Add oxygen to the list of resources Idaho health care providers must manage closely as COVID-19 continues to surge through the state.

One major regional supplier has expressed concern to hospital leaders about the mounting need for oxygen, which is often used to treat COVID-19 patients who have issues breathing.

Elias Margonis, the president of Norco Inc. — which is based in Boise and supplies oxygen to hospitals in the Pacific Northwest and Mountain West — sent a letter to customers Monday noting that oxygen is being used at “astounding rates.” He asked hospital customers to conserve the resource where possible.

“While there is not an immediate shortage of oxygen, there is a tremendous amount of growing stress to the supply chain network,” the letter said. “Many hospitals have already pushed their bulk storage systems to limits of requiring emergency upgrades.”

In an interview with the Idaho Statesman, Margonis said that his company’s storage systems are generally designed to require shipments of new oxygen every three weeks or, in some cases, every six weeks. These days, many hospitals that Norco supplies are needing new shipments every three or four days, and some have had to use their reserve tanks.

“The hospitals in the Treasure Valley are probably in their highest mode of oxygen consumption that we’ve ever seen,” he said of the valley mostly in southwestern Idaho, the state’s most populated area.

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Oxygen is one of a number of resources listed in the Department of Health and Welfare’s guidelines for rationing care that may need to be conserved during times of scarcity. The entire state has been in crisis standards of care since Sept. 16, though individual hospitals can determine whether they need to implement them.

On Sept. 23, a doctor at St. Luke’s Health System, which is supplied by Norco, described some of the difficulties the hospital system is having routing enough oxygen into its buildings. St. Luke’s is the only Treasure Valley health system known to have implemented crisis standards.

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“We are facing a situation in some of our hospitals, our big hospitals, where the building itself isn’t designed to allow for the the administration of all the oxygen that’s coming through the walls,” said Dr. Frank Johnson, chief medical officer for St. Luke’s in Boise, Elmore and McCall.

With huge numbers of intensive care patients, St. Luke’s is running low on ventilators and having to move around devices like BiPAP machines, or bilevel positive airway pressures devices, which are connected to ventilators and use air pressure to help ease breathing issues.

As of Tuesday, 44% of the 632 patients admitted at St. Luke’s hospitals have tested positive for COVID-19.

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At Saint Alphonsus Health System, which is also supplied by Norco, the hospital system is working to adjust its oxygen usage.

“Saint Alphonsus is aware of the growing need for oxygen in our region and we have taken steps to monitor usage and to conserve this life-saving resource,” Mark Snider, a spokesperson for the health system, said by phone. “We were notified by our main supplier of the supply chain issues and have taken measures to try and ease the crunch.”

In the Saint Al’s system, 33% of the 484 hospitalized patients have COVID-19.

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Other parts of the U.S., which saw COVID-19 cases and hospitalizations surging earlier than Idaho, have also seen shortages of oxygen. In Idaho, health officials predict that peak hospitalizations won’t come until late November.

“There’s dozens of hospitals right now consuming a lot of liquid oxygen,” Margonis said. He said his company is facing particular issues at smaller, rural hospitals, which are harder to get to and have smaller oxygen tanks on site. When oxygen has to be delivered to smaller hospitals more frequently, it diverts resources going to the state’s largest hospitals.

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Norco monitors the oxygen supply levels of its customers independently, he said, and trucks make deliveries as needed. Those drivers, whom Margonis called “heroes,” then deliver the lifesaving chemical element at all times of the day or night.

Though Norco has recently begun contracting with third parties to help add to its delivery capabilities, Margonis said shipping oxygen is highly specialized and requires a lot of planning. The company produces its own oxygen at facilities in Boise and Central Washington; the oxygen is stored in a compact liquid form at extremely cold temperatures for space efficiency.

If the demand for oxygen at hospitals continues to ramp up, other industries that use the resource — agriculture, food and beverage producers, fabricators — may be denied it, Margonis said.

“It’s just this compounding system of equations,” he added. “There really is a lot of liquid oxygen out there, it’s just amazing how much of it is being used to treat patients that chose not to get vaccinated. It’s unfortunate.”