New Delhi: In the past few weeks, news and social media have been flooded with photographs of Covid patients gasping for air as the country faces an acute shortage of medical oxygen.
The aggressive second wave of the pandemic has overwhelmed health infrastructures in most states, with hospitals unable to arrange adequate oxygen supply for the mounting case numbers.
This shortage has led to over 20 patients dying within hours at Delhi’s Jaipur Golden Hospital Friday. Similarly, six patients died in Amritsar after a private hospital could not procure oxygen. Families of deceased patients in Uttar Pradesh have also alleged that several of these occurred due to a lack of oxygen.
One of the biggest lessons learnt from the first wave was that oxygen therapy helps patients with moderate and severe Covid get better, and only a handful of them need a ventilator after that.
However, despite this information, the present surge in infections seems to have caught the Indian health infrastructure unawares. Almost all states, particularly in north India, are struggling with the supply of medical oxygen.
ThePrint explains how oxygen is distributed to hospitals and the reasons behind the supply shortage.
How medical grade oxygen is made
Medical grade oxygen refers to, as the name suggests, oxygen used by hospitals and clinics in the treatment of various illnesses that cause oxygen saturation levels in the body to drop. In this sense, it is similar to a drug.
Unlike the air we breathe — which has only 21 per cent oxygen that is filtered by our lungs — medical grade oxygen is highly concentrated and can be obtained in several ways.
One is by liquifying air through a process called cryogenic distillation. In this method, oxygen is produced in air separation plants where the air is cooled and the oxygen is distilled based on its boiling point. Liquified air also separates into argon and nitrogen through the same method.
Oxygen can also be generated from the air itself by a machine called an oxygen concentrator. According to a note by the Ministry of Health and Family Welfare, an oxygen concentrator is “a self-contained, electrically powered medical device designed to concentrate oxygen from ambient air”.
A third method of oxygen generation is through pressure swing absorption (PSA) plants. A PSA oxygen plant employs a technology that absorbs nitrogen from ambient air to concentrate oxygen for supply to hospitals. They operate at near-ambient temperatures and use specific adsorbent materials (that trap a substance on their surface) like zeolites, activated carbon, molecular sieves etc., to trap oxygen at high pressure.
The cost of setting up a PSA plant is approximately Rs 33 lakh while the cost of an oxygen cylinder can range anywhere between Rs 6,000 and Rs 8,000. An oxygen concentrator is priced between Rs 40,000 and Rs 90,000.
Transport of oxygen
Once obtained, oxygen is stored either in cylinders and tanks in a gaseous form under pressure or in cryogenic tanks at very low temperatures in liquid form.
The government is in the process of building 551 PSA plants to meet the current demand of oxygen, but till then, most hospitals are relying on cylinders or a supply of liquid oxygen.
“There are about 1,171 cryogenic tanks in the country for oxygen, and another 800 for nitrogen and argon. Tankers have varying capacities, from 2 metric tonnes (MT) to 30 MT. We are in the process of converting nitrogen tanks into oxygen tanks so we can ease the supply crunch,” S.D. Mishra, nodal officer of oxygen supply for Covid-19 at the Petroleum and Explosives Safety Organisation (PESO), told ThePrint.
This is several times higher than the demand for medical oxygen in pre-Covid times, which was around 700 MT per day.
“Before, just 10 to 20 per cent of all oxygen supply was for medical use. Now, almost all of it is being diverted for medical use. This kind of demand has never been seen before,” said Mishra.
Among the biggest manufacturers of oxygen are Inox Air Products — which manufactures 60 per cent of the country’s total oxygen supply — along with Linde and Goyal MG Gases. The country also plans on importing 50,000 MT of oxygen.
The supply chain
Medical gases are regulated both by the Central Drugs Standard Control Organisation (CDSCO) and the Ministry of Industry and Commerce, which PESO comes under.
Earlier, no governments were actively involved or monitored the supply of medical oxygen to hospitals. Hospitals contracted suppliers directly, who would then deliver it every two to four days or whenever stocks needed to be replenished, explained Mishra.
However, since the nationwide lockdown was first announced in March 2020, the Empowered Group 2 — one among the several other empowered groups — was formed under the Ministry of Home Affairs to monitor and ensure availability of essential medical supplies, including oxygen. This is why states must appeal to the central government for allocations.
The Empowered Group 2 has estimated that 12 states will require a total of 4,880 MT, 5619 MT and 6,593 MT on 20 April, 25 April and 30 April, respectively.
These 12 states are Maharashtra, Madhya Pradesh, Gujarat, Uttar Pradesh, Delhi, Chhattisgarh, Karnataka, Kerala, Tamil Nadu, Punjab, Haryana and Rajasthan.
“Sources of medical oxygen and their production capacity was mapped to match the requirement of states and an indicative framework has been developed to guide the states on the sources of medical oxygen,” the health ministry said in a statement.
Mishra told ThePrint that the biggest challenge was transporting oxygen from the eastern and southern states, where demand isn’t growing as quickly to the northern and western states, which are struggling for supplies.
In Delhi, which has been allocated 490 MT of oxygen, the state is rationing its supply by allocating each hospital with a fixed amount.
Despite this, the city has continued to see SOS calls from hospitals because these allocations have been inadequate. The Delhi government, which had appealed to the central government for a larger supply, says at least 700 MT of oxygen is required to meet current medical needs.