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India’s oxygen crisis, what needs to be done

As the second wave of the Covid-19 pandemic continues to overwhelm India’s medical system, no resource has emerged as precious or in as short supply as medical oxygen. India has now recorded over 300,000 Covid-19 cases for over a fortnight in a row. An estimated 17 per cent of all persons hospitalised with Covid-19 symptoms require medical oxygen, with Government data released on May 8 saying more than 137,000 people across India are on oxygen support. This is more than three times the number of those needing oxygen in the first wave.

To make up the supply shortfall, the production of medical oxygen has surged, from 700-800 tons per day in February to over 9,000 tons per day on May 4. Several countries have also sent India much-needed relief materials, from ISO tanks to oxygen concentrators and cylinders. As aid has poured in, mostly in the form of oxygen making plants and concentrators, Mukesh Ambani’s Reliance Industries pitched in, contributing over 1,000 metric tons of medical grade oxygen per day free of charge. The DRDO is working with several private and public sector agencies to produce over 700 Pressure Swing Adsorbption (PSA) plants, which use technology developed for India’s LCA Tejas light fighter aircraft. With the steady increase in cases, the demand for medical oxygen is unlikely to subside. In Delhi, the Central and state administration are currently in an unseemly standoff over oxygen supply that led the Supreme Court to step in on May 7 to compel the Centre to issue Delhi its assigned quota of 700 tons per day.

Experts suggest the following steps be taken on priority:

1. Create oxygen storage capacities at major hospitals
Liquid oxygen is shipped in ISO tanks—specially made cryogenic containers the size of standard 20-foot shipping containers. Each ISO tank is refillable and can store over 21,000 litres of liquid medical oxygen, the equivalent of two tanker loads. They are also stackable to save space. To operate, all they need is a heat exchanger, which converts the liquid oxygen into gas that can be piped into the hospital. More of these tanks are required at hospitals in the most affected centres.

There is also a need to convert existing nitrogen and argon tanks to store medical oxygen and for them to be positioned at hospitals. The Petroleum and Explosives Safety Organisation, which works under the Commerce Ministry, has a list of all available ISO tanks in India so these tanks would not be difficult to locate. “Storage tanks at hospitals will free up jumbo cylinders for home-treatment of Covid-19 patients and reduce pressure on the hospitals,” says Aditya Kumar, MD of the Ahmedabad-based Enviro Water Integrated Pvt Ltd.

2) Restore order in Delhi
The national capital remains the worst affected by the oxygen shortfall, with rampant black-marketing and hoarding of cylinders taking place. In a May 3 press release, prominent medical organisations urged the government to restore the old roster system of oxygen supply in Delhi. The erstwhile system of allocating vendors to hospitals was disrupted when the Delhi government reallocated oxygen suppliers in April. Today, while patients scramble for hospital beds, hospitals and nursing homes are unable to admit them because they have no oxygen. Vendors have asked smaller hospitals to collect oxygen from their production sites. This has led to hospitals spending a bulk of their time procuring oxygen rather than caring for patients. Smaller nursing homes with spare bed capacity have no oxygen. The medical organisations, including the Association of Healthcare Providers-India (AHPI), the Consortium of Accredited Healthcare Organizations (CAHO), the IMA Hospital Board and Delhi Nursing Home Federation in Delhi have red flagged the crisis and asked the government to stop the chaos of individuals collecting oxygen cylinders. “Redistribution spoiled the relationship between vendors and suppliers, with private citizens and NGOs now storing and procuring cylinders,” says Dr Giridhar Gyani, founder of the AHPI.

3) Manage existing oxygen supply, set up PSA oxygen plants on a war footing
PSA plants draw oxygen directly from the atmosphere and can directly pipe the harvested gas into hospitals. The technology to set these up already exists in India, but these plants need between 4-6 weeks to be commissioned. A standard sized PSA plant can produce 360 litres of oxygen per minute, supplying 60-70 oxygen beds. (One patient generally requires 5 litres of oxygen per hour, which goes up to 20 litres per hour for critically ill patients). PSA plants are long-term investments, but are cost effective and ensure that hospitals always have a backup supply of oxygen. They produce oxygen at a cost of Rs 10 per cubic metre (1,000 litres) while cylinders are being sold right now in Delhi for over Rs 30,000 per jumbo tube (7,000 litres).

There is also huge wastage of medical oxygen taking place. In many cases, hospital authorities are unfamiliar with the machines involved, resulting in accidents or even patient deaths because of falls in medical oxygen supply. Experts say that oxygen plant professionals should be brought in to guide hospitals on how to best manage their supplies. “Oxygen saved is oxygen produced,” says Saket Tiku,” president of the All India Gas Manufacturer’s Association. India Today

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