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November 2021 Issue 199-Food and Beverage
Gasworld US Edition, Volume 59, Issue 11 (November)-LNG
Author: Rob Cockerill, Global Editor-in-Chief2021-10-27T07:00:00 01:00
The Covid-19 pandemic is a preventable disaster, with weaknesses in every link of the chain of preparation and response.
This is a summary of the findings of a report by the Independent Panel on Pandemic Preparedness and Response, entitled Covid-19: Make it the last pandemic. The report concluded that the alert system is too slow, the World Health Organization (WHO) is insufficient and lacks global political leadership.
According to an article published by BMJ on May 13, 202193, the 13-member team spent eight months reviewing the evidence on the spread, actions, and response of the pandemic, and finally in May 2020 The report was commissioned by the Director-General of WHO. It described Covid-19 as a terrible wake-up call and "the Chernobyl moment of the 21st century." Furthermore, it curses that, as far as the current situation is concerned, the system is not suitable for preventing another new and highly infectious pathogen that may emerge at any time from developing into a pandemic.
The question is, is our oxygen preparation one of the key weaknesses in this response?
Medical oxygen shortages around the world have always been a tragic feature of this pandemic, appearing in both advanced and emerging economies, but there is no doubt that the impact on the poorest countries is disproportionate.
Before Covid-19, these access difficulties were deeply ingrained in many parts of the world and were exacerbated by the pandemic, putting pressure on fragile health systems and leading to preventable deaths.
PATH estimates on June 29, 2021, a global non-profit organization that aims to improve public health, indicated that approximately 1 million severe Covid-19 patients in low- and middle-income countries (LMICs) need 2 million oxygen cylinders (1420 Million cubic meters) currently every day. These needs were not met at all, but it has been more than a year since the pandemic broke out.
Leith Greenslade, founder and CEO of JustActions and coordinator of Every Breath Counts Coalition, has always bluntly believed that we are not prepared for the Covid-19 pandemic. In addition, she believes that the response to the Covid-19 pandemic was hampered by the main focus on vaccines because it was necessary to pay equal attention to treatments such as vaccines, tests and oxygen "from the beginning".
The Every Breath Counts Coalition is an important part of the Covid-19 Oxygen Emergency Working Group. The working group is led by Unitaid and Wellcome, a group of partners under the ACT-Accelerator Therapeutics pillar, respectively announcing the unprecedented signing of agreements with Air Liquide and Linde. Medical oxygen protocol. June 15 (2021). As early as 2013, the alliance has been working to coordinate greater access to oxygen in low- and middle-income countries, and has determined that the inability to obtain medical oxygen-liquids, plants, and concentrators-is a major risk to life in the southern part of the world, and it also leads to a large number of Death, especially in children with severe pneumonia.
When the Covid-19 pandemic hit, this risk escalated into tragedy in almost all age groups and brought the issue of oxygen supply into focus. "We knew it would be a nightmare (oxygen). We just knew that we were observing," she told gasworld 94 in an exclusive interview.
"We have seen international agencies mobilize around the topic of vaccines. This is obviously crucial: we need a vaccine, and they have put a lot of effort into it. We think this is good, but what about oxygen?"
"If you don't make the same effort for oxygen, and your country waits for a vaccine for a long time, that's the secret of mass death-unfortunately, this is how it happened."
Greenslade believes that global health leaders and political leaders have a "blind spot" in the supply of oxygen, and likens their response to the pandemic to a vaccine-focused "single-legged stool." It seems that the number of casualties and statistics in the past 15 months are not enough. This method is now the focus of attention again. Several countries in Africa, Latin America and Southeast Asia have reported a "worrisome surge" of Covid-19.
She affirmed our lack of preparation. She explained: “This is not just the industry’s fault. Global health leaders and political leaders who support the global Covid response have blind spots in oxygen. I don’t think they know it is in Africa, Not available in hospitals in Asia and Latin America. I think they just take it for granted."
"The international community has always been very concerned about vaccines, and we are critical of it. I have said publicly that during a pandemic, you will never put all your eggs in one basket, because these pandemic beasts are unpredictable. ——You are not sure what you are dealing with or how it will turn. You need to be equally proactive in prevention, diagnosis and treatment."
"We need to give equal attention to vaccines, diagnostic tests, and treatments from the beginning. Each item requires equal funding and an equal partnership with the industry—and we don’t. We have a one-legged stool with vaccines. For the key point, they now realize that their approach is wrong, because Africa is responding to the third wave of the epidemic, and the vaccine coverage rate is only 3%. 97% of Africa is not vaccinated, and they do not have oxygen."
There are good reasons to believe that there is indeed a blind spot in the supply of oxygen.
Twelve months ago, we were all familiar with high-profile headlines about oxygen supply in Europe and the United States, when these two regions were at the center of the pandemic. The established hospital infrastructure does not seem to be prepared for the huge quantities that need to be processed during the peak of the pandemic, and new field hospitals require a large amount of additional supplies, and are also responsible for adding medical oxygen cylinders and filling them.
In the past 12 months, Peru and Brazil in South America, especially in India and Nepal in recent months, have also experienced an oxygen crisis-when the whole world mobilized through roads, railways, rivers and air.
But Greenslade also pointed out that the lack of data highlights this sense of blind spots. "The lack of oxygen data is the fault of global health leaders, such as the World Health Organization and UNICEF-none of them have good oxygen data. In the first six months of the pandemic, they were scrambling to obtain information about the supply of oxygen in hospitals. What has been done and there is no data," she said.
"If we had this data and had a proper plan, we could have acted faster."
Since March 2020, in many interviews with gasworld, industry insiders generally believe that the supply chain is not prepared for this kind of demand. Scrambling to assemble the extreme oxygen and related equipment needed. Let's look at some examples of random selection.
In May 2020, as an enthusiastic supporter of on-site generators, AirSep Corporation was asked by gasworld whether this unexpected crisis revealed the role of oxygen generators in the medical field. Vice President and General Manager Lawrence J. Hughes replied: "Yes, of course... At the beginning of the crisis, people paid great attention to ventilators, but globally, we see clinicians and rescuers Raised awareness of the need for ventilators to provide adequate oxygen supply to communities that have been hit hard by the virus."
"We have seen increased demand for stationary oxygen generators, liquid oxygen storage containers, and medical oxygen generators from customers around the world, especially those who provide emergency assistance in hot areas of the pandemic." 95
PSA system manufacturer INMATEC shared this view in an interview with gasworld in August 2021. Dr. Peter Biedenkopf, General Manager of INMATEC, said: “Yes. Due to limited logistics, the increasing demand for oxygen has led to a shortage of liquid oxygen in many countries. Hospitals all over the world are aware that in order to ensure patient care, oxygen supply must be redundant in the future. I design, this is very important."
"In areas where LOX (liquid oxygen) drugs are not available at all or only at high prices, pure PSA supply including a redundant design with two systems and an additional storage tank will be the technology of the future." 96
Nippon Gases Europe is a more traditional bulk liquid oxygen supplier and was at the forefront of meeting Europe's huge oxygen demand at the height of the pandemic last year. When asked what lessons we learned in the medical oxygen supply chain, Pasquale Di Chio, Head of Healthcare and Home Care Europe at Nippon Gases Europe, told gasworld in an interview in August 2021, “We understand everyone’s role in managing the crisis. How important is his commitment, and the most important thing is to work flexibly, have a team spirit, abide by safety rules, and be confident in his own methods."
"The hospital also understands the importance of the oxygen supply chain and the necessity of maintaining the medical gas pipeline system. I think in the future, every hospital will work with the supplier to develop an emergency management plan and properly maintain or improve the medical gas pipeline system."
"Hospitals can understand the importance of strategic reserves and how easy it is to increase oxygen supply: This is an important weapon in response to the pandemic, but not all hospitals are prepared for such an attack, so the lesson worth learning is that prevention is needed. With the most advanced oxygen storage and distribution facilities, and knowing that through cooperation between suppliers and demanders, we can win."
"The importance of oxygen in hospitals will increase," he added. "For a long time, people have been talking about using self-produced oxygen in hospitals, but now it is found that delivery solutions such as liquid oxygen are more efficient, reliable and safe in terms of flexibility and quality-especially by increasing the quantity when necessary and having high-quality Drugs to combat respiratory diseases such as Covid-19. Facts have proved that high-flow oxygen therapy is very useful for Covid patients in hospitals, and will play an increasingly important role not only in hospitals but also in home care.” 97
This is just a preliminary investigation of dozens of interviews published by gasworld since the beginning of the pandemic, but clearly supports the argument that the oxygen supply chain is not prepared for this situation. What about the broader oxygen infrastructure? In Europe, at the peak of the 2020 spring and summer pandemic, hospitals are struggling to cope with the required oxygen flow, even if oxygen is available and provided, as described by Di Chio above.
Source: Derek Oldfield/Shutterstock.com
Leeds, Yorkshire, October 2021: Liquid oxygen tanks in a hospital environment.
This is a lesson that has recently appeared in the news, although it can easily be largely ignored. Gasworld only reported in July 2021 how the Medical Safety Investigation Service completed its investigation of providing pipeline oxygen supply to British hospitals, and concluded that the existing infrastructure can be improved to ensure that the hospital meets the oxygen flow demand98.
The report, entitled Oxygen during the Covid-19 pandemic, is dedicated to investigating the limitations of pipeline oxygen delivery to hospitals and discussing the role of engineering experts and medical gas committees in pipeline oxygen supply. The investigation explored a reference event when the demand for oxygen supply through its Medical Gas Pipeline System (MGPS) resulted in patients being transferred to a different hospital, selective (planned, non-emergency) surgery was cancelled, and the ward environment needed to be reconfigured .
In addition, the report states that the trust fund is beginning to identify mitigation measures to enable it to test MGPS in high-dependency units (HDU). It also noted that the Trust Fund conducted stress tests on MGPS to identify failures, and as a result, identified several areas where the ability to provide expected oxygen flow from MGPS was reduced.
Although the trust fund understands that the HDU should be able to provide a specified oxygen flow rate for a certain number of patients, the report found that the expected oxygen flow rate to the HDU and other wards is affected by the early oxygen influx and the demand from the MGPS system before the pipeline reaches the HDU. It was found that because the overall demand for MGPS never exceeded 56% of its total capacity, the trust fund had excess capacity to generate oxygen. Therefore, the investigation concluded that the limitations of the Trust’s existing pipeline infrastructure caused the HDU to lack available oxygen flow.
Other influencing factors include the distribution of patients throughout the hospital and the type of oxygen therapy required to treat patients throughout the hospital.
From the survey, the report proposed several solutions that can be studied to prevent oxygen shortages in the future when they are most needed. One of the main findings is the lack of investment in MGPS itself. A safety observation suggests that if medical gas pipeline systems are prioritized for financial investment and ongoing management, and they may not be able to meet the expected clinical needs in the future, this may be beneficial. '
It is also recommended to update key technical documents to reflect the latest developments in healthcare. The report pointed out that the last update of the MGPS Health Technical Memorandum was in 2006.
HSIB investigation director Dr. Stephen Drage said: "Our investigation emphasized the importance of MGPS. If it fails, the impact will be huge."
"Any unbalanced demand in the pipeline may mean that the oxygen concentration in one area-such as Covid-19 patients-may lead to a decrease in oxygen concentration elsewhere. The health of patients may be at greater risk because they may have to Make difficult decisions about the priority of care to ensure that enough oxygen is distributed throughout the hospital."
"We recognize that the NHS must adapt to this unprecedented speed of demand."
In order to have a balanced discussion on the preparation of the oxygen supply chain, one must question the feasibility of anticipating unexpected events-and be able to respond under such pressures.
As the author wrote in a column in May 202199, there are several industrial gas economics factors at play when considering oxygen preparation, not to mention the practicality associated with these factors. Under the circumstances, all of these are based on huge unpredictability.
In any story of shortage, of course there is always a supply and demand problem. The impact of Covid has pushed us to the brink of (or even further) the demand for fundamentals such as oxygen, ventilators, ICU beds, and all necessary infrastructure and supplies. All of this has appeared on a scale that has not been witnessed in nearly a century. The supply chain was not designed for this at all; how could they be?
When it comes to the oxygen supply chain, generally speaking, it is not due to insufficient production capacity. We often return to the same basic principle: cylinders and delivery. In most hospitals around the world, the supply of oxygen depends on the use and supply of gas cylinders. This is especially true for temporary field hospitals, even in the wards of dedicated medical institutions.
Even in advanced developed economies, where a large amount of oxygen is directly supplied to the pipeline system of the facility, the same hospital infrastructure usually cannot cope with the increase in the large amount of low-temperature supply. As discussed earlier, it is not designed to deal with this kind of demand/scenario at all.
In situations where bulk supplies are not so easily available and transported in-whether by road, rail or river-there is usually still a problem of filling additional bulk supplies in cylinders. There may be other complications, some of which are also caused by Covid. Are there enough cylinders in the partial circulation? As Covid hits the entire transportation and industrial labor force, are there critical points in the delivery of gas cylinders or circular logistics, all aspects of infrastructure disruption? Are empty cylinders effectively returned from the hospital or crisis center, ready to be flipped and refilled?
Erlangen, Germany, May 2018: An external liquid oxygen supply tank at the University Hospital of Erlangen (Universitatsklinikum Erlangen), Germany.
Stephen B Harrison, a former industrial gas professional, current consultant, and managing director of sbh4 consulting company, put forward that it is not just the production capacity of oxygen that needs to be questioned, but the preparation of the entire distribution and value chain. Harrison has more than 30 years of experience in the global industrial and specialty gas business and was a member of the panel on gasworld TV’s April 23 webinar on Covid-19 and Medical Gases: Lessons Learned in the Past Year.
The webinar was held on the same day as gasworld reported that India is seeking emergency help from the international industrial gas community to meet its oxygen needs. Therefore, although India has naturally become the focus of attention, Harrison’s discussion focused on how Europe and the European continent are responding to the epidemic for just over a year.
"In Europe, fortunately we overcame the impact of challenges last year," he said. "That's really when we had to install all the infrastructure in place to increase the amount of oxygen we can supply to the hospital. I think this reminds us that the industrial gas industry is both a natural gas distribution business and a natural gas production business."
"In addition, it also reminds us that molecules and what we do is only one link in the chain, which is also absolutely necessary. From molecular production to liquid storage tanks to patients, we must look at all the links in the chain, any of them Either link can become a bottleneck. Maybe we can’t make enough molecules, maybe we don’t have enough storage tanks to put the molecules into it, or the natural gas pipelines inside the hospital need to have high capacity.”
"Solving all these challenges and solving them is really what we did in the first six months of last year. To be honest, oxygen supply is the least of these problems, and we need to reflect this."
"Europe is a highly industrialized region in the world. The amount of oxygen used in oil refineries, steelmaking or other heavy industrial applications is very large. Compared with this, the amount of oxygen used in medical applications is quite large. Small."
"So even if the hospital’s oxygen demand increases substantially, as it does, [it] will only consume the overall oxygen supply here in Europe. For other parts of the world that are not highly industrialized, the oxygen demand in some countries will increase. Doubling actually means doubling the country’s oxygen demand. Therefore, for many, many reasons, we have always been a very good place in Europe, much better than in many other places in the world." 100
This is a complex supply chain, and there are multiple potential bottlenecks during the social and industrial crisis. As Harrison suggests, even the most advanced and industrialized economies have proved this.
Chiang Rai Hospital, Thailand, January 2016: Liquid oxygen tank and vaporizer installation.
Even in the field of PSA and VPSA systems, as well as oxygen concentrators, although they have proven to be particularly promising during this pandemic, they are not without their own important considerations—especially those that need to consider orders and physical dimensions. Delivery time is used for containerized or skid-mounted installations. This is another challenge of unpredictability.
We must remember that this is an unprecedented pandemic in more than a century. This is the point made by Martin Litvik, Commercial Director of Cylinders Holding in the Czech Republic in an interview with gasworld in April 2020. At that time, Cylinders Holding was one of the few companies in Europe that manufactured medical oxygen cylinders. The Covid-19 crisis and Litvik said: “Frankly, we have never seen such a high demand and demand for oxygen cylinders. The demand is 30-40 times the usual. For anyone diagnosed with Covid-19 For patients, oxygen is more important than ever." 101
This seems to be a very obvious point, but the scale of increasing the demand for oxygen cylinders by at least 30 times is huge. In terms of pure numbers, this means that there were approximately 35,000 finished medical gas cylinders in April, while the "normal" monthly production volume is about 1,000-1,500 medical gas cylinders.
When asked if the company has learned any lessons from the crisis, even in the early days of the April 2020 pandemic, Litvik said: “This is a very difficult question because in the modern era or era, we don’t have enough Experience an epidemic/disaster of this scale. I think it’s very important to remember that we need to be more prepared than ever before we can accept any change. Literally, everything is possible now."
"The company needs to organize in a more flexible, effective and adaptable way in order to meet any challenges."
It can be said that the oxygen industry has been disappointed by governments and leaders around the world because of the lack of awareness of the importance of gas as a medical treatment.
In fact, Litvik stated in an interview in April 2020 that the biggest lesson is arguably learned at the political level and in the process of preparing for this situation. "We can say that this is an unprecedented situation, but now we have the opportunity to prepare again. The state and the government should invest in the establishment of a national medical gas cylinder material reserve in case of a disaster or emergency."
"They said'if you want peace, prepare for war'. Oxygen cylinders have been proven to be the basis for the treatment of Covid-19. As we all know, even British Prime Minister Boris Johnson said, "They saved my life." He Received oxygen therapy, so it goes without saying."
"We must invest in a retail structure so that anyone can buy cylinders filled with oxygen."
If this is a common theme of the conversation, as Greenslade described, then can we question whether health leaders and political leaders have "blind spots" in the supply of oxygen?
Litvik observed in April 2020 that even if the pandemic has hit some regions and supply chains, "now we have a chance to prepare." However, we still don’t have oxygen products or gas cylinders ready to transport them around the world in response to the second and third waves of the virus, as demonstrated in Africa, Brazil and India, for example. So, can it also be said that the industry has been harmed by the relative inaction and/or slowness of these governments or leaders in responding to Covid-19?
As mentioned earlier in this chapter, when we begin with the findings of the pandemic report commissioned by the WHO, some people think that a pandemic is a preventable disaster, with weaknesses in every link of the chain of preparation and response. The report called Covid-19: Making It the Last Pandemic came from the independent pandemic preparedness and response team. Clinicians in Wuhan, China, quickly discovered an abnormal cluster of pneumonia of unknown origin in late December 2019. However, the notification and emergency declaration procedures under the formal international health regulations are too slow and waste time. The expert team found that WHO should declare a global emergency a week earlier than January 30.
Too many countries subsequently adopted a "wait and see" attitude. Therefore, February 2020 is a "lost month" when measures can and should be taken to curb the spread of SARS-CoV-2. Only a few countries have adopted comprehensive and coordinated measures to control and prevent the spread of the virus. Many countries only start to act when hospitals begin to be overwhelmed. The countries with the worst results have adopted an uncoordinated approach, degrading the value of science and denying the potential impact of the pandemic 102.
This seems to be the conclusion of a report specifically commissioned to study the global response to Covid-19. In addition, it was reported that Ellen Johnson Sirleaf, the co-chair of the group and former President of Liberia, added: “The storage shelves of the United Nations and capitals are full of reports and comments on previous health crises. If their warnings are received Pay attention, we could have avoided the disaster we are facing today. This time it must be different."
The report made several recommendations to stop the current spread of Covid-19 and prevent future outbreaks from becoming a pandemic. Among them, particularly interesting in the preparation of the oxygen supply chain is the suggestion that the international leaders of the G7 should immediately commit to 60% of the US$19 billion (£14 billion; €16 billion) needed to obtain Covid-19. Tool accelerator for vaccines, diagnosis, treatment, and strengthening of health systems in 2021.
Then it is clear that the oxygen supply chain is not prepared for the Covid-19 pandemic. It seems that all parties to the Oxygen Roundtable were not prepared.
If this is within the range foreseen by the Every Breath Counting Coalition and the Oxygen Task Force, as we have heard, they have been fighting for more oxygen in LMICs for years before Covid, then this will not be questioned. Why is there actually not an oxygen roundtable at all?
This is the biggest problem here, whether in the continuation of the pandemic or in terms of the lessons to be learned?
"Think of it this way: If we don't sit down and talk with pharmaceutical companies such as Pfizer, how can we reach an agreement on a Covid-19 vaccine, let alone develop and distribute it?" Greenslade said in another gasworld interview. Reflected on the importance of the recent breakthrough oxygen agreements with Air Liquide and Linde respectively103.
"A basic prerequisite during a pandemic is that you have an ongoing conversation with the industry on one of the main solutions to reduce deaths. We have already had a conversation with vaccines, and we have had conversations with diagnostic tests and other kinds of drugs (such as steroids). Dialogue, but we have not yet established a partnership with the oxygen industry-not before Covid, or for the first year of Covid. This is the first concrete example of direct cooperation with the oxygen industry, as the World Health Organization now calls it The most basic medicine for the treatment of Covid-19-oxygen."
“When you say that, it’s shocking,” she added. “We have entered this pandemic, and the essential medicine for Covid patients-oxygen-has no cooperation of any kind. Now we have this. One point, there are at least two oxygen giants. It is great that we have these two players, but we do need to actively engage and reach agreements with all the leading oxygen suppliers in the liquids, PSA plants, and concentrator fields."
Even at the time of writing this report, the question remains as to why there are still only two "big giants" in the oxygen industry sitting at the table and committed to establishing these partnerships. Are there market competition issues, regional dynamics, or even the inherent reluctance/misunderstanding that may need to be overcome in order to promote a truly joint global oxygen emergency response? If oxygen is a prerequisite, an essential medicine that has been so painfully proven, then obviously more adequate preparation is a basis.
93BMJ 2021;373:n1234, published on May 13, 2021. (https://www.bmj.com/content/373/bmj.n1234) 94 https://www.gasworld.com/exclusive-oxygen-now-part- of-public-health-architecture/2021156.article 95 https://www.gasworld.com/a-third-way-onsite-oxygen-generators/2019596.article 96 https://www.gasworld.com/10-minute-withdr-peter-biedenkopf/2021466.article 97 https://www.gasworld.com/covid-19-and-the-impact-on-healthcare-businesses/2021456.article 98 https://www.gasworld. com/hsib-releases-report-on-uk-oxygen-supply-issues-during-pandemic/2021192.article 99 https://www.gasworld.com/oxygen-preparedness-vs-unpredictability/2020867.article 100 https: //www.gasworld.com/covid-19-and-medical-gases-lessons-learned-one-year-on/2020806.article / https://gasworld.tv/covid-19-medical-gases-lessons- Study for one year/101 https://www.gasworld.com/oxygen-demand-up-to-40-times-greater-than-usual/2019184.article 102 BMJ 2021;373:n1234, published 13 2021 5 moon. (Https://www.bmj.com/content/373/bmj.n1234) 103 htt ps://www.gasworld.com/beyond-covid-medical-oxygen/2021401.article
https://www.gasworld.com/exclusive-oxygen-now-part-of-public-health-architecture/2021156.article
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https://www.gasworld.com/10-minutes-withdr-peter-biedenkopf/2021466.article
https://www.gasworld.com/covid-19-and-the-impact-on-healthcare-businesses/2021456.article
https://www.gasworld.com/hsib-releases-report-on-uk-oxygen-supply-issues-during-pandemic/2021192.article
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https://www.gasworld.com/beyond-covid-medical-oxygen/2021401.article
Can we say that our oxygen needs have been met? How are we prepared to deal with Covid-19, and how will we prepare in the future? Is it time to make a global estimate of the number of deaths caused by a lack of medical oxygen? all these are...
In the final analysis part of this exclusive series, we will ask how we are preparing for the next pandemic. If needed, is our oxygen supply chain ready? Have we learned the lessons of the Covid-19 pandemic? Can we even expect to improve our response?
In Part 7 of this exclusive series, we asked whether our oxygen preparedness is one of the key weaknesses in the global response to Covid-19. In Part 8, we picked up the baton and asked what we think about whether the barrier between industrial oxygen and medical oxygen has been broken?
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