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There has always been a critical global shortage of oxygen for clinical care, especially for poor communities. This lack of access was dramatically exacerbated and highlighted by the COVID-19 pandemic. During the pandemic, it was estimated that more than 500,000 patients with COVID-19 in low- and middle-income countries (LMICs) needed oxygen each day, and a lack of oxygen led to innumerable preventable deaths.1 This is only a small fraction of the total number of patients who require oxygen each day as part of routine care for pneumonia, surgery, childbirth, and chronic lung conditions to name a few. Despite being considered an “essential” medicine by the World Health Organization (WHO), in some countries oxygen therapy may be unavailable for up to 80% of patients.2 In a review of 35 studies across 22 African countries, < 50% of facilities had reliable access to oxygen delivery systems.3 It is perhaps telling that oxygen was not considered a WHO essential medicine for hypoxemia outside of the operating theater until 2017.4 COVID-19 even exposed issues with oxygen systems in the United States.5,6
Out of the necessity to expand access to oxygen therapy during COVID-19 has come an explosion of new products and proposed solutions. This included hundreds if not thousands of “new” ventilator designs, oxygen concentrators, oxygen delivery interfaces, and oxygen-conserving devices. Many of these were do-it-yourself designs and obviously unsafe (at least to those with clinical expertise). Some were marketing of old concepts that had never gained adoption due to lack of efficacy. Others …
Correspondence: Richard D Branson MSc RRT FAARC. E-mail: richard.branson{at}uc.edu
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