Amid the much harsher, second wave of COVID infections, India has also been suffering from a shortage of medical oxygen. With more than 22 lakh active cases, several states have reported shortages in oxygen and have been appealing to the Central government to cater to their needs.
On Wednesday, 24 COVID-19 patients died due to low oxygen supply after an oxygen tanker leaked outside Dr Zakir Hussain Hospital in Nashik, Maharashtra. The incident caused the oxygen supply to be disrupted for 30 crucial minutes and led to the death of 24 patients on ventilators. Another tragedy that could’ve been avoided.
A tender to import 50,000 tonnes of medical oxygen has been floated by the Ministry of Health and Family Welfare, and ‘Oxygen Express’ trains have been started to help hard-hit states. But how did we reach this point of commotion despite having a year to prepare? We explain.
Explained: Oxygen Crisis in India and Some Distant Solutions
1. What Is the Current Situation?
Hospitals from Lucknow to Delhi have put up notices stating oxygen shortage and several hospitals have had to refuse admitting patients.
As of Tuesday, 21 April, 1.75% of the patients were in ICU beds, 0.40% were on ventilators, and 4.03% were occupying oxygen beds. Since the total active cases have now risen to 20,31,977, the number of patients requiring oxygen beds is significant.
Maharashtra’s consumption of medical oxygen has utilised the state’s full production capacity of 1,250 tonnes. The state has 6.38 lakh active cases, and about 60,000 to 65,000 are on oxygen support, the highest for any state.
Maharashtra is additionally taking 50 tonnes of oxygen from Chhattisgarh and another 50 tonnes from Gujarat daily. Reliance’s plant in Jamnagar will also be delivering 100 tonnes from Gujarat.
Madhya Pradesh, which is reporting the highest oxygen shortage, requires at least 250 tonnes of medical oxygen daily for its tally of 78,271 active patients as of 21 April. The state relies on Gujarat, Chhattisgarh, and Uttar Pradesh for its oxygen supply as it does not have its own manufacturing plant.
Gujarat’s requirement has crossed 500 tonnes per day for over 61,647 active COVID-19 cases as of 18 April.
Expand2. What Efforts Are Being Made Now?
The Empowered Group 2, a group formed by the PMO comprising officials from different ministries and experts, on Thursday, 22 April, started mapping the sources of medical oxygen and their production capacity to match the requirement of 12 high-burden states, including Maharashtra, MP, Gujarat, Rajasthan Karnataka, UP, Delhi, Chhattisgarh, Kerala, Tamil Nadu, Punjab and Haryana — where oxygen requirement is set to increase even further in the coming days.
The group also plans to identify 100 hospitals in remote areas where the health infrastructure is weaker, to install pressure swing absorption (PSA) plants, which can manufacture their own oxygen and make the hospitals self-reliant. This will cut transportation costs and delays in oxygen supply to remote parts.
Over 17,000 tonnes of oxygen will also be directed in three batches from states that have surplus oxygen to these 12 states, to meet their projected demand, The Indian Express reported.
However, while all these efforts are being made, the health infrastructure in the country has nearly crumbled. In October 2020, the government had planned to install PSA oxygen units in 150 district hospitals of the country. The total cost of the plan is Rs 201 crore and yet the government is far from achieving its target.
Even after six months, only 33 plants have been set up. This is despite the low cost of the units and ease of installation. According to the Health Ministry, by the end of May, only 80 plants will be in working condition.
What Is the Pressure Swing Adjustment Process?
Oxygen is required to be purified up to 99.5% for medical use. For the 162 plants mentioned above, the technology of pressure swing adjustment process (PSA) will be used for small scale medical oxygen production.
The PSA technique uses synthetic zeolite molecular sieves, which absorb nitrogen in its pores when the air passes with pressure. In this way, the remaining oxygen is further purified to achieve 99.5% purity. Such pure oxygen is then transported to the beds of the patients by a copper pipe.
Expand3. What Are the Challenges in Transporting Oxygen?
Industry experts said India has the capacity to produce more than 7,000 metric tonnes of medical oxygen. The major manufacturers are Inox Air Products, Linde India, Goyal MG Gases Pvt Ltd, and National Oxygen Limited.
The largest of these, Inox, produces 2,000 tonnes per day. “We are currently contributing to 60 percent of the total medical oxygen requirement in country. We have stopped nitrogen and argon gas production and diverted all resources for oxygen production,” an Inox official told The Indian Express.
Manufacturers prepare liquid oxygen with 99.5% purity, which is stored in jumbo tankers, which are then transported to distributors in cryogenic tankers at a specified temperature.
At the distributor level, a process of regasification is followed to convert the oxygen into gaseous form and fill it in jumbo cylinders and dura cylinders. These cylinders then go to smaller suppliers or directly to hospitals.
One dura cylinder is equivalent to around 30 jumbo cylinders and one jumbo cylinder contains 7,000 litres of oxygen.
With some patients requiring as high as many as eight to 10 litres of oxygen per minute, a jumbo cylinder can get exhausted in less than an hour, Hindustan Times reported.
An industry expert explained that though the demand had massively increased, there are just not enough cylinders and tankers to store and transport oxygen.
India does not have enough cryogenic tankers either to ensure round-the-clock road transport of medical oxygen.
As oxygen is being transported from one state to another, the travel time from the manufacturer to a patient’s bed has increased from 3-5 to 6-8 days. The smaller a hospital or the more remote its location, the longer the time taken for the oxygen to reach there.
Smaller suppliers have also complained they do not have enough jumbo and dura cylinders to keep the flow steady.
The increase in cost for transport and logistics has increased the cost of refilling cylinders as well. A cylinder that would earlier cost Rs 100-150 for refiling, now costs Rs 500-2,000.
Expand
What Is the Current Situation?
Hospitals from Lucknow to Delhi have put up notices stating oxygen shortage and several hospitals have had to refuse admitting patients.
As of Tuesday, 21 April, 1.75% of the patients were in ICU beds, 0.40% were on ventilators, and 4.03% were occupying oxygen beds. Since the total active cases have now risen to 20,31,977, the number of patients requiring oxygen beds is significant.
Maharashtra’s consumption of medical oxygen has utilised the state’s full production capacity of 1,250 tonnes. The state has 6.38 lakh active cases, and about 60,000 to 65,000 are on oxygen support, the highest for any state.
Maharashtra is additionally taking 50 tonnes of oxygen from Chhattisgarh and another 50 tonnes from Gujarat daily. Reliance’s plant in Jamnagar will also be delivering 100 tonnes from Gujarat.
Madhya Pradesh, which is reporting the highest oxygen shortage, requires at least 250 tonnes of medical oxygen daily for its tally of 78,271 active patients as of 21 April. The state relies on Gujarat, Chhattisgarh, and Uttar Pradesh for its oxygen supply as it does not have its own manufacturing plant.
Gujarat’s requirement has crossed 500 tonnes per day for over 61,647 active COVID-19 cases as of 18 April.
What Efforts Are Being Made Now?
The Empowered Group 2, a group formed by the PMO comprising officials from different ministries and experts, on Thursday, 22 April, started mapping the sources of medical oxygen and their production capacity to match the requirement of 12 high-burden states, including Maharashtra, MP, Gujarat, Rajasthan Karnataka, UP, Delhi, Chhattisgarh, Kerala, Tamil Nadu, Punjab and Haryana — where oxygen requirement is set to increase even further in the coming days.
The group also plans to identify 100 hospitals in remote areas where the health infrastructure is weaker, to install pressure swing absorption (PSA) plants, which can manufacture their own oxygen and make the hospitals self-reliant. This will cut transportation costs and delays in oxygen supply to remote parts.
Over 17,000 tonnes of oxygen will also be directed in three batches from states that have surplus oxygen to these 12 states, to meet their projected demand, The Indian Express reported.
However, while all these efforts are being made, the health infrastructure in the country has nearly crumbled. In October 2020, the government had planned to install PSA oxygen units in 150 district hospitals of the country. The total cost of the plan is Rs 201 crore and yet the government is far from achieving its target.
Even after six months, only 33 plants have been set up. This is despite the low cost of the units and ease of installation. According to the Health Ministry, by the end of May, only 80 plants will be in working condition.
What Is the Pressure Swing Adjustment Process?
Oxygen is required to be purified up to 99.5% for medical use. For the 162 plants mentioned above, the technology of pressure swing adjustment process (PSA) will be used for small scale medical oxygen production.
The PSA technique uses synthetic zeolite molecular sieves, which absorb nitrogen in its pores when the air passes with pressure. In this way, the remaining oxygen is further purified to achieve 99.5% purity. Such pure oxygen is then transported to the beds of the patients by a copper pipe.
Industry experts said India has the capacity to produce more than 7,000 metric tonnes of medical oxygen. The major manufacturers are Inox Air Products, Linde India, Goyal MG Gases Pvt Ltd, and National Oxygen Limited.
The largest of these, Inox, produces 2,000 tonnes per day. “We are currently contributing to 60 percent of the total medical oxygen requirement in country. We have stopped nitrogen and argon gas production and diverted all resources for oxygen production,” an Inox official told The Indian Express.
What Are the Challenges in Transporting Oxygen?
Manufacturers prepare liquid oxygen with 99.5% purity, which is stored in jumbo tankers, which are then transported to distributors in cryogenic tankers at a specified temperature.
At the distributor level, a process of regasification is followed to convert the oxygen into gaseous form and fill it in jumbo cylinders and dura cylinders. These cylinders then go to smaller suppliers or directly to hospitals.
One dura cylinder is equivalent to around 30 jumbo cylinders and one jumbo cylinder contains 7,000 litres of oxygen.
With some patients requiring as high as many as eight to 10 litres of oxygen per minute, a jumbo cylinder can get exhausted in less than an hour, Hindustan Times reported.
An industry expert explained that though the demand had massively increased, there are just not enough cylinders and tankers to store and transport oxygen.
India does not have enough cryogenic tankers either to ensure round-the-clock road transport of medical oxygen.
As oxygen is being transported from one state to another, the travel time from the manufacturer to a patient’s bed has increased from 3-5 to 6-8 days. The smaller a hospital or the more remote its location, the longer the time taken for the oxygen to reach there.
Smaller suppliers have also complained they do not have enough jumbo and dura cylinders to keep the flow steady.
The increase in cost for transport and logistics has increased the cost of refilling cylinders as well. A cylinder that would earlier cost Rs 100-150 for refiling, now costs Rs 500-2,000.
India on Thursday, 22 April, reported 3,14,835 fresh COVID-19 cases – the highest one-day spike so far and also the world’s biggest daily spike.
As many as 2,104 COVID fatalities and 1,78,841 discharges in 24 hours were recorded, as per the Union Health Ministry. The total case tally has now reached 1,59,30,965 with 22,91,428 active patients and 1,84,657 deaths. The total number of recoveries, meanwhile stands at 1,34,54,880.
In an urgent hearing, the Delhi High Court on Wednesday, 21 April, directed the Central government to ensure the supply of medical oxygen by “whatever means required” and also slammed the Centre for not having diverted oxygen supply from industries till 22 April.
On Thursday, Delhi Chief Minister Arvind Kejriwal also said that they were looking to airlift oxygen from Odisha to cut travel time.
(With inputs from ANI, The Indian Express and Hindustan Times.)
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