Another day, another COVID-19 headline. The world is nearing the first anniversary since the outbreak of the virus in Wuhan, China, and every day since the news media is overflowing with stories of countless tragedies, deaths, and unprecedented predicaments. The most recent of said news cycles is based in Manaus, Brazil, as a second wave of the virus overwhelms the medical system and hospitals suffer oxygen shortages. Covid-19 deeply impacts the respiratory system, bombarding the lungs, debilitating them until patients have no option other than going to the hospital. One of the main reasons for hospitalization by COVID-19 is to receive supplemental oxygen in order to increase the amount of oxygen in the blood and lungs, and as supplies run low, doctors, nurses, and families are left defenseless against the world’s common enemy. On Thursday, January 14th, around 2,516 new infections were reported in Manaus, reaching the highest figure since the start of the pandemic. Virus victims in need of hospital equipment became defenseless and resorted to manual ventilation both from medical staff and desperate family members that found no way of reaching experts of resources. Donations are consistently arriving, but they do not last, and patients who are in dire need of oxygen therapy are dying, due to the lack of a resource which is seen as a given in richer countries. According to an interview with a residential doctor at the Getulio Vargas Hospital with Al Jazeera, around 100 patients have died from asphyxiation since January 14th. An epidemiologist from the Fiocruz public health research center clarified, “The world thinks that the crisis is due to a lack of oxygen, but it’s a lack of everything. A lack of medical equipment, basic sanitary conditions and above all containment measures.”
Jair Bolsonaro, the president of Brazil, has been highly criticized for his handling of the pandemic, as his initial narrative was dismissing a virus and calling it an “inoffensive cold.” Infectious disease professionals have been warning authorities to impose a lockdown as many other countries have done since August 2020, but efforts have been futile. The Attorney General’s office and the Ministry of Health claim to have foreseen the incoming lack of access to oxygen a week before the crisis but failed to inform federal authorities. The Brazilian health minister, Eduardo Pazuello, visited Manaus days before oxygen stock crashed and said that “they had done everything that needed to be done.” This comes to show that the current situation in Manaus is a result of mediocrity from the Brazilian government, and an inability to tackle the pandemic with an iron fist.
Medical oxygen is one of the most important tools when treating complex illnesses. From pneumonia, malaria, sepsis, meningitis, and now COVID-19, it is easy to overlook the fact that oxygen is a life-saving medicine. However, it also proves as an indicator of health inequalities between developing and developed countries. Providing oxygen for patients, even before the pandemic, is extremely expensive, and it comes with a plethora of logistical barriers in terms of transportation and distribution. According to the World Bank.Org treating a child with severe pneumonia can use from 4,000 to 8,000 cubic liters of oxygen at a cost of $40 to $60. While this may not seem to be a significant cost at first glance, it is important to note that many people in third-world countries earn around a dollar a day, and the costs of oxygen are completely out of reach, resulting in a significant barricade against treatment. Furthermore, the oxygen tanks need to be preserved under certain temperature and pressure conditions in order for them to be effective, a task that is not easy to achieve without strong financial backup. Acquiring oxygen is one part of the process, but having a reliable oxygen supply is yet another barrier. Those who need oxygen therapy as a result of respiratory conditions like COVID-19 and pneumonia, use oxygen cylinders, which are filled at oxygen plants, oxygen concentrators from air on-sites, oxygen plants that are filled directly or distributed through oxygen cylinders, or liquid oxygen which is procured from specialized gas plants and stored at a very high pressure. Due to the complex, and thus expensive, nature of getting and preserving medical oxygen, countries that lack technical training for staff, have low quality or poorly maintained equipment, or suffer with poor infrastructure and support from governments and institutions, have lower abilities to treat their patients. According to Global Health: Science and Practice, surveys in Nigerian hospitals show that despite having oxygen sources in inpatient wards, the cylinders and concentrators were “frequently empty or nonfunctional.” As the survey team testing the quality of the oxygen, they found that only 5% of the concentrators tested produced medical grade oxygen. The study continues to state that, “Procurement of oxygen equipment was haphazard, preventive maintenance was nonexistent, and hospital technicians were untrained and under-supported. Hospital nurses were unfamiliar with pulse oximetry, and the majority of hypoxemic patients were not receiving oxygen. Hospital directors bemoaned the cost of oxygen, with one director describing oxygen as his “biggest headache.” This pattern repeated itself in studies conducted in Kenya, Uganda, Papua New Guinea and other African and Asian-Pacific countries.
Hospitals, governments, and private entities a like need to find a method of increasing the supply of medical oxygen while also reducing costs and making it more accessible. By not achieving said goals, the result is the inability to treat patients and the complete collapse of health care systems as is currently happening in Manaus. Health Equality has been an important factor to consider through out the endeavor of developing vaccines, treatments, and supplies. Many worry that third-world countries will be left behind, given that they often do not have the resources to purchase or invest in essential resources. This can be exemplified in the issue of vaccine distribution given that 52 countries have begun the vaccination process, leaving the other 142 behind. According to Ankar, around 53.78 million doses of the vaccine have been administered, of which 22.55 million were in Asia, 17.75 in North America, 13.15 million in Europe, and only 330,512 in Latin America and 7,000 in Africa.
These awe striking numbers clearly illustrate the division of resources, as vaccine availability is concentrated in wealthier continents, and poorer ones are left waiting as COVID-19 cases continue on the rise. Director General Tedros Adhanim Ghebreyesus said, "I need to be blunt: the world is on the brink of a catastrophic moral failure – and the price of this failure will be paid with lives and livelihoods in the world's poorest countries.” Pfizer, the biopharmaceutical company producing and distributing COVID-19 vaccines, is projected to produce around 1.3 billion vaccines by the end of 2021, most of the doses being compromised under bilateral agreements with high-income countries that were able to secure the vaccine first.
Although treatment distribution has come to the attention of the public eye because of the pandemic, it has been a problem for decades. Education, employment status, income level, gender, and ethnicity are only a few factors that affect the allocation and distribution of health-related resources. Statistics released by the World Health Organization in 2018 indicate that developing countries account for 99% of annual maternal deaths. Mothers in the African country Chad, have a 1 in 16 chance of dying as they give birth while women in Sweden have less than a 1 in 10,000 probability of dying because of birth related complications. Furthermore, WHO also states, “Children from the poorest 20% of households are nearly twice as likely to die before their fifth birthday as children in the richest 20%.” This is a result of disparaging differences between rich and poor countries and their level of access to live-saving treatments, medications, and medical professionals.
It is easy to get lost in the bleakness of the current global situation, but it is important to be constantly grateful toward the dedicated frontline workers that put their lives at risk on the daily. In moments of darkness, it is being thankful that helps one maintain oneself afloat, and cultivate the strength to endure the following months awaiting the vaccine. Although the first dose looms, the pandemic is far from over. Now more than ever, communities must come together and practice the recommended safety guidelines, under the common purpose of keeping each other healthy. The world will recover, we will recover, and from the grief we will rise into a safer, more tolerant society.
Written By: Carolina Mejia Rodriguez
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