaz said, reiterating issues around supply and distribution.

"[Another] challenge is knowing how to use the medical oxygen … keeping the technology maintained, repairing what may be broken, making sure the piping is functional. "

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How much is needed?

In February, the WHO estimated that half a million people needed 1.2 million oxygen canisters a day.

Unitaid put the price tag of helping the countries facing the greatest need at $1.6 billion this year.

"This is a global emergency that needs a truly global response," said Unitaid's Executive Director, Dr Philippe Duneton, in February.

It has identified some 20 countries facing the greatest difficulties with oxygen supplies, including Malawi, Nigeria and Afghanistan.

Who makes it?

Outside of China, the three main producers of medical oxygen are the German firm Linde — which is allied with Praxair in the US — the French firm Air Liquide and the US company Air Products.

But there are a large number of local and regional producers of medical oxygen given that it is difficult to shop long distances.

Industrialised countries are better served, as production facilities were designed to serve more than just the medical sector, such as the steel and chemicals industries.

What's being done for India?

The Indian military has used its cargo aircraft to transport oxygen tanker trucks where supplies are lacking, and a train called the Oxygen Express was put into service on April 22.

Days later, the nation received its first shipment of medical aid from Britain, which included 100 ventilators and 95 oxygen concentrators.

The military has said it plans to import 23 mobile production units from Germany, while France plans to send eight such units that will be able to produce enough oxygen to serve 10,000 patients a day.

It also plans to ship 200 tonnes of liquid oxygen to Indian hospitals.

Other nations including the US, Australia, Israel and Pakistan have also promised medical aid.

The countries have said they will supply oxygen, diagnostic tests, treatments, ventilators and protective gear to help India's crisis.


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