Role of Oxygenation Devices in Alleviating the Oxygen Crisis in India

Abstract

SummaryIntroductionThere has been an unprecedented increase in global demand for medical oxygen equipment to solve the acute oxygen shortages caused by SARS-CoV-2 infection. The study aims to assess the value of improved access and use of OCs and cylinders during the COVID-19 pandemic in India. This evaluation is relevant to strengthening health systems in many resource-constrained LMIC settings.MethodsUsing a Probability Proportional to Size (PPS) sampling method, primary surveys were conducted in 450 health facilities across 21 states in India. The primary outcomes measured were self-reported utility of oxygenation devices in meeting the oxygen demand in the short-run and long-run utility of devices compared to the pre-oxygen-devices-distribution-period. We perform bivariate and multivariate regression analyses.ResultsAround 53-54% of surveyed facilities reported that the distributed oxygenation devices helped meet oxygen demand in the short run and are expected to increase their long-run capacity to admit non-COVID patients with oxygen needs. Timely availability of technicians was associated with meeting oxygen demand using the additional oxygenation devices at the facilities. Facilities that increased the number of staff members who were able to administer oxygen devices were at higher odds of reducing the administrative load on their staff to organize oxygen support in the long run. Hospital infrastructure was also associated with the long-run outcomes.ConclusionWe find that oxygenation devices such as cylinders and OCs were useful in addressing the oxygen demand during the COVID-19-related oxygen emergency. Overall production of oxygen to meet the demands and investments in training personnel to administer oxygen could help save lives.FundingNoneResearch in ContextWhat is already known on this topic?Oxygen therapy is an essential medicine for the treatment of severely ill patients with COVID-19. Availability of adequate oxygen support was therefore crucial for every health facility that serves COVID-19 patients, particularly in low-resource settings. Medical equipment donation to low-resource settings is also a frequently used strategy to address existing disparities, but there is a paucity of reported experience and evaluation of the impact of these devices. Challenges such as infrastructure gaps, lack of technological and maintenance capabilities, and non-prioritization of essential supplies have previously been highlighted in other developing-country contexts.What this study adds?Timely availability of technicians, the average load of COVID-19 patients during the second wave, and timely availability of oxygenation devices such as OCs were factors associated with the additional oxygenation devices having a significant impact on meeting the oxygen demand at the facility. Further, facilities that increased the number of staff members that were able to administer oxygen devices at the beginning of the second wave were at higher odds of expecting a reduction in the administrative load on their staff to organize oxygen support in the long run.How this study might affect research, practice or policy?This is the first study to demonstrate the utility of oxygen devices such as cylinders and OCs in meeting oxygen demand during the COVID-19 oxygen emergency.Prior findings of the literature from other LMICs stress the importance of hospital infrastructure such as power outlets in the effective use of these oxygen devices. Our analysis also finds these barriers to be significant and additionally suggests that the timely availability of oxygen administrators and technicians is crucial in the utilization of these devices.