COVID's oxygen crisis

Oxygen has been crucial in the fight against the coronavirus, which damages the lungs and leads to dangerously low blood oxygen levels. But massive demand means many countries around the world are now facing severe oxygen shortages, to the point that it’s threatening to compromise their healthcare systems. So how have things become so bad? Leith Greenslade runs the Every Breath Counts Coalition, which supports national governments to try to end pneumonia deaths by 2030. She explained the situation to Chris Smith...

Leith - It's India and Nepal at the moment that are oxygen hotspots. I think most of us have seen the images from India, particularly families in parking lots of hospitals trying to give their family members CPR. There is no oxygen. There are no doctors. They scream for help. Nobody comes. They're unmasked. Some of the doctors in India are telling us they have never experienced anything like this in their working lives.

Chris - And why is this happening?

Leith - It's happening because health systems are not equipped with medical oxygen. This is a pre-COVID problem. Many health systems across Africa, Asia, Latin America, even parts of central Europe simply didn't have enough oxygen. It wasn't something they prioritised. And we know many of them are cash strapped, but still, oxygen was underestimated. And now you're seeing the tragic consequences of that in India, Nepal; we saw it in Brazil, Peru, Colombia; and we're all very nervous we're about to see this move into Africa.

Chris - And of course, coronavirus does cause pneumonia and hence the problem with oxygen. But you're coming at this from a bigger viewpoint, which is that pneumonia can be caused by a range of different infections. And if you get bad pneumonia and you get low oxygen in your blood, you're going to die. And that's eminently soluble by supplementing people with a decent supply of oxygen.

Leith - Yes, if you get really sick with COVID anywhere, oxygen is the basic thing you need. And the quantities of oxygen required by COVID patients was something even the doctors in the UK, Europe, and North America underestimated; the sheer quantities of litres per minute that COVID patients need are extreme. So this is like a perfect storm for health systems in many low- and middle-income countries. Not only did they not have much oxygen, but they certainly didn't have the vast quantities required to keep COVID patients alive. And you're right, it's not just for COVID patients. Oxygen throughout the health system is needed from the tiniest newborn, often born needing respiratory support, right through to elderly people with chronic diseases like COPD. There's a lot of applications for oxygen and health systems. Just that at the moment, all eyes are on COVID.

Chris - Is this problem soluble, at least in the short term? Because you mentioned India as one of the worst impacted places. Partly, India is a serious problem because they've got 1.4 billion people there, but half the population of that country don't even have access to a toilet, let alone an oxygen cylinder.

Leith - It's so soluble though, because if you go into industry in India, if you go to the oil and gas industry or the steel industry, they have beautiful oxygen. You should go and see some of the systems in industry. But the poor old public hospital down the road has nothing. So this is about national priorities for sure. And we know the government in India underspends on health. Many governments underspend on health. Health has not been seen as an investment, but an expenditure. So I think COVID has shaken everyone up about this. And I think governments need to look at health more as an investment. And if they're doing that, they need to be investing in oxygen in their health systems, at least to the extent that you find oxygen available in industry.

Chris - They have been sending oxygen from the steelworks down the road, in some cases haven't they? I have seen footage where people have been quite surprised. They don't realise that you could do that, but they have been redeploying oxygen destined for industry into healthcare in India.

Leith - They have done that and that was the right call. They could have done it a lot earlier. Most of the governments that are in a crisis like India with oxygen, it's the first thing they should do; work out what capacity industry has and get that diverted to the health system as quickly as possible. But that comes at a cost to industry as well. The best solution would be if countries made sure their hospitals, particularly their large hospitals that deal with a lot of critical care patients, have their own oxygen on site. So plants on site are the best solution for big hospitals, even in India. This idea of getting it from industry is not optimal.

Chris - Which countries? Because thinking along the lines of 'prevention is better than cure', which countries are potentially in the firing line next? Who should be gearing up, taking your advice to heart, and planning so that they're in better shape than India is?

Leith - This is the big question. So we built a tracker, a COVID-19 oxygen needs tracker online, a kind of open source tool. Anyone can go on and click and see what's happening with oxygen needs every day in every low- and middle-income country. And we put a trend, a three month trend on that so you can see if it's ticking up or down. So from that data set, we have a list of 40, there are 40 countries now that are either experiencing or at risk of experiencing oxygen shortages. There's a huge cluster in Latin America; pretty much all of the South American countries have a high oxygen need and it's moving into even Central America, Costa Rica, and Guatemala, Honduras, Cuba. And then coming across to Asia: all of the countries that border India are going to be in trouble, and Nepal we've seen already, but watch out for Pakistan. Sri Lanka is already in trouble, and watch out for Bangladesh really closely as we see this variant sort of seep across the borders. So we're very worried about those nations. And then the Middle East, there's clusters across the Middle East; and then Africa. So in Africa, we're all watching South Africa at the moment, which is just starting to tick up. Everyone's been sort of scratching their head because no one can figure out why COVID in Africa is... It just hasn't really taken off in the way we've seen in other parts of the world. People think that's a bit of a ticking time bomb, and it's only a matter of time before we see in Africa what we've seen in India. And that's why the focus of our coalition at the moment is to help prepare those countries so they can get ahead of the curve, because they can't be blindsided like India.