Hospitals in the southern states of the United States are dealing with tight supplies of oxygen, as suppliers reallocate product from industrial customers to keep up with demand caused by the coronavirus (Covid-19) pandemic.

In recent weeks, some hospitals in Florida have had to draw from their reserve tanks of medical oxygen, as rising cases of Covid-19 over the summer led to increased hospitalisations and demand for oxygen.

Disruption caused by Hurricane Ida last Sunday has also created concerns about oxygen supplies running low in Louisiana.

Supplies of medical oxygen, which is used in the treatment of Covid-19 patients, has also reportedly been stretched in Georgia, South Carolina, Texas, Oregon and Mississippi. In Hawaii, the state’s daily consumption for medical grade oxygen has increased by nearly 250%, according to reports.

Liquid oxygen being unloaded from a truck into tanks at a medical facility in Sioux Falls, South Dakota

Rich Craig, Vice-President of Technical and Regulatory Affairs at the Compressed Gas Association (CGA), told gasworld, “Florida is the state that has been in the news before the hurricane and right now there are issues in Louisiana, Texas, Georgia and Mississippi. Some of that is not unexpected due to the hurricane with the damage it leaves. It takes a while to get the debris cleared and get the trucks going again to the hospitals. Companies are used to this and have dealt with hurricanes before. It’s been reported that Hawaii is also having issues. There are a just a couple of oxygen plants in Hawaii which adds to the strain.

“Supplies are tight, what we saw in California in January and February we are seeing in Florida now. We are seeing as hospitalisations go up the need for medical oxygen goes up because the favoured treatment for Covid patients is high flow oxygen therapy. Patients are given 30-60 litres of oxygen per minute through high flow oxygen therapy, which is a huge amount. That increases demand by two or three times and can put a strain on an oxygen supply system.”

Premier Inc. is a hospital-supply purchasing firm based out of North Carolina, which has been coordinating with the Federal Emergency Management Agency (FEMA) about the scarcity of oxygen in the Southeast US.

Donna Craft, service line senior director at Premier Inc., told gasworld, “It’s been strained across the Southeastern US, but our concern is that as Covid cases shift to other hot spots, it could become an issue in other parts of the country, too. Fortunately, hospitals in the path of Hurricane Ida were able to get their oxygen tanks filled before the storm hit. However, we’re still dealing with storm assessments, evacuations and road closures, so we continue to watch this situation very closely.”

Premier has notified the White House, FEMA and Health and Human Services department the oxygen situation in the region, as well as the implications on a national level given the current surge of Covid cases. FEMA has formed a task force/ working group on oxygen.

Craft added, “It is acute. We have heard reports of hospitals needing to resort to their reserve tanks multiple times over the past two weeks. That is a very troublesome situation, since going on reserve tanks means that a health system then has a single point of failure. The strain over the past two or so weeks has been acute and concerning. Since the economy is more open than it was in wave one, there are competing needs for oxygen. This further compounds the issue.”

Increasing demand

To treat the new wave of Covid patients, hospitals require a large amount of oxygen for the preferred treatment of high-flow oxygen therapy, which requires more than treating patients on ventilators. Some hospitals in Florida have been running on less than 48 hours’ worth of oxygen on site.

Craig said, “I’ve not heard that hospitals are running out of oxygen. We keep asking the question, ‘are you running out of oxygen’, and keep hearing it is not happening. Some hospitals may be running into their reserve tanks. The Florida Hospital Association did a survey at the end of last week and some hospitals were reporting 48 hours supply and a couple reported 12 hours supply. I don’t know if that’s their normal supply or includes their reserves. Sometimes 48 hours is not a problem depending on how far you are from the supply point.”

The CGA, which has headquarters in Virginia, represents more than 130 companies including manufacturers, distributors, suppliers, and transporters of gases, cryogenic liquids, and related products and services. The CGA said its members have responded to the demand for medical oxygen through a range of measures including sourcing additional medical gas cylinders, converting cylinders and containers to medical oxygen use, and where possible, increasing production and distribution capacity.

Renown Regional Hospital in Reno, Nevada.

Industrial gas companies and independent distributors are also reallocating oxygen for the industrial sector to hospitals, to ensure hospitals are kept stocked.

“Hospital supply is being prioritised above other uses,” Craig said.

“They may not like it, but industrial customers can understand why our members are prioritizing hospitals with oxygen rather than a welding shop.”

Driver availability and distribution capacity is also an issue.

“Suppliers are bringing in drivers from other areas to pick up the load, they are also using drivers that usually deliver nitrogen, so they can deliver oxygen and meet demand,” Craig said.

“In Florida, the geography exacerbates the problems because it’s a peninsula and if you bring products in from outside the state it has got to go down the length of the state, which creates other issues and takes time.”

The Federal Motor Carrier Safety Administration has extended its Covid-related Emergency Declaration through November 30 and extended the scope of the hours of service and other exemptions under the declaration to include gasoline, diesel, jet fuel, and ethyl alcohol, as well as supplies to assist individuals impacted by the consequences of the Covid-19 pandemic.

Covid cases associated with Delta are on the decline in the current hot spots, which should help free up supply, and the federal government’s work group around oxygen will help coordinate a national response.

Impact on other uses

Also, in some areas in Florida and Oregon, water use restrictions have been imposed as residents have been asked to stop watering their lawns and washing their cars. Liquid oxygen is used in the water-treatment process, and liquid oxygen in these areas has been diverted to hospitals. Water utilities use liquid oxygen to create ozone to treat water and destroy bacteria.

The surge in demand for liquid oxygen is impacting on the space industry too, which uses the product in rocket launches as supply to hospitals is prioritised.

NASA and United Launch Alliance are reviewing the launch date for the Landsat 9 spacecraft scheduled to launch from Vandenberg Space Force Base in California.

NASA said in a statement last Friday, “Current pandemic demands for medical liquid oxygen have impacted the delivery of the needed liquid nitrogen supply to Vandenberg by the Defense Logistics Agency (DLA) and its supplier Airgas [a major supplier of industrial gases]. Airgas converts the liquid nitrogen to gaseous nitrogen needed for launch vehicle testing and countdown sequences. DLA and Airgas now have implemented efforts to increase the supply of liquid nitrogen to Vandenberg. The Landsat 9 launch now is expected no earlier than Thursday, Sept. 23, 2021.”