April 2020: The Nippon Gases Group and its respiratory therapies division Oximesa are firmly committed to assisting in the fight to tackle the coronavirus pandemic. Like so many other liquid oxygen providers, PSA system innovators and medical equipment suppliers, the company was entrenched in the frontline fight again Covid-19.

In terms of sector share, Nippon Gases is one of largest producers of medical oxygen in Europe with production plants and pharmaceutical laboratories, both for production and for filling, with a strong distribution service.

The company had highlighted the essential role that medical oxygen was playing in the fight against Covid-19, urging even back then at what we now consider the early stages of the pandemic, that it was extremely necessary to ensure the supply of not only masks or ventilators, but also of medical oxygen to hospitals, residences and individual homes. This would ultimately go onto become a painful and at times tragic lesson learned during the pandemic.

At one time back during the first wave in Europe, Nippon Gases was supplying more than 150 hospitals, 750 health centres, 1,000 small medical centres and thousands of residences with these essential items. It was a dedication made possible thanks to the constant activity of a team working 24 hours per day, and also included in-home care to more than 300,000 patients, 52,000 of which were receiving oxygen therapy.

The company was front and centre among those on the frontline of meeting mammoth oxygen demand in Europe during the height of the pandemic, and continues to be today, as and when required. As gasworld chronicles the evolving medical gases market and devotes its second successive annual Medical Gases issue largely to the lessons learned from the Covid-19 pandemic, we talked with Pasquale Di Chio – European Leader for Healthcare & Homecare at Nippon Gases Europe – about the experiences taken forward in Europe.

We all understand the importance of the oxygen supply chain

In fact, our interview was aptly timed. Di Chio explained that we caught him at a time when he is focused on the analysis of new ideas for the launch of new projects that can strengthen Nippon Gases’ offering to the healthcare market.

Looking back at arguably the greatest test of that offering’s strength over the last 18 months, he reflected, “The pandemic required the utmost effort from all companies in our sector. The commitment to support healthcare companies has been enormous due to investments to reply to the increasing oxygen demand, and due to the activity carried out by our staff, who had to continue working in the highest safety standards.”

“Suffice to say, oxygen demand increased enormously in the areas most affected by Covid-19 and this has required a huge increase of effort, people, products, cylinders and tanks, dedicated vehicles for transport, and much more. Our staff had to work tirelessly to organise supplies and respond to many requests, which were all urgent, as is easily imagined.”

“We all felt personally involved and it was a great proof of seriousness and professionalism. During such a difficult time, where the world had to effectively stop with the lockdowns, we instead had to speed up our processes and face new difficulties relentlessly – because we had to bring oxygen to both the hospitals and direct to the patients’ homes. We had to face our limitations and overcome them in a very short timeframe.”

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Source: Nippon Gases Europe

Limitations. Challenges. Difficulties to overcome. This seemed a good time to ask, what lessons do we – as an industry – need to learn from this crisis? What have we learned about the medical oxygen supply chain in Europe?

Di Chio is under no illusions that there are many lessons to be learned, and at various levels. But he summarises that perhaps the biggest learning or outcome from this has been that we all now understand the importance of the oxygen supply chain.

“We understood how important is everyone’s commitment to managing a crisis and how essential it is to work flexibly, with team spirit, in compliance with safety rules and with great confidence in one’s own means,” he said. “Hospitals have also understood the importance of the oxygen supply chain and the need to maintenance the medical gas piping systems. I think that in the future each hospital will define an emergency plan management with the suppliers and make the appropriate maintenance or improvements to the medical gas piping systems.”

“Hospitals were able to understand how important strategic stocks are and how easily the supplies of oxygen can increase: it was an important weapon in responding to the pandemic, but not all hospitals were prepared for such an attack, so a lesson to be learned is the need for prevention, the need to have state-of-the-art oxygen storage and distribution facilities, and the knowledge that together with collaboration between supplier and demander, we can win.”

In his role as leader of the healthcare and homecare business for one of Europe’s biggest and foremost industrial gas companies and oxygen producers, Di Chio is rightly proud of the efforts of both his team, his colleagues and the industry as a whole. He affirms it’s been a challenging and rewarding time, but also points to the learnings on an individual level and the great understanding he now has of other aspects of the medical gases business too.

“It has certainly been a busy year for everyone. In particular, I have followed with great interest the developments of new inhalation therapies to treat Covid-19 such as inhaled nitric oxide. Inhaled nitric oxide is well known for its properties to improve blood oxygenation in premature babies with its selective vasodilator action, but there were still no clinical studies to understand if it was also effective in Covid-19 patients,” he explained.

“From the results of the first clinical studies carried out in the spring 2020, great benefits were immediately noticed in patients and therefore, in the second wave of Covid, I supported the team with great interest in managing the growing demand for nitric oxide mixtures and machinery useful for managing this therapy.”

And what of the impact on the homecare side of healthcare services? As a society we understandably saw and heard a great deal about the impact on hospitals, field hospitals and healthcare facilities as a whole, but there has not been quite such a focus on the homecare element of the industry – perhaps largely due to this being a feature more of the advanced economies and not those so affected in low and middle-income countries (LMICs).

Asked what level of challenges were required to be met in homecare services during the past year, Di Chio described how even in this area, there were hurdles to be overcome in terms of distribution and unknown factors or protocols arising from the virus.

He said, “The commitment of homecare in the fight against the pandemic is also certainly very important with the activation of therapies with liquid oxygen in dewars or with gaseous oxygen in cylinders. The main problems we experienced, were the recovery of cylinders and dewars from isolated patients at home and the definition of safe protocols for the safe management of both patients and our operating staff.”

“To increase sensitivity to the return of dewars and cylinders, communication campaigns have been activated to ask everyone to return these tools to treat other patients and people have responded in a positive way, showing great responsibility.”

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Source: Nippon Gases Europe

Change ahead?

With all of these lessons learned, across the oxygen supply chain, the additional therapeutics, hospital infrastructures and indeed in homecare services and how these are managed, do we expect to see noticeable change ahead in the medical gases business?

Again, Di Chio and Nippon Gases are under no illusions about the changing face of the medical gases scene in the years to come – and further still, the necessity for that change. He concluded, “Everyone now knows much more about the importance of homecare and the role it plays in the strategic management of patient care. In the near future it will be essential that governments continue to improve the management of the territory with homecare, developing better synergies between hospital care and homecare – even with digital tools, such as telemedicine.”

“And the importance of oxygen in hospitals will grow. For a long time there has been talk of using self-produced oxygen in hospitals, but now it has been found that delivery solutions such as liquid oxygen are more efficient, reliable and safer in terms of flexibility and quality, especially when it is necessary to increase the quantity and have a high-quality drug to fight respiratory diseases such as Covid-19.”

“High flow oxygen therapy has proved very useful for Covid-19 patients in hospitals and will play an increasingly important role not only in hospitals but also in homecare.”