Oxygen and Ventilator Logistics During California’s COVID-19 Surge: When Oxygen Becomes a Scarce Resource

Abstract

The state of California, in the United States of America, has a population of nearly 40 million people and is the 5th largest economy in the world. During the COVID-19 (Coronavirus Disease) pandemic in 2020-2021, the state experienced a medical surge that stressed its sophisticated healthcare and public health system. During this period, ventilators, oxygen, and other equipment necessary for providing ventilatory support became a scarce resource in many healthcare settings. When demand overwhelms supply, creative solutions are required at all levels of disaster management and healthcare. This paper describes the disaster response by the state of California to mitigate the emergency demands for oxygen delivery resources.

Utilization of Alternate Care Sites During the COVID-19 Surge and Mass Care: California, 2020–2021

“…11 Respiratory therapists rounded at least once daily, walked patients to assess oxygen needs with activity, and provided nebulizer treatments when a safe outdoor setting was available to reduce aerosol exposure risk to providers working indoors. 9 , 12 …”

“…11 Respiratory therapists rounded at least once daily, walked patients to assess oxygen needs with activity, and provided nebulizer treatments when a safe outdoor setting was available to reduce aerosol exposure risk to providers working indoors. 9,12 Standard COVID-19 treatments including Remdesivir and steroids were administered according to clinical condition and hospital transfer orders. Some sites also later provided outpatient monoclonal antibody infusions for the newly diagnosed and/or mildly symptomatic COVID-19 patients who did not require hospitalization or ACS care.…”

“…At some ACS, the paramedics were authorized to administer medications and document in the Medication Administration Record (MAR). An expanded scope of practice for many providers was allowed under Governor Gavin Newsom's Executive Order of March 12, 2020, 12,14 which was preceded by the Proclamation of a State of Emergency on March 4, 2020. 13,15 The RN-to-patient ratio was lower in the ACS compared to traditional hospital settings due to limited availability of RNs.…”

“…At times, oxygen shortage was critical due to the limited supply of oxygen cylinders. 12 During a period when oxygen was in especially short supply statewide, the respiratory therapists and providers created innovative solutions to mitigate this shortage. 9,12 All of these ongoing challenges required timely collaboration and mitigation strategies to maintain patient safety.…”

Limited Utility of Self-made Oxygen Generators Assembled From Everyday Commodities During the COVID-19 Pandemic

“…Shortage of medical oxygen has been reported in the current COVID-19 pandemic in low, middle, and even high-income countries. 1,2 In fact, shortness of oxygen supply in the face of a raging COVID-19 pandemic has been reported in California, jeopardizing medical care, hospitalizations, and patient discharges, 3,4 in one of the strongest economies in the world. While high-income countries have the infrastructure to rapidly respond to changing oxygen demands, oxygen supply is a chronic challenge in low-and middle-income countries in Africa, 5 Asia, 6 and South America.…”