Covid anniversary: Time to give this issue oxygen

Look, I know – no one really wants to think about the Covid pandemic, particularly in those parts of the world that suffered its worst horrors. We’ve moved on. But hear me out – if there’s one thing we can learn from those dark times it’s to get ready for the next one.

People dying around the world because they couldn’t get oxygen treatment was in our faces and in our headlines during the pandemic. Even without a pandemic over 70 percent of the 373 million people who need oxygen treatment worldwide every year simply don’t get it. And the just released Lancet Global Health Commission on Medical Oxygen Security’s report, to which I contributed, is a timely call for us to get our act together.

Let’s take a step back and have a refresher on oxygen. The vast majority of life on Earth needs oxygen to survive. We get it from the air we breathe, which is 21 percent oxygen, without giving it a thought. But when we have a disease like pneumonia that stops us getting enough air in our lungs and therefore oxygen in our bodies (‘hypoxia’, in medical jargon) medical oxygen can save our lives.

There are different ways that medical oxygen is produced. If you walk out the back of many hospitals in wealthy countries, you will find large tanks marked ‘Oxygen’, produced by factories that supercool air into liquid form, decant off the oxygen layer and store it under high pressure.

Producing medical oxygen in this way is an expensive, high-energy process. And dangerous if you don’t have adequate storage systems. Dozens of people were killed when an oxygen tank exploded at a hospital in Bagdad in 2021.

Medical oxygen is also produced by devices called concentrators and generators. They take air, which is mostly nitrogen, and filter out the nitrogen to provide medical oxygen. Concentrators can be small enough to sit at bedsides and treat one or more people, while generators are large enough to supply pipelines or fill cylinders. Both produce cheap continuous oxygen but need reliable power to work.

Does that sound too hard? We know it isn’t, if you have a plan. If Covid-19 exposed anything it is what happens when planning is missing in action: planning to stop a virus getting into the population, planning to squash it when it does; and planning to treat the sick hit by the virus.

Guidelines like the recently updated World Health Organization guidelines for managing pneumonia tell those of us at the clinical coalface what to do: suspect the situations where oxygen levels might be low, confirm it with a clever non-invasive device called a pulse oximeter (that peg they put on your finger when you’re in hospital), and then treat with oxygen. Diagnose. Treat. Simple.

What’s so hard about that? The vast majority (82 percent) of the millions who need oxygen and don’t get it are in low and middle-income countries (LMIC). Some people don’t manage to get to hospital– too far, too expensive, or just too hard.

If they manage to get there, the hospital may not have a working pulse oximeter – only around half of general hospitals in LMICs do – or they don’t have staff who know how to use it. And then the hospital needs the oxygen, but only 58 percent of general hospitals in LMICs have oxygen supplies at the best of times. In the Commission we heard from survivors like Blessina from Delhi whose husband had to return borrowed oxygen even as she was gasping for breath.

So what does it take to solve the oxygen challenge, and make sure that those who need it get it? First, it needs collective intent. In key breakthroughs in 2023 the WHO and its member states issued a declaration on ‘Increasing access to medical oxygen’ and the Global Oxygen Alliance (GO2AL) was formed – tick.

Second, collective agreement needs to result in a roadmap for implementation, and this is provided by initiatives like the Lancet Commission and GO2AL’s Strategic Framework and Investment Case.

But these are all only documents and meetings. What is needed, finally, is to actually get things done. Each country needs to commit to solving this, with funded national oxygen plans. Why? Because they want the best for their people, because oxygen treatment is highly cost-effective, and because there’ll be political fallout if they kick the can down the road.

The Commission identified that US$34b is needed to fill the oxygen funding gap over the next five years as we head to 2030. Most of that will need to come from countries themselves, and the rest from the international community, motivated if nothing else by enlightened self-interest – global political and economic shocks are in very few countries’ interests. Implementation also needs industry to come to the party, and there are signs of this happening.

Oxygen is a life-saving essential medicine and there isn’t any substitute for it. No one should die for lack of oxygen, and where there’s a will, there is certainly a way.

The reward is not only lives saved right now, with all the benefits this brings, but also readiness for the next pandemic we would be mad to think won’t come. The time is now. Even in the face of geopolitical dramas the nightmarish lessons of the Covid pandemic can help save us from ourselves.