The story so far: A shortage of medical oxygen in hospitals in many parts of the country following the second continuing wave of COVID-19 infections has caused several deaths, including in the capital, and has led the Delhi High Court to seek it is up to the central government to explain. its approach to allocating critical resources to various states and Delhi. On Thursday, he asked the Center why states like Madhya Pradesh and Maharashtra were given more oxygen than they had requested, while Delhi did not even have the expected obligation. to treat COVID-19 patients. On Saturday, the Batra Hospital in New Delhi reported that 12 patients had died from lack of oxygen. On April 30, India crossed the 4 lakh mark for new daily cases of COVID-19.

How much oxygen does India produce?

In an April 15 statement, the Department of Health and Family Welfare recognized from the outset that “medical oxygen is an essential part of the treatment of patients with COVID” and said India has a daily production capacity of 7,127 metric tons (MT). of oxygen, which she said was sufficient given that the nationwide medical oxygen consumption as of April 12 was 3,842 MT. Although the capacity of 7,127 tonnes to which the ministry refers was the overall oxygen production capacity, including volumes produced for industrial purposes, the fact that the Center has restricted the supply of oxygen for all non-medical purposes. , with the exception of a list of exempt industries which includes pharmaceuticals, food products, petroleum refineries and manufacturers of oxygen cylinders, this means that most of the production has been reserved for a medical use.

Subsequently, in a statement shared by the Press Information Office on its website on April 27, the Prime Minister’s Office said, “The production of LMOs [liquid medical oxygen] in the country went from 5,700 MT / day in August 2020 to today 8,922 MT (April 25, 2021). National production of LMOs is expected to exceed 9,250 MT / day by the end of April 2021. “

What led to the shortage?

Demand for medical oxygen, which before the start of the pandemic last year was around 10% of global production, or 700 MT / day, has skyrocketed in recent weeks, with the incidence of patients suffering from acute respiratory distress having sharply increased during the current wave. While the Union government established an empowered inter-ministerial group (EG2) of senior officers in March 2020 to ensure the availability of essential medical equipment, including medical oxygen, to affected states, the group appears have been caught off guard, along with much of the country’s health sector by the scale and speed of the rise in infections. As a result, projections of oxygen demand are unfortunately lagging behind actual needs.

For example, in an affidavit filed with the Supreme Court last month, the Union government pointed out that shortly after passing an oxygen allocation order for 12 high-load states on April 15, some d ‘between them quickly ended up dramatically revising their projections of medical oxygen needs for April 20. So, while Uttar Pradesh doubled its forecast needs to 800 MT from 400 MT earlier, Delhi said it would need 700 MT as of April 20, a 133% increase from the 300 MT. MT that she had previously sought. . Three other states, which were not previously on the list, have also requested allocations from the Center, bringing the forecast demand for April 20 to 5,619 tonnes, from 4,880 tonnes previously estimated. The sharp revisions from two states even prompted the government to point out in the affidavit that “it is also relevant to note that medical oxygen in no country can be unlimited.”

In addition, preparation for a possible second wave in India and oxygen requirements appear to have been totally inadequate. As a reminder, in August last year, the European Industrial Gases Association found that its members like Air Liquide and Linde were experiencing five to ten times the usual demand for medical oxygen, at a time when some countries, y including in Europe, lived their second wave. Add to that the unique logistical challenges facing the distribution of medical oxygen to hospitals in India, and we had a perfect storm of supplies running out, replenishment not arriving on time and many patients severely affected. sick breathless.

Why are we facing supply issues?

Prior to the pandemic, much of the health sector’s medical oxygen needs had been met with supplies delivered either as oxygen cylinders containing the element as a high purity gas or by road tankers. dedicated cryogenic systems that transport and deliver oxygen in liquid form. storage tanks in hospitals.

Stand-alone oxygen production facilities, including the medical variant, have so far been geographically concentrated mainly in clusters in the eastern, southern and western parts of the country, requiring the element to be transported over distances by road. . With only 1,224 cryogenic tankers available for transporting LMOs, according to the affidavit filed with the Supreme Court, there have not been enough vehicles to quickly transport medical oxygen to critical locations. This is despite the fact that some tanker fleet owners have deployed at least two drivers with each vehicle to improve on-road times and the times between each delivery. As cylinders and tankers are scarce, authorities are now considering other means of urgently rectifying the situation.

What are we doing to increase the supply?

The Center takes a multidimensional approach to dealing with the crisis. On the one hand, it decided to deploy excess inventory of the item available from steel mills across the country, including public sector units. In addition, the movement of transport tankers for LMOs is now closely monitored and Indian Railways and the Indian Air Force have been roped up to help transport tankers by rail and air (although planes mainly transport empty tankers because it is dangerous for transport (filled cryogenic receptacles). The Petroleum and Explosives Safety Organization (PESO) has also issued instructions to oversee the conversion of argon and nitrogen tankers for use as oxygen tankers. The production of additional cryogenic tankers is also underway to increase the capacity of the fleet. Separately, industrial cylinders were allowed to be used for medical oxygen after an appropriate purge, and the Ministry of Health is placing orders for another one lakh oxygen cylinder.

The ministry is also stepping up on a “war footing” the commissioning of 162 variable pressure adsorption (PSA) plants that can generate oxygen from the air in various hospitals across the country, according to its report. affidavit. And for now, the government is also accepting aid from abroad with several countries, including Russia and Singapore, shipping oxygen equipment.

What awaits us?

Despite efforts to boost production and improve supplies, many challenges remain. For relatives of patients who are struggling to secure a guaranteed supply of oxygen, either at home or after admission to hospital, it is difficult to get real-time information on availability. Therefore, they mainly had to rely on networks of volunteers disseminating data through social media platforms. Here again, the Supreme Court had to intervene to warn the authorities against any punitive action against the volunteers and those who appeal for help.

Further, the allocation of oxygen to the states by the empowered group appears to be uneven, with the Delhi High Court pointing out that against the local government’s request for 700 MT, it had only received 490 MT, while the Madhya Pradesh and Maharashtra had been penalized for more supplies than they asked for. The problems of matching supply and demand, both at the institutional and individual level, must be addressed without further delay.