Never mind vaccines, what is most needed right now is oxygen
MSF says countries most affected by lack of oxygen are also the ones struggling to access vaccines
Medical oxygen supply must be at the heart of the Covid-19 response, not just vaccines.
This is the word from Medecins Sans Frontieres (Doctors Without Borders, MSF), which has released a paper titled Gasping for Air, highlighting the importance of placing it at the centre of the global fight against the virus.
Being directly involved in patient care, including for critically ill people requiring oxygen therapy, MSF has drawn on its experiences in countries such as SA, India, Brazil, the Democratic Republic of the Congo (DRC), Lesotho and Yemen.
“Oxygen is a crucial medicine for severe Covid-19 patients, but in many places where we work, we see that oxygen supply is insufficient.
“While governments and donors focus on vaccines, we still see patients getting sick and facing an unacceptable shortage of an essential medicine. In the worst cases, this has led to catastrophic peaks in mortality.
“But even in places with less dramatic outcomes, medical teams have struggled to provide the right treatment for their patients.
“With vaccines unavailable in the majority of countries worldwide, people will continue to fall ill with Covid-19 and without a significant investment in oxygen infrastructure, those whose illness is severe and who cannot access oxygen will continue to die,” said MSF.
Dr Marc Biot, the organisation’s director of operations, said while oxygen is the single most important medicine for severe and critical Covid-19 patients, “supply is often insufficient because infrastructure has been neglected in lower- and middle-income countries for decades.
“Before the pandemic we saw patients suffering from pneumonia, malaria, sepsis and a variety of other conditions, as well as far too many premature babies [who] die due to a lack of medical oxygen, but Covid-19 has brought this issue into a sharp new focus.
“Unstable oxygen supplies kill,” he warned.
In the under-resourced countries where MSF works, hospitals and health centres often rely on unstable and expensive oxygen supply chains.
While hospitals in wealthy countries have plants and pipe highly concentrated oxygen to the bedside, patients across lower- and middle-income countries must rely on bulky, expensive and easily depleted oxygen cylinders or small concentrators which are not sufficient for a critical patient. “Our teams working in such places are implementing creative solutions to get their patients the oxygen they so desperately need.
“In SA, oxygen concentrators, small machines that take the oxygen from the air, but are not powerful enough for a critically ill Covid-19 patient, were linked together to increase their capacity. In the DRC, oxygen cylinders were connected together to create a central oxygen bank.
“Health workers are being trained in the appropriate use of oxygen therapy. In some contexts, the prices of oxygen have been regulated to ensure the cost does not become an unnecessary barrier as demand increases,” said Biot.
MSF said calculations for oxygen needs must be made before waves hit their peaks and creative solutions must be found to ensure a sufficient supply.
“Even though real investment in oxygen infrastructure is needed, there are some shortterm solutions that can improve the situation, such as increasing the number of oxygen concentrators and generators.
“These steps will continue to save many lives after the pandemic is over.”
According to the paper, international and national Covid-19 responses have neglected the need to scale up oxygen supplies.
“This has left a gap in the treatment of the critically ill. It is often only when a surge in cases occurs that the limitations on oxygen supplies are confronted. By then, it can be too late.
“The countries most affected by lack of access to medical oxygen are also the ones struggling to access vaccines.
“Patients in these countries will continue to face the twin threat of being less likely to avoid infection in the first place and less able to access treatment when they are sick.
“These vulnerable patients will continue to die due to a lack of oxygen, while people in richer countries receive protection through expanded vaccination programmes.
“Faced with such a reality, access to medical oxygen must be increased to ensure all critically ill Covid-19 patients receive the care they need to survive. Oxygen plants are the ideal solution, but are not always available, especially in rural locations.
“This disease, and the many other conditions that require oxygen, are not going to disappear.
“The appropriate resources must be made available to ensure the disparities between wealthy and resource-limited countries do not result in preventable deaths from Covid19.
“With so many lives at stake, healthcare workers and patients in low-income settings should not be forced to ‘make do’ with the insufficient resources,” the paper states.