Under normal conditions, under ideal conditions, everyone who needs oxygen would be admitted to the hospital”

You might not think of oxygen as a rare or expendable commodity, but for use in hospitals and ambulances, and by some 1.5 million Americans who rely on life-saving portable devices at home, the precious gas can be in precariously short supply when demand is high. Now, thanks to Covid-19, increased oxygen demand in some parts of the country and around the world is forcing rationing, governmental price caps, and life-or-death decisions by doctors and first responders.

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“[…] Under normal conditions, under ideal conditions, everyone who needs oxygen would be admitted to the hospital”, says Dr. Rais Vohra, interim health officer in Fresno County, in California’s Central Valley. “Unfortunately, we’re operating in a disaster and so we don’t have that luxury, and we have to make really hard choices and do the best that we can.”
Oxygen shortages currently do not appear to be widespread in the United States. But with Covid-19 hospitalizations already at a record high across the nation, experts now fear a burgeoning caseload as the recently discovered and more contagious mutant coronavirus strain spreads throughout the country.
Yes, it’s in the air, but …
Earth’s atmosphere is made up of nitrogen (79.09%), oxygen ( 20.95%), argon (0.93%) and carbon dioxide (0.039%), along with traces of other gases and water vapor.
Like any gas used for industrial, commercial or health care purposes, oxygen must be extracted and separated into its pure form. That’s done either by on-site machines at hospitals or by outside companies that package and ship the oxygen in canisters or pump it into large on-site storage containers.
Oxygen is traded like other commodities — its price fluctuates based on supply and demand.
The price of oxygen has been rising gradually since about 2004, roughly doubling. The global demand is expected to skyrocket in coming years, for health care and industrial uses, with healthcare demand reaching $2.3 billion by 2027, owing to the “huge number of patients dependent on oxygen,” a new report predicts.
Now the production and delivery methods are being strained in multiple communities, threatening both the pumping of oxygen into patient rooms and the portable supplies used by paramedics and people at home.
For a healthy person, there’s plenty of oxygen in the air. But when someone’s lungs aren’t working properly, as can happen with Covid-19, oxygen is administered at varying levels of purity, or concentration. (Similarly, athletes and mountain climbers take oxygen to counteract the effects of extreme exertion or thin air.)
A Covid patient with severe symptoms might need 10 times as much oxygen as someone whose lungs are functioning reasonably well. Many other health emergencies and chronic conditions also require oxygen therapy, so any supply shortage is doubly troubling.
Rationing and rebuilding
In Los Angeles, ambulance crews have been instructed to ration their oxygen supplies, forcing decisions about who might survive or not, and putting some at risk for worsening symptoms due to lack of care. Hospitals have also delayed releasing Covid patients when they lack oxygen tanks to send with them.
There’s another purely mechanical problem at some hospitals: Oxygen is often stored in liquid form, at high pressures and extremely low temperatures. Now, with the demand being so high in some hospitals due to Covid-19, the flow of oxygen is freezing delivery equipment, particularly in aging systems that haven’t been modernized in years. The situation is so grave, the Army Corps of Engineers has been called in by the California governor to help rebuild some of the old setups.
For some poor countries that don’t have the technologies and supply chain for the precious air product, lack of oxygen has been a problem for many months. “Oxygen is one of the most important interventions, (but) it’s in very short supply,” Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention, said last June. In September, India capped the price of medical oxygen.
Meanwhile, hospitalizations in California continue to soar, and the nationwide caseload builds.
“Everybody is worried about what’s going to happen in the next week or so,” says Cathy Chidester, director of the L.A. County Emergency Medical Services Agency.