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Oxygen Industry Scrambles To Keep U.S. Patients With COVID-19 Breathing

A technician adjusts the oxygen tanks for medical use at a Columbia University field hospital in April of 2020. The surging waves of cases of COVID-19 around the U.S. have led to shifting surges in demand by hospitals for extra oxygen.
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A technician adjusts the oxygen tanks for medical use at a Columbia University field hospital in April of 2020. The surging waves of cases of COVID-19 around the U.S. have led to shifting surges in demand by hospitals for extra oxygen.

The cold snap late last year hit El Paso at the exact wrong time; new COVID-19 patients were streaming into hospitals, many needing high flows of oxygen to breathe. That abrupt, massive draw on the gas created myriad problems: It froze the hospital's pipes and the vaporizers on oxygen tanks, restricting the flow by as much as 70%.

So local companies built pop-up tents with new oxygen pipes in hospital parking lots. That wasn't the only hurdle; tubes, flow meters, nasal cannulas and portable cylinders needed to make the gas breathable were also in short supply.

"When things got pretty bad in our area, we saw the demand for the cylinders at least triple," says Esteban Trejo, general manager of Syoxsa, an El Paso-based oxygen distributor.

But by then, medical oxygen companies were familiar with what happens in COVID-19 hot spots. From hundreds of miles away in Minnesota, a company shipped Trejo the cylinders they could spare. When his usual oxygen supplier in Albuquerque ran out, Trejo's drivers drove hundreds of extra miles to truck in more from producers in Houston and Phoenix. And no sick patient had to go without.

As hospitals in Brazil, Mexico and across Africa agonize over critical shortages of oxygen, similar worries in the U.S. have been alleviated in part by an industry that's developed new ways of pooling precious resources.

That's not easy to do. Oxygen is not easy to move around. It must be liquified and stored at minus 280 degrees Fahrenheit and requires special trucks to transport.

Because of this, oxygen is typically produced within about 100 miles of where it's used, near steel factories or paper mills, for example. So there are plenty of oxygen producers throughout the Rust Belt and along the East Coast, but few exist out West, adding to the difficulties of increasing supply in places like Los Angeles.

"That's the problem El Paso has, Albuquerque has, even Denver has," says
Rich Mansmann vice president of the Industrial Welding Distributors Cooperative. That also explains why, for example, oxygen produced in Texas cannot ship to hospitals in Brazil.

But unlike toilet paper or medical masks, demand for oxygen also doesn't hit everywhere at once. It spikes where hospitals reach capacity. So as hot zones travel from coast to coast so, too, do the demands on oxygen.

Learning from the early pandemic experiences in Seattle and New York, the medical oxygen industry now tries to anticipate the virus's path, moving resources to where they're needed.

Mansmann says companies have found new ways to transfer oxygen and supplies across longer distances. His trade group started acting as a clearinghouse for exchanging resources, like "who has access cylinders, who has access storage equipment, who can lend somebody something for a short period of time," he says. It's not just equipment and gas, but also trucks and even manpower.

People like Elias Margonis now track the virus like a weatherman watches hurricanes. "Every day, I start my day to look at where case trends are moving," says Margonis, president of Norco, an oxygen producer and distributor based in Boise, Idaho.

Data, Margonis says, helps him anticipate what's needed, where. He places orders for things when he anticipates short supply, but sometimes he also ends up with excess items. Recently, for example, he had extra portable oxygen machines.

"We then quickly had the ability to move those into the market that really needed them," he says. "And at the end of the day, you know, 50 patients in one market is a significant amount. ... Every life matters."

The increased demand for new machines came primarily from COVID-19 patients who were getting new prescriptions for portable oxygen. Other patients who already had been reliant on portable oxygen cylinders to treat conditions like emphysema and COPD at home or in the hospital were still able to get their devices refilled, even amid the pandemic, Trejo says.

The cooperation among members of the oxygen supply industry extended beyond transferring medical equipment. When hospitals overflowed, companies exchanged information about what they'd learned earlier in the pandemic about how to build pop-up hospitals in places like New York, so they could quickly work around the problem of oxygen pipes freezing.

"We learned the processes to go through there, so when it came to L.A. and elsewhere, we knew how to work with the facilities to get these things set up quickly," says Richard Gottwald, president of the Compressed Gas Association.

Trejo, the El Paso oxygen distributor, says monitoring the fluctuating demands is unrelenting. But he's also inspired by the humanity of his industry colleagues — truck drivers working all night to supply oxygen, one-time rivals, who partner to fill orders.

"All competitive thoughts go out the window," he says. "We're all just trying to help."

Copyright 2021 NPR. To see more, visit https://www.npr.org.

Corrected: February 4, 2021 at 12:00 AM EST
The audio and online version of this story as originally published characterized oxygen as flammable, which it is not.
Yuki Noguchi is a correspondent on the Science Desk based out of NPR's headquarters in Washington, D.C. She started covering consumer health in the midst of the pandemic, reporting on everything from vaccination and racial inequities in access to health, to cancer care, obesity and mental health.