In the past five days we have seen headlines that oxygen is in short supply across Europe and the US. Unlike the carbon dioxide shortage two years ago, this would, if true, have significantly more consequences and would be a matter of literally life or death!

There is no doubt that a few hospitals have experienced low levels of oxygen or a lack of cylinders but it would be wrong to assume there will be national shortages of oxygen. It is important to understand both the current supply situation and the measures the gas companies are taking in order to supply the significant increase in demand due to Covid-19.

Firstly, oxygen is available in huge quantities as it makes up 21% of the air we breathe (in comparison CO2 is 0.04% and is produced as a by-product of industrial processes). The air separation plants that separate the oxygen from the air for industrial and medical purposes exist in most countries around the world and in the industrialised countries; the air separation units are widely dispersed across the country and the production capacity is significant.

Source: gasworld Business Intelligence

Figure 1: European ASU map

Source: gasworld Business Intelligence

Figure 2: US ASU map

While much of the installed capacity supplies major industries such as steel and petrochemicals – many of these plants produce liquid oxygen (LOX) and nitrogen (LIN) for the merchant (bulk and cylinder) markets.

Medical oxygen use (in hospitals and at home) normally accounts for around 15% of the use of merchant oxygen. The key is more about how oxygen gets supplied to the patient – whether at home or in the hospital. Oxygen separated from air for distribution is either trucked in liquid form (LOX) to the hospital that has specialised storage tanks that feed the gas into the hospital or it is compressed into metal cylinders that vary in size from five litre water capacity to 40/50 litre capacity.

In the latter case – there are certainly millions of cylinders in use or circulation – of which probably 15-20% of the pool are used to supply patients with oxygen but as you can imagine, it is a logistical issue to manage that number of cylinders – especially when the demand has become ever more fragmented with the temporary hospitals and triage tents being set up across badly affected regions.

At this moment in time, the industrial and medical gas suppliers have reported a rise in demand for medical oxygen of between three and five-fold – in both liquid and cylinder form. According to gasworld’s Business Intelligence service, Europe’s liquid oxygen nameplate capacity amounts to 31,000 tons per day (tpd). Total demand (including all industrial uses) is around 24,500 tpd of which medical oxygen use has a normal run rate of 3,150 tpd or about 10% of nameplate capacity.

Based on publicly available data and growth predictions of hospital admissions due to the virus, gasworld has calculated that the realistic growth in demand would rise by another 2,300 tpd but this would only represent another 7% of the LOX capacity. Even if it tripled there would be sufficient production capacity to supply the demand.

According to gasworld’s Business Intelligence service, the US liquid oxygen nameplate capacity amounts to 33,200 tons per day (tpd). Total demand (including all industrial uses) is around 26,000 tpd of which medical oxygen use has a normal run rate of about 2,000 tpd or about 6% of nameplate capacity.

We have calculated that the realistic growth in demand would double or triple the daily demand from the medical sector, but this would only represent an increase of between 6-12% of the LOX capacity.

Source: gasworld Business Intelligence

Figure 3: Impact on Covid-19 cases on oxygen demand

Figure 3 presents the expected increases in oxygen demand over the next few months showing the US will be higher. One reason for this is the general lower number of beds they have per 1000 population when compared to Europe. This shows that the larger concern in the US is surrounding the lack of beds than the shortage of oxygen.

So one can summarise that despite a significant increase in demand for medical oxygen, there should be sufficient capacity to meet the increased demand – especially when some of the other industrial segments consuming oxygen are down on volume due to factories and/or manufacturing facilities closures or turn-downs.

Another issue is over regulatory standards and that liquid or compressed oxygen supplied to hospitals has to be 99.99% pure and medically certified by the FDA (in the US) or to European Pharmacopeia standards (in Europe). Most liquid oxygen produced is of 99.99% purity but not all the volumes or the distribution equipment are certified for medical use.

In Europe, some of the medical and industrial gas associations are seeking approval to temporarily extend cylinder testing timelines (pressure testing) in order to free up more cylinders that would normally be sat around waiting to be tested at approved testing facilities.

We have also heard that some companies are seeking approval to convert cylinders used for other gases or industrial oxygen over to medical oxygen use. This does have health and safety implications, but the priority is to get the oxygen to the patients. Regulatory bodies across Europe and the US will have to show more flexibility to ensure oxygen gets to where it needs to be.

We have also seen some very quick and imaginative work by gas companies working with medical authorities setting up temporary hospitals in conference centres across Europe. Already well reported were the combined efforts of Air Products and Air Liquide to install 7km of pipelines in the IFEMA Convention Centre in Madrid so that each bed could be supplied directly via pipeline supplies from liquid storage tanks located outside of the venue. In London, the Nightingale Hospital, set up in the ExCel Conference Centre, is opening up for service with 4,000 beds – Europe’s largest hospital (albeit temporary) – BOC, part of the Linde Group, has installed four miles of pipeline and associated valve and regulator systems to supply all 4,000 beds. Using trucked-in LOX supplies to the liquid storage outside the venue – this hopefully will mean the 3,000 high pressure cylinders also marked for use there could be used elsewhere. These are just two examples of how the medical gas suppliers are thinking rapidly to ensure sufficient supplies of oxygen are where and when they are needed.

Logistically, there should be enough tankers and tanker drivers to supply the liquid storage facilities across countries or deliver cylinders to the hospitals. As a contingency, the gas companies are working with hauliers and the military, to train a pool of reserve drivers to be able to truck, and more importantly, safely fill the liquid tanks and/or deliver cylinders.

Regarding cylinders – in both Europe and the US, there are over 45 million cylinders in use in each region – however we can say only 15-20% of this pool of cylinders are currently certified for medical oxygen service. Both regions have steel and aluminium cylinder manufacturers that have no doubt ramped up production to meet additional demand.

Obviously, alongside the need and use of cylinders are the valves and regulators which have to be medically conditioned as well as be fit for oxygen service. The producers of these items have also ramped up production to meet the demand from the gas companies and also the hospitals.

Therefore there is a complete supply chain responding to the needs and the demand. Yes, we will probably hear of some hospitals going ‘critically low’ in oxygen supplies but the medical gas suppliers across the world are responding to this demand. In both Europe and the US there is no real shortage of oxygen availability, the gas companies are managing the logistics for both liquid and cylinder supplies and ‘thinking out of the box’ and responding rapidly to changing events to ensure oxygen supplies get to the patients.

The demand will increase further as many countries have not seen a peak in virus cases yet but as the supply of respiratory ventilators improves, that either don’t need oxygen or only use oxygen enriched air, this may also help ease the concerns on oxygen supply to the ever-increasing patient needs. Yes, there is an extremely urgent timeline as each day we see more patients dying but there is no need for sensationalist or unhelpful headlines that mask the efforts being made.

Many medical gas suppliers (and equipment manufactures), too many to mention here, are responding to the Covid-19 crisis – we (gasworld) thank them for their service, speed and support to the general public.