{"id":50358,"date":"2021-06-01T15:20:50","date_gmt":"2021-06-01T14:20:50","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=50358"},"modified":"2021-06-04T13:22:33","modified_gmt":"2021-06-04T12:22:33","slug":"covid-19-highlights-the-worlds-chronic-shortage-of-life-saving-medical-oxygen","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/06\/01\/covid-19-highlights-the-worlds-chronic-shortage-of-life-saving-medical-oxygen\/","title":{"rendered":"Covid-19 highlights the world\u2019s chronic shortage of life saving medical oxygen"},"content":{"rendered":"<p><span style=\"font-weight: 400\">Oxygen therapy is essential for treating severe covid-19 and numerous other conditions. However, for many patients, including women, children, and newborns, this essential treatment is unavailable, resulting in <\/span><a href=\"https:\/\/www.who.int\/news-room\/feature-stories\/detail\/the-life-saving-power-of-medical-oxygen\"><span style=\"font-weight: 400\">millions of deaths globally<\/span><\/a><span style=\"font-weight: 400\">.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Oxygen shortages are an indicator of health inequities within and across countries. Oxygen has been on the <\/span><a href=\"https:\/\/www.who.int\/publications\/i\/item\/WHOMVPEMPIAU2019.06\"><span style=\"font-weight: 400\">WHO Model List of Essential Medicines<\/span><\/a><span style=\"font-weight: 400\"> and <\/span><a href=\"https:\/\/www.who.int\/publications\/i\/item\/WHOMVPEMPIAU201907\"><span style=\"font-weight: 400\">List of Essential Medicines for Children<\/span><\/a><span style=\"font-weight: 400\"> since 2017 for treatment of hypoxemia and is also crticical for treating patients with pneumonia. However, nearly <\/span><a href=\"https:\/\/path.azureedge.net\/media\/documents\/DRG_Oxygen_Primer.pdf\"><span style=\"font-weight: 400\">50% of health facilities in low resource settings<\/span><\/a><span style=\"font-weight: 400\"> had inconsistent or no supply, only half had pulse oximeters, and the poorest countries had less than 20% of the medical oxygen they needed. Oxygen shortages and rising prices are reported in countries that have some of the highest numbers of child deaths due to pneumonia, such as India, Bangladesh, and Nigeria.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Severe pneumonia affects more than <\/span><a href=\"https:\/\/www.unicef.org\/press-releases\/severe-pneumonia-leaves-42-million-children-desperate-oxygen-each-year\"><span style=\"font-weight: 400\">22 million<\/span><\/a><span style=\"font-weight: 400\"> young children in low and middle income countries annually and is the single largest infectious cause of death among children worldwide. More than <\/span><a href=\"https:\/\/data.unicef.org\/topic\/child-health\/pneumonia\/\"><span style=\"font-weight: 400\">800 000<\/span><\/a><span style=\"font-weight: 400\"> children aged under 5 died from pneumonia in 2017 alone\u2014that\u2019s more than from malaria, measles, and diarrhea combined. It accounts for <\/span><a href=\"https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/pneumonia\"><span style=\"font-weight: 400\">15% of all deaths<\/span><\/a><span style=\"font-weight: 400\"> of children in that age group, and d<\/span><span style=\"font-weight: 400\">eath rates are <\/span><a href=\"https:\/\/resourcecentre.savethechildren.net\/node\/12479\/pdf\/fighting_for_breath_-_africa_cover.pdf\"><span style=\"font-weight: 400\">three times higher among children in the poorest 20% of households<\/span><\/a><span style=\"font-weight: 400\"> than in the richest.<\/span><span style=\"font-weight: 400\"> Cost is a huge barrier to treatment for low income households; oxygen to treat a child with severe pneumonia <\/span><a href=\"https:\/\/blogs.worldbank.org\/health\/oxygen-all-during-covid-19-coronavirus-and-beyond\"><span style=\"font-weight: 400\">over 3-4 days costs around US$40-60.<\/span><\/a><span style=\"font-weight: 400\"> It\u2019s estimated that<\/span><span style=\"font-weight: 400\"> better access to oxygen <\/span><a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ppul.24656\"><span style=\"font-weight: 400\">could save 148 000 children aged under 5 each year<\/span><\/a><span style=\"font-weight: 400\"> in the 15 countries that have the highest burden of mortality due to pneumonia. Availability of oxygen could also prevent deaths from other non-respiratory conditions that result in hypoxemia, such as sepsis and severe malaria, and is equally essential during surgical care, anesthesia, and childbirth.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Covid-19 has exacerbated health inequities among the poorest and most vulnerable, particularly among women, children, and adolescents. With health systems and supply chains under huge added stress, it has become even more difficult in some countries to get oxygen for everyone who needs it. In many hospitals, health workers have to make heartbreaking choices about who gets oxygen and who doesn\u2019t. This is an immense moral burden for health workers, who may themselves be <\/span><a href=\"https:\/\/www.who.int\/publications\/m\/item\/oxygen-cylinder-safety\"><span style=\"font-weight: 400\">vulnerable<\/span><\/a><span style=\"font-weight: 400\">, often working without <\/span><a href=\"https:\/\/www.who.int\/publications\/m\/item\/medical-oxygen-fire-risk-mitigation-measures\"><span style=\"font-weight: 400\">adequate protection and support<\/span><\/a><span style=\"font-weight: 400\">. Meanwhile, demand for oxygen for patients with covid-19 inevitably competes with demand for non-covid patients.<\/span><\/p>\n<p><b>Invest in oxygen<\/b><\/p>\n<p><span style=\"font-weight: 400\">As part of the <\/span><a href=\"https:\/\/pmnch.who.int\/about-pmnch\/constituencies\/health-care-professional-associations\"><span style=\"font-weight: 400\">PMNCH Health-Care Professionals Associations constituency<\/span><\/a><span style=\"font-weight: 400\">, and in the context of the <\/span><a href=\"https:\/\/pmnch.who.int\/news-and-events\/campaigns\/pmnch-call-to-action-on-covid-19\/\"><span style=\"font-weight: 400\">PMNCH \u201cCall to Action on COVID-19,<\/span><\/a><span style=\"font-weight: 400\">\u201d<\/span><span style=\"font-weight: 400\">\u00a0we want to underline how urgent investment in medical oxygen is to ensure equitable, safe, and efficient manufacture, distribution, and supply management, and to maximize safety and support for health workers. This includes investing in oxygen concentrators to <\/span><span style=\"font-weight: 400\">increase the availability, management, and quality of oxygen therapy available <\/span><span style=\"font-weight: 400\">in low resource settings (when reliable electricity is available). In parallel, health system investments must be in place for the appropriate transport, set up, and storage of <\/span><a href=\"https:\/\/www.who.int\/publications\/m\/item\/oxygen-cylinder-safety\"><span style=\"font-weight: 400\">oxygen cylinders<\/span><\/a><span style=\"font-weight: 400\">, as well as <\/span><a href=\"https:\/\/www.who.int\/publications\/m\/item\/medical-gas-piping-systems-safety\"><span style=\"font-weight: 400\">structural maintenance of oxygen piping<\/span><\/a><span style=\"font-weight: 400\"> to ensure the delivery of quality oxygen. These investments will strengthen health systems\u2019 ability to provide access to maternal, newborn, child, and adolescent health services and supplies through the covid-19 response and recovery period, helping us to protect and promote the health, wellbeing, and rights of the most vulnerable.<\/span><\/p>\n<p><span style=\"font-weight: 400\">While securing adequate supplies in every setting, we also need to ensure that healthcare facilities have the expertise and equipment in place to deliver oxygen safely and effectively. Health workers require training in emergency triage, pulse oximetry, and oxygen therapy. For infants and small children, we need to ensure the supply of suitable delivery devices, such as appropriately sized masks, nasal cannulas, and monitoring devices such as portable pulse oximeters, as well as improved laboratory facilities to monitor blood oxygen levels. There are many situations where babies may be born compromised outside of medical facilities, or there might be a need to administer oxygen during transfer to higher level of care facilities. Task shifting and task sharing could improve the capacity of low resource settings to manage these scenarios, with appropriately trained and<\/span><a href=\"https:\/\/www.who.int\/reproductivehealth\/publications\/maternal_perinatal_health\/978924504843\/en\/\"><span style=\"font-weight: 400\"> experienced midwives and nurses<\/span><\/a><span style=\"font-weight: 400\"> authorized to administer oxygen in the absence of a medical doctor, when an <\/span><a href=\"https:\/\/www.who.int\/publications\/i\/item\/9789241515887\"><span style=\"font-weight: 400\">adequate support system<\/span><\/a><span style=\"font-weight: 400\"> is in place.<\/span><\/p>\n<p><span style=\"font-weight: 400\">We urge governments not to divert already limited oxygen supply away from essential needs for women, newborns, children, and adolescents. They should invest in sustainable and robust oxygen management systems during and after covid-19, guaranteeing equity in oxygen manufacture and management, and ensuring access for people on lower incomes. Equipment should be safely delivered, maintained, and stored. Providing oxygen therapy can introduce certain risks in the workplace, such as exposure to aerosols when treating patients on respiratory support. Governments should therefore provide frontline healthcare workers, notably nurses, midwives, and doctors, with adequate protective personal equipment and ensure safe working conditions.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The availability of oxygen therapy can make the difference between life and death, and healthcare workers should not be forced to decide who should, or should not, receive it. While covid-19 has exacerbated the oxygen divide, there was already a chronic shortage. Our focus now must be on ensuring we have a sustainable supply, with equitable and safe distribution of this essential commodity at a community level. We must meet the need for oxygen without delay.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Authors \u2013 as part of PMNCH Health Care Professional Associations constituency<\/span><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Errol R Alden<\/strong>, president, International Pediatric Association.<\/span><\/em><\/p>\n<p><strong>Competing interests:<\/strong> none declared.<\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Franka Cad\u00e9e<\/strong>, president, International Confederation of Midwives.<\/span><\/em><\/p>\n<p><strong>Competing interests:<\/strong> none declared.<\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Jeanne Conry<\/strong>, president elect, International Federation of Gynecology and Obstetrics.<\/span><\/em><\/p>\n<p><span style=\"font-weight: 400\"><strong>Competing interests:<\/strong> I sit on the board of directors for two non-profit organizations: <\/span><span style=\"font-weight: 400\">Forum Institute and <\/span><span style=\"font-weight: 400\">Heartland Health Research Alliance. It is unpaid. T<\/span><span style=\"font-weight: 400\">hey both advocate or do research on environmental exposures and newborn\/maternal health.<\/span><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Annette Kennedy<\/strong>, president, International Council of Nurses.<\/span><\/em><\/p>\n<p><strong>Competing interests:<\/strong> none declared.<\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Karen Walker<\/strong>, president, Council of International Neonatal Nurses.<\/span><\/em><\/p>\n<p><strong>Competing interests:<\/strong> none declared.<\/p>\n<p><strong>Acknowledgments:\u00a0<\/strong><span style=\"font-weight: 400\">We would like to thank Ann Yates and Florence West, International Confederation of Midwives, Anne-Sylvie Ramelet, International Council of Nurses, Carole Kenner, Council of International Neonatal Nurses, and Jonathan D Klein, International Pediatric Association, for their contributions.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Oxygen therapy is essential for treating severe covid-19 and numerous other conditions. However, for many patients, including women, children, and newborns, this essential treatment is unavailable, resulting in millions of [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2021\/06\/01\/covid-19-highlights-the-worlds-chronic-shortage-of-life-saving-medical-oxygen\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":419,"featured_media":50361,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[263],"tags":[],"class_list":["post-50358","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-global-health"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Covid-19 highlights the world\u2019s chronic shortage of life saving medical oxygen - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2021\/06\/01\/covid-19-highlights-the-worlds-chronic-shortage-of-life-saving-medical-oxygen\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Covid-19 highlights the world\u2019s chronic shortage of life saving medical oxygen - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Oxygen therapy is essential for treating severe covid-19 and numerous other conditions. 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Juba, Republic of South Sudan ? A midwife takes care of a newborn baby with complications at Neonatal Intensive Care Unit in Juba Teaching Hospital, South Sudan's oldest, and by far the largest and best-equipped in the new country. South Sudan has the highest maternal mortality rate in the world. One in seven South Sudanese women is likely to die because of complications from delivery. Just 10 per cent of South Sudanese women have access to medical professionals during childbirth. 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Juba, Republic of South Sudan ? A midwife takes care of a newborn baby with complications at Neonatal Intensive Care Unit in Juba Teaching Hospital, South Sudan's oldest, and by far the largest and best-equipped in the new country. South Sudan has the highest maternal mortality rate in the world. One in seven South Sudanese women is likely to die because of complications from delivery. Just 10 per cent of South Sudanese women have access to medical professionals during childbirth. 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