Multinational companies dominate the industrial oxygen market. Only 10% of the production is for medical use “Please help my mother,” shouts a man in tears at the door of a New Delhi hospital where they were no longer receiving COVID-19 patients. Like him, dozens of people carry their dying loved ones while awaiting medical treatment. But no one answers. Most of the health centers in the Indian capital are overcrowded and the sick are dying on the streets. Charanjeev helps cremate the bodies of the victims. “There is no oxygen and people are dying like animals,” he told the BBC. Getty Images One in five COVID-19 patients need oxygen. In Latin America, countries like Brazil, Peru and Mexico have gone through the same thing. Earlier this year, patients with Covid-19 died from lack of oxygen in hospitals in Manaus, in northern Brazil. In Lima, Peru, the crisis has also reached extreme levels. The oxygen shortage has been such that there is a black market in various parts of Latin America where it is sold at exorbitant prices. One in five patients needs oxygen About 20% of COVID-19 patients (one in five patients) need oxygen. According to the World Health Organization, WHO, 40% of infected people develop a mild illness; another 40% moderate; 15% severe (requiring oxygen supply); and 5% critical. So when cases do occur in a short period of time, healthcare systems collapse and have no way to meet the demand for this gas. Reuters Globally, three manufacturers account for 69% of the industrial gas market (which includes medical oxygen): Air Liquide, Linde and Air Products. Currently, low- and middle-income countries need 3.8 million cylinders of oxygen per day (or 26,400,000 cubic meters), according to a needs monitoring tool for this gas developed by experts working within the non-profit organization. They are part of the Special Oxygen Emergency Corps, in which other international organizations such as the World Health Organization (WHO) are also participating, to deal with the pandemic emergency. “It is extremely expensive to build an oxygen plant,” Evan Spark-DePass, director of market dynamics at PATH, explains that oxygen shortages are an ongoing problem in many low-income countries. “It is extremely expensive to build a liquid oxygen plant in a country,” he says in dialogue with BBC Mundo. Since these are private sector investments, he adds, the company needs to be sure that there is sufficient demand for its business to be profitable. It is common for around 90% of a plant’s capacity to be devoted to industrial oxygen consumption. Getty Images The lack of oxygen in India has killed thousands of people. Therefore, if there is no industrial demand, “it is very unlikely that anyone will build a liquid oxygen plant for medical use only,” says Spark-DePass. On the other hand, the system of production, transport, distribution and storage is quite complex. In most of Europe and the United States, oxygen is delivered by truck and stored in large containers from where it reaches hospital beds. But in poor areas lacking this infrastructure, the sick depend on the use of cylinders which often leave families in ruins. Who do this? Globally, three manufacturers represent 69% of the industrial gases market (which includes medical oxygen): Air Liquide, Linde and Air Products, explains Jayasree K. Iyer, executive director of the Foundation for Access to Medicines. Some of the companies operating in the sector have made efforts during the pandemic to alleviate the emergency, he explains, but assures that it is not enough. Getty Images It is extremely expensive to build a liquid oxygen plant in a country, ”says Evan Spark-DePass. “As more and more patients in poor countries find it difficult to breathe, the companies that dominate the medical oxygen market have a duty to do more,” he said in a conversation with the BBC Mundo. Experts agree that the only way to solve the problem of oxygen deprivation, officially considered a drug by the WHO, is to promote agreements between the private sector, governments, donors and international organizations. In many countries, including Peru and Brazil (photo), relatives have had to provide oxygen to their sick relatives. One of the largest manufacturers, Air Liquide, a company present in 35 countries, claims to have increased its production of medical oxygen during the pandemic. The company maintains that, since it is a drug, its production must comply with very strict production and distribution rules. “Where possible, we work with local authorities to reallocate and medically qualify some of our industrial production and supply chain assets to supply hospitals,” the company said in response to a request for information. by BBC Mundo. Emergency solutions The conversion of industrial oxygen for medical purposes during the pandemic has occurred in several countries where authorities have entered into agreements with certain companies. In Mexico, for example, home oxygen demand rose 700% nationwide in the first three weeks of January, according to Ricardo Sheffield, director of the Federal Office of Consumer Protection. Getty Images In countries with limited access to oxygen, a black market has emerged in which families buy cylinders at exorbitant prices. Prices exploded quickly on the black market and internet scams have proliferated. To respond to the drug shortage, the Mexican government announced in February an agreement with three companies so that 70% of its industrial production is intended for medical use during the emergency. The same is happening in India now, even though the collapse of the health care system is so deep that even last minute deals have failed to stop the disaster. “It’s like being in a war zone” is the expression used by Soutik Biswas, BBC correspondent in India, to describe the situation there. Reuters “It’s like being in a war zone” is the phrase used by Soutik Biswas, a BBC correspondent in India, to describe the situation there. But in the case of countries that do not have industrial oxygen facilities, the gas conversion alternative does not exist. Another emergency option is to get more concentrators, machines that filter the air and turn it into oxygen, designed for individual use by a patient. However, concentrators have a limited range and are not sufficient for critically ill patients. The other way is to support the transport of oxygen in the form of pressurized gas in cylinders to the most affected areas. Long-term solutions to deal with shortages Liquid oxygen is the best alternative, experts say, but hospitals need the right infrastructure to channel it to the patient’s bed. Getty Images liquid oxygen is the best alternative, experts say, but hospitals need the right infrastructure to channel it to the patient’s bed. “You need to increase funding to build this infrastructure,” says Evan Spark-DePass. “Governments should prioritize it in their budgets,” he stresses, and enter into long-term trade agreements with producers that are negotiated at country level. Another option is to assess the feasibility of building oxygen plants, although due to their cost and maintenance requirements, they are often beyond the reach of poorer countries. And another key point, experts say, is to improve cylinder oxygen distribution networks so that in an emergency the system is better prepared. Even in a hypothetical scenario in which the COVID-19 pandemic goes away, oxygen therapy can save millions of lives of patients who need the drug when they have severe respiratory complications from other types of illnesses. Like pneumonia, a disease that kills a child every 39 seconds, according to a study by the United Nations Children’s Fund, Unicef. Getty Images Oxygen is used in patients with respiratory complications, such as pneumonia. According to Unicef, this disease kills a child every 39 seconds.
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