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."
The audio and online version of this story as originally published characterized oxygen as flammable, which it is not.
STEVE INSKEEP, HOST:
Hospitals in Brazil and in Mexico and across much of Africa face shortages of oxygen for COVID-19 patients. Some U.S. hospitals have also run short. Now the industry that supplies medical oxygen is learning how to anticipate and correct those shortfalls. NPR's Yuki Noguchi reports.
YUKI NOGUCHI, BYLINE: A cold snap late last year hit El Paso at the exact wrong time. New COVID-19 patients streamed into hospitals, many needing high flows of oxygen to live. But huge volumes of the gas created problems. It froze the hospital's pipes and vaporizers.
ESTEBAN TREJO: Depending on how cold it can get, they can reduce their efficiency by 70%.
NOGUCHI: That threatened the supply reaching patients. Esteban Trejo is general manager of Syoxsa, an oxygen distributor in El Paso. It wasn't just the gas in short supply, but also things needed to make the gas breathable - tubing, meters and storage cylinders.
TREJO: And things got pretty bad in our area. We saw the demand for the cylinders at least triple.
NOGUCHI: El Paso then also confronted a reality facing other COVID hot spots.
TREJO: Oxygen isn't easy to transport.
NOGUCHI: It must be liquefied and stored at minus-288 degrees Fahrenheit. It's unstable, flammable and requires special trucks to transport. Rich Mansmann is vice president of the Industrial Welding Distributors Cooperative. He says because of its volatility, oxygen is typically produced within about 100 miles of where it's used - near steel factories, for example. Oxygen producers dot the Rust Belt and the East Coast, but few exist out West.
RICH MANSMANN: That's kind of the problem El Paso has, Albuquerque has, even Denver has.
NOGUCHI: And why, for example, oxygen produced in Texas cannot ship to hospitals in Brazil. But unlike toilet paper or medical masks, demand for oxygen doesn't hit everywhere at once. So as hot zones travel from coast to coast, so too do the demands on oxygen. Mansmann says companies sought new ways to coordinate the transfer of oxygen and supplies across longer distances. His trade group started acting as a clearinghouse to exchange resources.
MANSMANN: Who has excess cylinders? Who has excess storage equipment? Who can lend somebody something for a short period of time? And it's everything from the oxygen itself to the storage tanks to even the people to come out and help set up an installation.
NOGUCHI: Companies like Norco, an oxygen producer in Boise. Its president, Elias Margonis, tracks the virus like a weatherman watches hurricanes.
ELIAS MARGONIS: Every day, I start my day to look at where case trends are moving.
NOGUCHI: Data, he says, helps him anticipate what's needed where. One time he had an excess supply of portable oxygen machines.
MARGONIS: We then quickly had the ability to move those into the market that really needed them. And at the end of the day, you know, 50 patients in one market is a significant amount. You know, every life matters.
NOGUCHI: This collaboration doesn't just help with tanks and tubes. When hospitals overflowed, the industry learned to quickly build pop-up hospitals to work around the problem of freezing pipes. Richard Gottwald is the president of the Compressed Gas Association.
RICHARD GOTTWALD: Rather than trying to upgrade those systems in the hospitals, like, let's just build a whole new system, put it in the parking lot so we can begin treating patients.
NOGUCHI: Esteban Trejo, the El Paso oxygen distributor, says such work is unrelenting, but he's inspired by the humanity of his industry colleagues - those who drive all night to truck in oxygen or one-time rivals who ship him their oxygen cylinders.
TREJO: All competitive thoughts go out the window. You're just trying to help.
NOGUCHI: Yuki Noguchi, NPR News.
(SOUNDBITE OF FRAMEWORKS' "SAND AND STONE") Transcript provided by NPR, Copyright NPR.