How to Slash COVID Deaths in India; Alternatives to Scarce Oxygen Cylinders and Ventilators
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Deatsh From COVID-19 In India
WASHINGTON, D.C. (April 27, 2021) - In India some 200,000 people - and probably many times that number - have already died from COVID-19 because of acute shortages of medical oxygen and hospital ventilators, but there is a life-saving solution which can work in many cases, says public interest law professor John Banzhaf, who helped popularize and get governmental approval for a technique to help COVID sufferers who need assistance breathing to remain alive.
According to the Wall Street Journal article Oxygen Scarcity Swells Covid-19’s Death Toll - In Some Cases, Patients Suffocate, "As Covid-19 cases increase sharply in much of the world, a scarcity of oxygen is forcing hospitals to ration it for patients and is driving up the coronavirus pandemic's death toll. The problem is especially acute in the developing world."
Yet, although medical-grade oxygen delivered in large cylinders (tanks) is best, and necessary for the patients most seriously ill with COVID, small inexpensive portable oxygen generators (or concentrators) may provide a partial solution in India and elsewhere, at least in the initial phases of the disease, and as a backup when pure oxygen is simply not available.
The problem is even occurring in developed countries, and the solution may be the same. For example, oxygen is also reportedly in short supply in South Africa, where a typical oxygen generator costs about $2,700 U.S., and a single scarce cylinder of oxygen can cost over $66 U.S. In India, such cylinders are often simply not available, and/or can't easily be delivered to many parts of the beleaguered country.
But right now, in the U.S., oxygen generators which can provide oxygen indefinitely, and which can be operated for extended periods of time from a 12-volt battery on any car or truck, can be ordered for about $400 U.S. retail, and presumably even less if purchased in bulk.
A Dire Situation
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 such as India, because medical personnel often lack two of the major essentials to treat the victims - breathing devices (and the people trained to operate them) and oxygen - notes Banzhaf, who helped develop two ways to help.
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.
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 to 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 and complex pieces of equipment which require trained operators, and are often already scarce during the current pandemic, even in major western countries.
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.
The Use of CPAPs and BiPAPs
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. The Australian counterpart of the FDA then did then same.
This dramatic expansion to the arsenal of weapons against the deadly virus is very important, says Banzhaf, because:
- hospital 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.
Dealing With Ventilator Shortage
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 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 same could help save many lives in India.
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 even 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 such as India, especially in rural areas. So an alternative, now being investigated, are oxygen concentrators; small devices which extract oxygen directly from the air.
Using Oxygen Concentrators
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 then 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 reliable 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.
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 rechargeable 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 12 volt oxygen generators at low cost (e.g., about $400 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.
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, probably can be used to keep many COVID-19 patients alive in India, 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 - 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.