Explained | What is being done to bridge medical oxygen demand and supply?
Home Health Explained | What is being done to bridge medical oxygen demand and supply?
Health - 5 days ago

Explained | What is being done to bridge medical oxygen demand and supply?

The story so far: A shortage of medical oxygen at hospitals in many parts of the country in the wake of the ongoing second wave of COVID-19 infections has caused multiple deaths, including in the capital city, and led to the Delhi High Court asking the Central government to explain its approach to the allocation of the critical resource to various States and Delhi. On Thursday, it questioned the Centre on why States like Madhya Pradesh and Maharashtra were allotted more oxygen than what they had asked for, while Delhi was not given even its projected requirement to treat COVID-19 patients. On Saturday, Batra Hospital in New Delhi reported that 12 patients had died as it ran out of oxygen. On April 30, India crossed the 4 lakh-mark for daily new COVID-19 cases.

How much oxygen does India produce?

In a release on April 15, the Ministry of Health and Family Welfare acknowledged at the outset that “medical oxygen is a critical component in the treatment of COVID affected patients” and said that India had a daily production capacity of 7,127 metric tonnes (MT) of oxygen, which it asserted was sufficient given that the countrywide medical oxygen consumption as of April 12 was 3,842 MT. While the 7,127 MT capacity that the Ministry referred to was the overall oxygen-producing capacity, including the volumes produced for industrial use, the fact that the Centre has restricted the supply of oxygen for all non-medical purposes, except a list of exempted industries that includes pharmaceuticals, food, oil refineries and oxygen cylinder makers, has meant that the major share of output has been earmarked for medical use.
 Subsequently, in a statement shared by the Press Information Bureau on its website on April 27, the Prime Minister’s Office said: “The production of LMO [liquid medical oxygen] in the country has increased from 5,700 MT/day in August 2020 to the present 8,922 MT (on April 25, 2021). The domestic production of LMO is expected to cross 9,250 MT/day by the end of April 2021.”

What led to the shortage?

The demand for medical oxygen, which prior to the onset of the pandemic last year was at about 10% of overall output, or 700 MT/day, has skyrocketed in recent weeks with the incidence of patients suffering acute respiratory distress having sharply spiked during the current wave. While the Union government did constitute an inter-ministerial Empowered Group (EG2) of senior officers in March 2020 to ensure the availability of essential medical equipment, including medical oxygen, to the affected States, the group appears to have been caught off guard, along with most of the country’s health sector by the sheer scale and speed of the rise in infections. As a result, oxygen demand projections have woefully lagged behind actual requirements.

For instance, in an affidavit filed in the Supreme Court last month, the Union government pointed out that soon after it had passed an order for allocation of oxygen to 12 high-burden States on April 15, some of them promptly ended up considerably revising their projections for medical oxygen requirements for April 20. So, while Uttar Pradesh doubled its requirement forecast 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 it had previously sought. Three other States, which had previously not been a part of the list, also sought allocations from the Centre, thus pushing up the demand forecast for April 20 to a total of 5,619 MT, from the 4,880 MT estimated earlier. The sharp revisions on the part of two States even prompted the government to remark in the affidavit that “it is also pertinent to note that the medical oxygen in any country cannot be unlimited”.
 Also, the preparation for a possible second wave in India and oxygen requirements appears to have been wholly inadequate. As a pointer, in August last year, the European Industrial Gases Association observed that its members such as Air Liquide and Linde were experiencing five to 10 times the usual demand for medical oxygen, and this at a time when some countries, including in Europe, were experiencing their second wave. Add to this the unique logistic challenges facing the distribution of medical oxygen to hospitals in India, and we had a perfect storm of supplies running out with replenishment not reaching on time and many seriously ill patients gasping to death.

Why are we facing supply challenges?

Prior to the pandemic, a bulk of the health sector’s medical oxygen requirement had been met with supplies delivered either in form of oxygen cylinders containing the element as a high-purity gas or through dedicated cryogenic tankers that transport the oxygen in liquid form and deliver them to storage tanks at hospitals.

The stand-alone facilities for the production of oxygen, including the medical variant, have so far been geographically concentrated mainly in clusters in the eastern, southern and western parts of the country, thus necessitating the transportation of the element over distances by road. With just 1,224 cryogenic tankers available for transporting LMO, according to the affidavit filed in the Supreme Court, there have not been enough vehicles to carry medical oxygen in quick time to critical locations. This despite the fact that some tanker fleet owners have deployed at least two drivers with each vehicle to improve on-road and turnaround times between each delivery. With cylinders and tankers scarce, the authorities are now eyeing other ways to urgently redress the situation.
 

What is being done to boost supply?

The Centre is taking a multi-pronged approach to address the crisis. For one, it has decided to deploy surplus stocks of the element available with steel plants across the country, including Public Sector Units. Also, the movement of transport tankers for LMO is now being closely monitored and the Indian Railways and the Indian Air Force have been roped in to help ferry tankers by both rail and air (though aircraft are mainly transporting empty tankers as it is hazardous to transport filled cryogenic vessels). The PESO (Petroleum and Explosives Safety Organisation) has also issued directions to oversee the conversion of argon and nitrogen tankers for use as oxygen tankers. Production of additional cryogenic tankers is also underway to augment fleet capacity. Separately, industrial cylinders have been permitted to be used for medical oxygen after due purging, and the Health Ministry is placing orders for another one lakh oxygen cylinders.

The Ministry is also expediting on “a war footing” the commissioning of 162 Pressure Swing Adsorption (PSA) plants that can generate oxygen from the air at various hospitals across the country, according to its affidavit. And for now, the government is also accepting assistance from abroad with several countries, including Russia and Singapore, despatching oxygen equipment.
 

What lies ahead?

The efforts to boost output and improve supplies notwithstanding, there are still multiple challenges. For the relatives of patients struggling to procure an assured supply of oxygen either at home or once admitted to a hospital, real-time information on availability has been hard to come by. Hence, they have mostly had to rely on volunteer networks disseminating data via social media platforms. Here again, the Supreme Court had to step in to warn authorities against initiating any punitive action against volunteers and those putting out appeals for help.

Further, the allocation of oxygen to the States by the empowered group appears to be uneven, with the Delhi High Court pointing to the fact that against the local government’s request for 700 MT, it had only been allocated 490 MT, while Madhya Pradesh and Maharashtra had been sanctioned more supply than they had sought. The wrinkles in matching supply and demand both at the institutional and individual level need to be ironed out without further delay.


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