One has to wonder when we’ll see the end of these devastating stories of Covid waves and resulting oxygen supply that seems to ebb more than it flows, at least on the face of it.

We’ve seen and endured such catastrophic tragedy and human loss. Our thoughts at gasworld continue to be with all those affected, then and now, and sadly still to come in the future.

With each new variant we grimace and hold our breath. With each new milestone in vaccination, we let out small gasps of relief at these glimmers of hope towards that collective path out of this nightmare.

We thought at many points in 2020 and in many regions of the world that we’d seen the crescendo of this pandemic. We saw colossal epicentres of death, disorder and societal destruction move and pulse across the globe from March to October last year. We saw a calming, of sorts, before the next deadly wave began again at speed.

But as someone said to me yesterday, “As new Covid-19 waves continue to affect poorer countries and regions, we will continue watching its devastating effects, putting in evidence how poverty, low health infrastructure and the uneven distribution of vaccines all make the situation worse.”

True enough, now we see stories daily of new lows in India’s struggle with Covid cases and fatalities; of whole hotspots simply running out of oxygen. We’ve seen sights we perhaps never thought we’d see, as liquid oxygen tanks and tankers are driven onto military aircraft and literally dropped off at their point of need.

Read more: India oxygen crsis – supplies arrive from overseas

We see Covid continuing to escalate out of control across South America as the continent enters its winter season and industrial gas companies alike all raise alerts to unsustainably high medical oxygen demand.

How long until Africa becomes the latest region to be the subject of such scenes?

I sat through a WHO webinar on medical oxygen preparedness only yesterday afternoon, during which Africa was mentioned numerous times. Amidst discussion of oxygen ecosystems, sources and production, it was acknowledged that there is a need to be more strategic and expansive in meeting the medical oxygen needs of various regions.

There was naturally talk of scaling up and accelerating the roll-out of oxygen and air separation. We heard explanation of the infrastructure and hospital installations required, as well as the various components and equipment required. There was also discussion of the role of PSA/VPSA units, but with the caveat that there is often not enough lead time to get PSA plants or even liquid oxygen systems and infrastructure in place for certain remote regions, once a crisis is in progress.

gasworld's Molly Burgess sits down with Global Managing Editor Rob Cockerill, to ask why a story of medical oxygen supply in Brazil was among his Q1 20201 Editor's Picks.

One has to wonder how long it is before we see the same distressing scenes as we’ve observed in India and South America in recent weeks and months. Let’s hope that isn’t the case.

I understand that in Morocco, a North African country closely linked both geographically and economically to Europe, there is a state of unofficial lockdown that is keeping the spread of the virus in check. At the opposite end of the continent, in South Africa, my understanding is that tight lockdown rules have prevented an epidemic getting out of control, but its vaccination programme is still slow to hit its stride. The country is on alert – vigilant with new variants, conscious of the situations in geographies like India.

But what of the many other countries and corners of Africa?

Preparedness vs practicalities

It’s worth reiterating that all issues with oxygen availability are, generally speaking, supply chain driven and not about actual capacity.

Of course, there are exceptions to that rule; we heard of sheer quantities of oxygen having to be delivered into Brazilian hotspots like Manaus in early 2021, and of course in India in just the last fortnight with those aforementioned scenes of oxygen tankers being dragged and dropped into the country and the issuance of an international tender for 50,000 tonnes of liquid oxygen.

Read more: India reaches out to global industrial gas community for help

But more often than not, it’s about the wider supply chain and the bigger picture that we’re looking at here. This was the sentiment coming out of yesterday’s webinar gathering of WHO and UNICEF too, which explored everything from liquid oxygen production to VPSA units and installations. This is about preparedness; but how can you prepare for something that you don’t necessarily know is going to happen?

There are several factors of industrial gas economics at play here, not to mention the practicalities relate to those, all of which are underpinned in this instance by a huge sense of unpredictability.

In any story of shortage there is of course always a question of supply and demand. The impact of Covid has pushed us to the brink (and beyond) of demand for oxygen, ventilators, ICU beds to name a few fundamentals, and all of the necessary infrastructure and supply around those. This has all been seen on a scale not witnessing for almost a century. Supply chains were simply not designed for this; how could they be?

When it comes to the oxygen supply chain more specifically, generally speaking it’s not for the lack of production capacity. We’re so often going to come back to the same fundamental: cylinders and delivery. In the majority of hospitals the world over, oxygen supply is dependent on the use and supply of cylinders. This is particularly true of makeshift field hospitals and even overspill wards at dedicated healthcare facilities.

Even in well-developed, advanced economies, where bulk oxygen is supplied direct to the facility’s pipeline systems, that same hospital infrastructure is often unable to cope with ramped up off-takes from bulk cryogenic supply. It simply wasn’t designed to cope with such demand/scenarios. We’ve seen plenty of examples of this, and heard of the custom solutions made in compression and vaporiser technologies to help overcome some of these limitations.

In instances where bulk supply hasn’t been as readily available and is shipped in – whether by road, rail or river – it is still often a question of getting that extra bulk supply into…cylinders. And therein could lie other complexities, some also Covid-induced.

Are there enough cylinders in local circulation? Are there pinch points in the logistics of delivery or cycling of cylinders, with various aspects of infrastructure disruption as Covid hits workforces across transport and industry? Are empty cylinders flowing back effectively from hospitals or crisis centres, ready to be turned around and refilled?

It’s a complex supply chain, with multiple potential intersections for bottlenecks during a societal and industrial crisis.

Even the realm of PSA and VPSA systems, as well as oxygen concentrators, while proven promising during this pandemic in particular, is not without its own important considerations – not least, those lead times for orders and factors of physical sizing to be taken into account for containerised or skid-mounted units. Again, it’s a challenge in unpredictability.

Some will say – and have said – that India’s current crisis was inevitable given the combination of a lack of hard-line restrictions, various societal, religious and political events in recent weeks, and the varying levels of adequacy of its healthcare infrastructure. Others have pointed to the fact that as of 16th January (2021), India had kicked off the world’s most extensive vaccination programme and its total number of active Covid-19 cases was around 150,000. Daily cases were just over 10,000, and ‘the mood was upbeat’.

What a difference mere weeks can make. This is a virus, an epidemic, that spreads with almost unparalleled speed and ferocity.

Read more: Swept off our feet by India’s Covid crisis

We may ask then, how prepared is the medical oxygen supply chain?

Even in extreme circumstances, it’s incredibly robust, as has been proven. The problem is, as with most things Covid over the last year, we’re going beyond even the extreme. As a friend in the industry said to me recently, “Nobody builds supply chains for this level of unique demand.”