Anatomy of Capital oxygen crisis, 5 things Delhi govt didn’t get right

Amid a raging fourth wave of the Covid-19 cases, Delhi, in the past 15 days, has been hit by an unprecedented medical oxygen crisis. While several Covid-19 patients have died waiting for beds with oxygen support, the family members of at least 32 say they died inside hospitals due to oxygen shortage.

The Delhi government says it continues to face oxygen shortage because of inadequate allocation and supply by the central government, but the crisis also seems to have been caused by its own failings, such as the inability to manage logistics or the absence of an allocation plan to hospitals.

There is a demand-supply imbalance. There is a demand-supply imbalance. “We need 976 MT of oxygen, but it was only yesterday that we started getting more than 500 MT. On April 19 and 20, when the oxygen crisis first began to unfold in the city, Delhi used to receive only 241 to 355 MT every day,” said a government spokesperson.

Communications sent by the Delhi government to the Centre, as seen by HT, showed that the city administration projected a demand for 700 MT per day till April 28, and revised its demand to 976 MT based on its bed augmentation plan on April 29. The Centre, however, began to increase Delhi’s quota of oxygen on a piecemeal basis from April 21, when it first raised it from 378 MT to 480 MT; then on April 30 to 490 MT; and then on May 1 to 590 MT.

But the crisis is not one of demand-supply alone. From supply chain management to distribution within Delhi to better preparation to robust information exchange with citizens, experts said there were several steps the Delhi government should have taken to manage the crisis better.

Supply Chain Management
Officials and company representatives said that the biggest problem–the lack of cryogenic tankers–became worse because Delhi started looking for tankers only from mid-April.

“By then, most of the tankers available with transporters in north India were booked by states such as Madhya Pradesh, Punjab, Uttar Pradesh and Haryana. Other states had predicted that there would be a clamour to grab tankers as the demand for oxygen first grew, and then spiked suddenly. Delhi kept its focus on demanding extra allocation from the Centre without giving much thought about the transportation bit,” said KK Yadav, a transporter in Faridabad, who was approached by the Delhi government between April 17 and 19.

Besides, the Delhi government’s announcement of procuring 18 cryogenic tankers from Bangkok was also a non-starter due to “technical and administrative issues”. A government spokesperson said it has now sourced seven tankers from the Central government, apart from procuring around five on its own. “Some industrialists and other states have also helped in providing tankers, but it is not enough. The high court has said it is the Central government’s responsibility to ensure oxygen reaches Delhi’s borders.”

A senior government official said a big challenge is to reduce the turnaround time of containers because at least 100MT was being sourced from over 1,500km away . “It is only over the past two days that Oxygen express has been pressed to full service for Delhi to reduce the turnaround time. The Centre should have done it from a week before,” said the official.

A central government official, however, said the railways were ready with rakes for several days but the Delhi administration could not arrange for tankers to lift the oxygen.

Distribution Network Inside Delhi
Delhi had no daily hospital-wise allocation plan for oxygen until a week ago. Earlier, the hospitals had contracts with oxygen suppliers. But, this arrangement went haywire with the sudden surge in demand for oxygen. On April 22, the government decided it will start giving daily schedules of allocation to every hospital. But, it was a rudimentary plan which did not work well.

It was only on April 29, when the crisis was at its peak, that the Delhi government issued an order prescribing quantities of oxygen to be used by each hospital in Delhi. This order also came after the directions of the high court.

On the basis of this, now Delhi government increases and decreases the oxygen supply to different hospitals depending on the total quantum received in the city on any day.

And while hospitals started sending SOS to the government from April 18, it was only on April 22 that the administration set up a helpline number, with a senior IAS officer in-charge of it, to coordinate with all medical facilities and address their demands and grievances.

Citizen Facilitation
Delhi does not have a verified central helpline number for people to meet their oxygen requirement, or get admitted to hospitals. It has not spread awareness about phone number or addresses of the 14 oxygen cylinder refillers in the city, and most people are managing their individual demands through crowdsourcing on social media or by word of mouth.

The Delhi government said that work on a centralised system was going on, but did not give a timeline of when it will be operational.

On April 28, when scores of people were waiting outside refillers for 6-10 hours for oxygen, the Delhi government issued an order clarifying that people will get to refill their cylinders in Delhi only with their own ID card, the patient’s ID card, and a doctor’s prescription for medical oxygen.

Uma Tyagi, whose 48-year old husband died of Covid-19, said her son and daughter waited outside two separate refillers for eight hours to get one cylinder. “My son was turned away because he did not have the documents. Nobody told us what papers were required. My daughter somehow managed one, but my husband died hours after that cylinder got over,” she said.

The state health department has now asked all district magistrates to deploy teams round-the-clock at refilling plants or retail establishments to check documents and to ensure adherence to Covid-19 appropriate behaviour.

Psa Plants
T Jacob John, former head of clinical virology at Christian Medical College, Vellore, said even if the central government failed to install PSA oxygen plants within the past one year, nothing stopped the Delhi government from being proactive and getting things done on its own during the entire run of the pandemic. The Delhi government has 11 hospitals under it, and the Centre is installing PSA oxygen plants in seven of them.

“The internationally required number of beds per 100,000 population is 300, India has only 50. So, we were anyway working at one-sixth efficiency of health care management. When a crisis comes, even the one-sixth becomes one-60th. About 20% of air is oxygen, the raw material is everywhere. It is only a matter of converting it into medical oxygen by using huge plants,” John said.

On April 27, the Delhi government announced that the city will import 21 PSA plants from France, but that remains on paper till now, which is why the Delhi government is now looking to DRDO for more such plants. In a letter to the Union health ministry, the Delhi government on Sunday sought 50 oxygen generators to Delhi instead of just four, as per the existing plan.

Late Call for Help
Dr Amit Singh, associate professor at Centre for Infectious Disease at Indian Institute of Science, Bangalore, said Delhi could have planned better during January-February, when cases had plummeted after the third wave. Even during the fourth wave, the administration’s response to the crisis was delayed on almost all aspects — putting in curbs, going into lockdown, seeking the Centre’s help, and planning for augmentation of beds and oxygen.

To be sure, several states in India are guilty of the same lapses.

“We could have planned better considering all other countries had a second wave. When it comes to planning about beds, oxygen etc., it all depends on predictions of how much the intensity of the second wave is likely to be. Because of lockdown during the first wave, we did not see as many fatalities, so we should have prepared for a fivefold increase in intensity, and calculated the percentage of people who need ventilator and oxygen support,” said Dr Singh.

“The lockdown should have been earlier (when the positivity rate was going up), but that can only be done if you envisage through data that there is going to be a huge wave,” he added.

Talking to reporters, chief minister Arvind Kejriwal on Wednesday said the Delhi government will continue the lockdown based on the situation of the Covid-19 cases in Delhi. “Right now, the citizens of Delhi themselves want this lockdown to continue to stop the spread of this virus… We are continuously monitoring the oxygen situation. Yesterday, we received 43 SOS calls regarding oxygen. I know that there were some unfortunate incidents but right now, we are working round the clock to ensure that no fatality in Delhi happens due to lack of oxygen,” he said.

“But our only hope is that the central government will provide Delhi with its full quota of oxygen. During this tough time, we have also received massive support from the Supreme Court and the high court. I am hopeful that in the coming days the situation will improve,” Kejriwal said. Hindustan Times