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Oxygen provision to fight COVID-19 in sub-Saharan Africa
  1. Felix Stein1,2,
  2. Meghan Perry3,
  3. Geoffrey Banda1,4,
  4. Mark Woolhouse1,2,
  5. Francisca Mutapi1,5
  1. 1NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Edinburgh, UK
  2. 2Usher Institute, University of Edinburgh, Edinburgh, UK
  3. 3Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, UK
  4. 4The Innogen Institute, University of Edinburgh, Science Technology and Innovation Studies, Edinburgh, UK
  5. 5Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Felix Stein; felix.stein{at}

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Summary box

  • The adequate provision of medical oxygen is going to make the difference between life and death for the majority of patients with COVID-19 in Africa.

  • Sub-Saharan African countries lack affordable and reliable oxygen supply.

  • There is evidence from sub-Saharan Africa for why medical oxygen provision must be made a regional urgent priority.

  • Efforts being made in some African countries demonstrate how oxygen provision can be scaled up through innovative cheap technologies.


Oxygen saves lives. Its provision is a critical component of emergency respiratory resuscitation around the world, and it consequently features on the WHO’s list of essential medicines.1 Oxygen therapy is not just used for pneumonia and other lung diseases. It is also crucial for treating various non-respiratory conditions that result in hypoxaemia, such as sepsis, severe malaria, trauma and cardiovascular diseases. It is equally essential for surgical care and anaesthesia.

In Western countries, the reaction to the COVID-19 pandemic has been to increase hospital capacity and to provide more intensive care units (ICUs) and more ventilators. There had been little discussion of the provision of oxygen as this is a standard clinical tool widely available in hospitals. This is not the case in sub-Saharan Africa (SSA). There is a shortage of oxygen in health centres in SSA.2 When it comes to prioritising medical resources, SSA needs to save the maximum number of lives during the COVID-19 pandemic; arguably, two things should be atop of that list before ICUs and ventilators. These are personal protective equipment (PPE) for frontline health workers and oxygen for the patients. The need for PPE is a global issue and one whose importance has been highlighted in the different health systems as it is critical to ensure frontline health workers are protected from COVID-19 infection and that they are not infection conduits within …

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