Bhopal: As the number of active novel coronavirus cases continues to surge in Madhya Pradesh, the state government has admitted in the high court that it is staring at a huge shortage of oxygen, a crucial treatment aid.
“A large number of Covid-19 patients are dying and the state can’t close it eyes towards persons dying on account of non-supply of liquid oxygen,” MP advocate general Purushaindra Kaurav said before the Indore bench of the high court, seeking a direction to the Maharashtra government not to discontinue supply of liquid oxygen to the state.
Through an order dated 7 September, the government of Maharashtra, one of the chief suppliers of medical oxygen to MP and the region worst hit by Covid-19, told local industry to reserve 80 per cent of their oxygen for the state’s needs.
The advocate general’s submission came as the MP High Court heard a plea filed by a government-run hospital — MY Hospital, Indore, the biggest government facility in the state — that found its oxygen supply from a Maharashtra firm disrupted by the state’s order.
A division bench of Justice S.C. Sharma and Justice Shailendra Shukla Wednesday directed the firm to continue uninterrupted oxygen supply to MP without being influenced by the Maharashtra government circular. The matter will next be heard in October.
The order of the Maharashtra government, aimed at ensuring adequate oxygen supply at home, triggered much worry in Madhya Pradesh, where the local production capacity has for long — since before Covid struck — been described as inadequate by health activists.
It led Madhya Pradesh Chief Minister Shivraj Singh Chouhan to immediately dial his Maharashtra counterpart Uddhav Thackeray, who is said to have assured the former of continued oxygen supply. The central government stepped in too, asking states that supply oxygen to not restrict their sales, citing the fact that the distribution of oxygen manufacturers is not equitable around India.
Even so, a scramble ensued in Madhya Pradesh to find alternatives, and boost local production as much as possible, to make sure they are not left struggling as the pandemic rages on.
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Boosting supplies
In the first 16 days of September, Madhya Pradesh added nearly 31,550 cases of coronavirus to its tally. The count of active cases increased from 13,914 to 22,136 during the same period. It has seen a total of 1,844 deaths.
Since Covid-19 is a respiratory illness, symptomatic patients require oxygen support. Union Health Ministry guidelines prescribe oxygen treatment for moderate as well as severe Covid-19 cases.
According to IAS officer S. Dhanaraju, a key member of the state’s Covid-19 team, about 15 per cent of active cases require oxygen support. Out of these, 10 per cent are mild and moderate cases, while 5 per cent are the more severe patients.
Dr Milind Shiralkar, the dean of Government Medical College at Shahdol, said 30 of the 38 Covid-19 patients in the facility’s ICU require oxygen.
“We require 130 cylinders daily and have 75 cylinders in stock. The hourly requirement was five cylinders, which has risen to six or seven recently,” he added.
In its submission before the Madhya Pradesh High Court, the government said the state’s current medical oxygen requirement is 100 metric tonnes, which is expected to climb to 270-280 metric tonnes per day by the end of October. This is a requirement the state is currently not equipped to deal with even though it claims to have arranged enough supplies for now.
Medical oxygen is also required in other illnesses that hamper breathing. Air-separation units that pack oxygen cylinders, however, cater to not just medical needs, but also industrial sectors like pharmaceuticals.
Madhya Pradesh doesn’t have enough air-separation units — as the name suggests, the units break air into its different components — to meet its requirements even in normal times.
Its 11 units have a total production capacity of 45 metric tonnes daily, forcing Madhya Pradesh to rely heavily on Maharashtra, Chhattisgarh and Gujarat to fulfil its requirements for oxygen, said Dhanraju. About 80 metric tonnes of liquid oxygen is imported by MP.
Most local units that produce oxygen are located near Indore. Gwalior sources its oxygen all the way from Bhilai in Chhattisgarh, over 850 km away.
Maharashtra’s restrictions on oxygen supply come as it grapples with a relentless Covid onslaught. As of Saturday, it had more than 14 times the number of active cases in MP.
The Maharashtra order led to an immediate SOS from Jabalpur and Damoh, which used to receive oxygen from a Nagpur-based firm, and the MP government started efforts to boost local production and sort out alternative arrangements.
As a result, the state claims its daily medical oxygen availability of 125-130 metric tonnes will go up to 200 metric tonnes by month-end. “Compared to the requirement, availability of oxygen is pretty good now,” said Dhanraju.
Sudam Khade, the commissioner for public relations in the Madhya Pradesh government, said the state currently has a medical oxygen supply of 130 metric tonnes daily, against a requirement of 110 metric tonnes. Additionally, the central government has assured the state of 50 tonnes daily.
Bridging the gap
Detailing the steps taken by the state to boost its supplies, Dhanraju said, “We don’t have much scope to increase production (at the existing units within the state) but we have been able to identify two more sources in Bhilai.’’
A unit in Jabalpur, he added, is working round the clock, but has been asked to take a maintenance break “rather than getting into deep trouble later”.
MP has also invited a private firm to set up an oxygen plant near Babai in Hoshangabad district. CM Chouhan said earlier this week that the unit will be installed within six months, and provide the state with 200 metric tonnes of oxygen daily.
Dhanraju, however, admitted there are logistical issues, adding that the state is aware that, given the positivity rate, the cases will increase.
Shahdol Chief Medical and Health Officer Rajesh Pande said the oxygen situation has improved after the administration tapped into additional sources.
Dr Milind Shiralkar of the Shahdol Government Medical College agreed, but faulted logistical issues for causing problems.
“Things have slightly improved but we still face shortage of cylinders because consumption has gone much higher. We had a serious crisis a week ago when the vehicle bringing oxygen from Jabalpur broke down,” he said.
“The vehicle that was supposed to reach at 8 pm arrived after 2 am, so our stock got exhausted. Then, on 9 September, there was shortage at Jabalpur and our supply stopped, forcing us to approach senior authorities.
The logistical issues are a big challenge as the patient count goes up, he said. “We had only two patients in ICU on 9 August but the number has exponentially increased to 38 a month later,” he added.
Shiralkar said the hospital has borrowed 250 cylinders but still can’t “say that we are in a comfortable position because the stored oxygen can last only for 17 to 18 hours and if there is even a slight snag we are in trouble”.
“A filling station in Baihar shut for two days and the supply of liquid oxygen from Satna stopped one day,” he added.
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‘Widespread shortage’
Health activists say the state would not have found itself in this situation if it had heeded repeated warnings about oxygen shortage.
“There is widespread oxygen shortage in the state. It points to the government’s failure to anticipate demand,” said health activist Amulya Nidhi of the Jan Swasthya Abhiyan. “Health governance has failed in MP because oxygen is needed not just for Covid patients. It’s required permanently.”
Rajiv Agrawal, president of the Association of All Industries in Mandideep, an industrial estate on the outskirts of Bhopal, said the government also ought to cater to industry requirements, saying businesses that use oxygen are on the verge of closure because all the supplies have been diverted for medical purposes.
“Units that use oxygen for cutting and fabrication have been told to look for alternatives but pharmaceutical units also require it,” he said. “All the oxygen supply has been diverted to hospitals. True, human life is more important, but pharmaceutical units also contribute to saving lives. We have requested the government to spare some quantity for pharma units.’’
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