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SALT LAKE CITY – A surging demand for at-home oxygen, coupled with national supply chain shortages, has presented a challenge for providers and caused worry for some patients who rely on supplemental oxygen.
While state public health officials say Utah has not seen emergency situations prompted by oxygen supply shortages, providers here are not immune as they try to anticipate and stay ahead of the demand during an unpredictable public health crisis.
Tethered 24/7
Freedom isn't supposed to be measured in liters of oxygen or feet of plastic tubing, but that is the reality for Francisca Andujo.
"I can't be without the oxygen," she said, explaining she even showers with it.
Tethered 24/7, Andujo is among a growing group known as COVID long-haulers.
"It was scary, very scary," she said. "I never thought I would have to fight just to breathe."
Andujo tested positive for COVID-19 on Dec. 5, 2020, and was hospitalized days later, all before vaccines were an option for her.
"They forced me," she said, remembering intensive care unit nurses coaching her through laborious breaths. ''In through your nose, out through your mouth.' And I wanted to live, and so I would do it."
Nearly 10 months after she was hospitalized, Andujo still relies on supplemental oxygen. She spends most days hooked up to an oxygen concentrator in her home – it pulls oxygen out of the air for her.
Leaving the house requires aluminum oxygen tanks, but in September, her daughter experienced concerning delays when trying to get the tanks refilled. "She says, 'They don't have any,'" Andujo said. "And I go, 'What do you mean they don't have any?'"
Andujo never ran out of oxygen but said she had to cancel some medical appointments, worried she wouldn't have enough oxygen in her portable tanks to get through the outing.
"They said there's a shortage because there's a lot of people that are being released from the hospitals with supplemental oxygen because of COVID," she explained.
Unprecedented demand
In a letter to the White House on Feb. 10, several national health organizations flagged spot shortages of supplemental oxygen in six states, including Utah.
"The oxygen need is certainly unprecedented," said Kevin McCulley, director of preparedness and response for the Utah Department of Health.
McCulley said September was a particularly difficult month for at-home oxygen suppliers.
"It appears that at least in Utah, that the current delivery system has been stabilized and it's more optimistic than it was even a month ago," he said during an interview in October.
He said the state has several contingency plans in place and is ready to respond, should an urgent oxygen need arise. The response would include reaching out to local partners, other states and even the federal government – to quickly source oxygen.
Dr. Andy Badke, who treated Andujo during her time in the ICU at Intermountain LDS Hospital, said a majority of COVID-19 patients leaving the hospital require supplemental oxygen for at least a short time after going home.
"I'd say the majority of these patients that leave the hospital do need supplemental oxygen, sometimes for months, sometimes longer," he said.
Prior to the pandemic, Badke treated patients with various lung-related diseases who rely on supplemental oxygen too.
"But they certainly are now becoming the minority of patients," he said. "Whereas now we're seeing so many patients that need oxygen with kind of post-COVID syndrome."
"Many individuals will be released from the hospital with a prescription for oxygen and many more patients are now being released with that same aftercare oxygen delivery," said McCulley. "So naturally, it would stand to reason that there are probably many more new orders for home oxygen than there have ever been at any time during this pandemic."
'Behind the scenes'
Local providers, including durable medical equipment companies like Alpine Home Medical, are feeling the strain.
Sherry Mildenberger, director of clinical services at Alpine Home Medical, described the business as operating behind the scenes during the pandemic.
"Those hospitals that you're seeing on the news with increased, you know, ICU bed rates and so forth, as they fill up, they're pushing patients home sicker and quicker," said Alpine Home Medical president Scott Maughan.
Maughan and Mildenberger said that's where companies like theirs enter the picture – supplying oxygen systems to patients like Andujo who need to continue recovery at home.
And they've seen record-level demand for supplemental oxygen during the pandemic.
According to data supplied by Maughan, Alpine Home Medical provided new home oxygen setups for five recovering COVID-19 patients during the month of March 2020. During September of 2021, that number soared to more than 350.
And the new COVID-19 patients are an added layer on top of their existing patients with other lung-related illnesses.
"The huge increase in COVID diagnoses coming into the home coupled with the supply chain shortages, it's become a very real problem that we're having to deal with on a daily basis," said Maughan.
As is the case with many industries right now, Maughan said the business has dealt with staffing shortages, burnout and finding ways to keep employees safe from exposure to the coronavirus. Additionally, they've been working to overcome supply chain issues and anticipate significantly longer lead times for products patients need.
Before the pandemic, Maughan said a new home oxygen concentrator would arrive in one to two weeks. Now, it takes two to three months.
Portable oxygen tanks used to have a lead time of about a month. Now, Maughan says it's up to seven to nine months.
At times, they've had to ration supplies for some patients to make sure there's enough to go around. "Patients are used to being able to walk in and get 10 oxygen tanks for portability and to be out and about," Mildenberger explained. "We've had to limit that just a little bit."
Maughan urged patience as providers work to take care of an influx of patients and said he hopes anyone who has an excess of portable tanks or oxygen equipment they're no longer using will return them to their provider.
A costly alternative
Several months after her COVID-19 diagnosis, scans of Andujo's lungs show inflammation and scarring rather than the progress she'd hoped for.
"COVID has just overtaken my lungs," she said.
Andujo has since received her COVID-19 vaccine and a booster shot. She urged others to do the same.
"I want everybody just to look at me and just see what it can do, what this virus can do," she said.
I want everybody just to look at me and just see what it can do, what this virus can do.
–Francisca Andujo
Badke said the biggest concern he hears from patients enduring long COVID-19 is that they want to return to their normal level of function in life and at work.
"A lot of times, in order to get around, patients require an oxygen tank and that is really, really hard to do your previous level of activity or work when you're carrying around an oxygen tank," he said. "And there are other devices like portable oxygen concentrators, but those certainly are hard to come by."
Worried about future oxygen shortages and hoping to ditch the cumbersome aluminum tanks, Andujo started a GoFundMe* page collecting donations to purchase a portable oxygen concentrator.
"It's like a purse and it makes oxygen," she explained.
She believes the device will help her be more independent, but it's not covered by insurance.
In the meantime, Alpine Home Medical provided her with a home fill unit – it allows her to fill a small tank at home using her concentrator.
"This is what makes me happy so far today," Andujo said, "that I can fill my own tank."
It's not the freedom she lost to COVID-19, but the machine offers her a new level of convenience. Andujo said she's happy to rely a little less on others for something so many Utahns now need.
*Disclaimer: KSL.com has not verified the accuracy of the information provided with respect to the account nor does KSL.com assure that the monies deposited will be applied for the benefit of the persons named as beneficiaries. If you are considering a deposit or donation you should consult your own advisers and otherwise proceed at your own risk.
