Hello! Unfortunately I don't think they have a list for all the countries where they're tax exempt, but if you have a specific country in mind, I can try and check for you!
3. Are most concentrators/cylinders being sourced by GiveIndia or Milaap being sourced internationally or domestically?
Both the Milaap fundraisers source internationally only (China, Israel, Russia, Europe), I'm less sure about GiveIndia but very very likely that it's only international. They might get a domestic concentrator if a citizen gives them an unused concentrator they have, but no domestic purchases.
- How does this interact with the seemingly constrained transport of oxygen (as opposed to concentrators) given the specialized distribution infrastructure?
Not sure if they interact? Concentrators are fairly easy to transport from what I understand (think an AC being transported). Empty cylinders can be transported easily, but we don't know enough about liquid oxygen distribution infrastructure to vouch for cylinders confidently.
- In the international case, what seems to be the timeframe for getting them to where they are needed?
Varies quite a bit! Most fundraisers are pursuing a lot of leads to procure concentrators, so the timeframe for each supplier is slightly different. It isn't an insane amount of time such that they'll get them when the crisis is significantly better, though. The first Milaap fundraiser plans to deploy a third of their aim by mid-May, the second Swasth fundraiser has so far deployed many concentrators so they seem to have a functional timeline as well.
- In the domestic case, is there enough certainty around where concentrators will be needed over the next month for us to be confident that this is having a meaningful effect in alleviating a constraint on healthcare?
The way distribution works is based on active data collected on oxygen shortages collected on national dashboards. As far as I understand, there aren't pre-existing partnerships about where to supply the concentrators. Once they get the concentrators, they will assess where they are needed, and get them there asap. The areas the pandemic in India is affecting are expected to keep changing, but it's been many weeks of major Tier-1 cities being completely cripped and Tier-2 cities essentially also out of ventilators and oxygen. The likelihood that the problem is solved to the extent that this isn't a bottleneck by the time the concentrator is supplied seems low to me, but that's based on my intuition, anecdotal knowledge, and trends so far; I don't have data to support that.
I hope this helps!! Thanks so much for your interest and your questions. I'll ask someone about the 28 days question, but (a) all the doctors I know are struggling to find time to answer questions (b) the claim that oxygen for this much time can make a meaningful difference for moderate cases (spO2>90) seems to be confounded anecdotally quite a bit.
Really interesting point! I think the first thing I have to agree on is doing both is ideal, but if you need to pick, people should think about their comparative advantage. If you work with or know people at medical gas companies who could be convinced by your lobbying efforts, your time and resources are probably really effective when it comes to convincing them to supply here. The largest difficulty is certainly sourcing medical oxygen for hospital usage, and this is going to be really effective if it works out. If you have the ability to donate and earn to give, and can maybe tweet once about medical gas but don't have the ability or capacity to try to meet and convince higher-ups in the companies, then donating is probably better as a focus area.
These are really excellent questions, and I want to take a day or so to do some research and speak to people in pulmonary crit care about (1) to respond. In the meantime, I want to point out https://opencriticalcare.org/oxygen-supply-demand-calculator/ and other content on open critical care for more information about how concentrators and a specific amount of O2 supply affects patients. Based on people on the GiveIndia fundraisers' board, concentrators can make a fairly large difference in preventing moderate cases for worsening.
For question (2), this is what we're unclear on as well, re: cylinder refilling, which is why we recommend concentrators above cylinders for the timebeing, or increasing cylinder refilling capacity by investing in plants.
For question (3), the majority of the ones sourced by the first Milaap fundraiser are international and all the ones in the second Milaap fundraiser are international. We're calling a person who runs that fundraiser today for more information on their procurement and distribution processes, and I will keep you updated. Thanks!
Hello! Unfortunately I don't think they have a list for all the countries where they're tax exempt, but if you have a specific country in mind, I can try and check for you!
Thank you so much!!
More information on 3:
3. Are most concentrators/cylinders being sourced by GiveIndia or Milaap being sourced internationally or domestically?
Both the Milaap fundraisers source internationally only (China, Israel, Russia, Europe), I'm less sure about GiveIndia but very very likely that it's only international. They might get a domestic concentrator if a citizen gives them an unused concentrator they have, but no domestic purchases.
- How does this interact with the seemingly constrained transport of oxygen (as opposed to concentrators) given the specialized distribution infrastructure?
Not sure if they interact? Concentrators are fairly easy to transport from what I understand (think an AC being transported). Empty cylinders can be transported easily, but we don't know enough about liquid oxygen distribution infrastructure to vouch for cylinders confidently.
- In the international case, what seems to be the timeframe for getting them to where they are needed?
Varies quite a bit! Most fundraisers are pursuing a lot of leads to procure concentrators, so the timeframe for each supplier is slightly different. It isn't an insane amount of time such that they'll get them when the crisis is significantly better, though. The first Milaap fundraiser plans to deploy a third of their aim by mid-May, the second Swasth fundraiser has so far deployed many concentrators so they seem to have a functional timeline as well.
- In the domestic case, is there enough certainty around where concentrators will be needed over the next month for us to be confident that this is having a meaningful effect in alleviating a constraint on healthcare?
The way distribution works is based on active data collected on oxygen shortages collected on national dashboards. As far as I understand, there aren't pre-existing partnerships about where to supply the concentrators. Once they get the concentrators, they will assess where they are needed, and get them there asap. The areas the pandemic in India is affecting are expected to keep changing, but it's been many weeks of major Tier-1 cities being completely cripped and Tier-2 cities essentially also out of ventilators and oxygen. The likelihood that the problem is solved to the extent that this isn't a bottleneck by the time the concentrator is supplied seems low to me, but that's based on my intuition, anecdotal knowledge, and trends so far; I don't have data to support that.
I hope this helps!! Thanks so much for your interest and your questions. I'll ask someone about the 28 days question, but (a) all the doctors I know are struggling to find time to answer questions (b) the claim that oxygen for this much time can make a meaningful difference for moderate cases (spO2>90) seems to be confounded anecdotally quite a bit.
Really interesting point! I think the first thing I have to agree on is doing both is ideal, but if you need to pick, people should think about their comparative advantage. If you work with or know people at medical gas companies who could be convinced by your lobbying efforts, your time and resources are probably really effective when it comes to convincing them to supply here. The largest difficulty is certainly sourcing medical oxygen for hospital usage, and this is going to be really effective if it works out. If you have the ability to donate and earn to give, and can maybe tweet once about medical gas but don't have the ability or capacity to try to meet and convince higher-ups in the companies, then donating is probably better as a focus area.
These are really excellent questions, and I want to take a day or so to do some research and speak to people in pulmonary crit care about (1) to respond. In the meantime, I want to point out https://opencriticalcare.org/oxygen-supply-demand-calculator/ and other content on open critical care for more information about how concentrators and a specific amount of O2 supply affects patients. Based on people on the GiveIndia fundraisers' board, concentrators can make a fairly large difference in preventing moderate cases for worsening.
For question (2), this is what we're unclear on as well, re: cylinder refilling, which is why we recommend concentrators above cylinders for the timebeing, or increasing cylinder refilling capacity by investing in plants.
For question (3), the majority of the ones sourced by the first Milaap fundraiser are international and all the ones in the second Milaap fundraiser are international. We're calling a person who runs that fundraiser today for more information on their procurement and distribution processes, and I will keep you updated. Thanks!