COVID More Deadly in Poorer Countries – Two Weapons; CPAPs and Oxygen Generators Can Save Millions, Even Without Electricity
The Dealiness Of COVID-19
WASHINGTON, D.C. (June 29, 2020) - COVID-19 has proven to be incredibly deadly, even in the U.S. and in many countries in Europe, but the situation is even more dire in poorer countries of Africa, Latin America, and South Asia, because they often lack two of the major essentials to treat the victims - breathing devices and oxygen - notes public interest law professor John Banzhaf, who helped develop two ways to help.
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The Associated Press put it starkly in an article entitled Scarce Medical Oxygen Worldwide Leaves Many Gasping For Life: "Even the right to breathe depends on money. In much of the world, oxygen is expensive and hard to get," it reports. The UN Economic Commission for Africa reports that Africa might see 3.3 million deaths and 1.2 billion infections, and, even under a best-case scenario, a total of 300,000 deaths from the coronavirus can be expected this year alone.
But a novel proven strategy now growing in use could make it possible to provide enough respiratory assistance to save hundreds of thousands of lives, even for people who live in remove areas without access to reliable electricity, much less oxygen or ventilators and those trained to operate them, says Banzhaf, who was one of the first to suggest and aggressively promote this new procedure.
Ventilators are very expensive ($25K-$50K) and complex pieces of equipment which require trained operators, and are often already scarce during the current pandemic, even in major western countries.
Using CPAP, BiPAP, And Other Breathing Machines
But CPAP, BiPAP, and similar breathing machines - sometimes called "poor man's ventilators," and used to treat snoring and other sleep apnea problems - have now been approved for use in treating COVID-19 patients, and have been shown to be effective in many cases.
Banzhaf, an MIT-educated engineer and inventor, was one of the first to suggest and widely promote the concept of using these comparatively simple and much less expensive devices in many situations in which a COVID-19 patient required respiratory assistance to remain alive, but did not necessarily need the full power and sophistication of a modern hospital ventilator.
His suggestion received a major boost when the U.S. Food and Drug Administration [FDA] not only recommended the procedure, but made it legal by a ruling dated March 22, 2020.
In a guidance document for treating COVID-19 patients issued on that date, the agency said: "Continuous Positive Airway Pressure (CPAP), auto-CPAP, and bilevel positive airway pressure (BiPAP or BPAP) machines typically used for treatment of sleep apnea (either in the home or facility setting) may be used to support patients with respiratory insufficiency provided appropriate monitoring (as available) and patient condition."
The Australian counterpart of the FDA - its TGA - issued a similar ruling shortly thereafter, and doctors treating COVID-19 begin using the devices where it seemed appropriate, occasionally adding oxygen and/or making modifications.
The Arsenal Of Weapons
This dramatic expansion to the arsenal of weapons against the deadly virus is very important, says Banzhaf, because:
- ventilators are in short supply while there are millions of existing CPAP machines, in homes and in medical warehouses, with some no longer even needed by former users;
- hospitals and medical treatment centers are able to afford many more CPAPs (at about $850) than ventilators ($25K-50K), especially since there is little use for the latter once COVID-19 peak demand ceases;
- people are readily donating CPAP machines which are no longer needed, something Banzhaf originally suggested in a TV interview;
- many CPAP machines can be powered by 12-volt electricity, so they can be used wherever there is a vehicle or vehicle battery, even if electric power in the region is spotty, intermittent, or even unavailable.
New York State has already acquired thousands of CPAP and BiPAP devices to deal with its anticipated ventilator shortage. Indeed, the New York Times has just reported that "doctors at North Shore University Hospital on Long Island have been using machines designed for people with sleep apnea to keep scores of coronavirus patients breathing," and that such innovations "may have helped stave off the dire ventilator shortages and rationing that some had feared but have not come to pass."
The Times report also points out that "many hospitals are using them to increase oxygen levels without resorting to intubation" - since intubation is a procedure with major risks because most COVID-19 patients who are intubated die, and others suffer long-lasting problems. The Times also says that "the devices, doctors say, have been especially helpful for coronavirus patients with moderately impaired lung function."
In a modern hospital setting, oxygen is usually readily available, and doctors have found that it can be used to increase the effectiveness of CPAP, BiPAP, and similar breathing devices, and in some situation may be used to treat COVID-19 patients without ventilators or CPAP-type devices.
But any oxygen at all, much less a ready and reliable supply, is frequently not available in many locations in poor countries, especially in rural areas. So an alternative, now being investigated, are oxygen concentrators; small devices which extract oxygen directly from the air. In many situations, using an oxygen concentrator is far less expensive than obtaining the gas by buying it in liquid form in large cylindrical tanks which often must also be transported long distances under difficult conditions.
Also, unlike oxygen tanks, oxygen concentrators never run out, and don't have to even be refilled.
Such devices supply a continuous supply of oxygen, although at a lower pressure than that from oxygen tanks. However, even if the oxygen available isn't at high pressure, as it ordinarily is in a hospital situation, the O2 stream can be connected to a CPAP to enrich the air the device helps blow into the lungs.
Advantages Of Using Oxygen Concentrators
Another great advantage of using oxygen concentrators is that, like many CPAP machines, they are not only designed to operate from a 12 volt source; they often have built-in batteries to make them completely portable. Indeed, many elderly Americans who need additional oxygen actually carry their concentrators with them as they go about their daily activities.
This suggests that, in addition to being able to buy them at low cost (e.g., about $300 each), many used ones from elderly users who died might well be donated by the heirs if a campaign seeking such donations were to be launched.
For example, suggests Banzhaf, US-based Hispanic organizations could seek donations of no-longer-needed oxygen concentrators and/or CPAP machines, while organizations working on behalf of African Americans could do the same for shipment to poor countries in Africa.
Thus, suggests electrical engineer Banzhaf, both a CPAP device to help ventilate lungs, and an oxygen concentrator to help provide more oxygen for the lungs, can be used to keep many COVID-19 patients alive anywhere, even if electricity is not available or not reliable, where there is a car or truck which can be operated occasionally to keep the battery fully charged.
Indeed, in many cases even an older used battery from a car or truck - one no longer able to provide sufficient power to turn over an electrical starter on a car or truck - can still store far more electrical energy than is necessary to operate both a CPAP breathing device and an oxygen concentrator to keep a COVID-19 patient in respiratory distress alive, even if there is no ventilator and a trained ventilator operator.
And even if one or both of these devices does require 117-volt AC power to operate, an inverter - a device about the size of a pack of cigarettes which converts 12-volt DC power from an automobile or truck battery to 117-volt AC power - can be used to keep the patient alive or breathing even in the most remote parts of the continent.
For more information about using CPAP devices to help treat COVID-19 patients in respiratory distress, please see http://banzhaf.net/by/COVID.html