Ten days ago, a journalist from Lucknow, Vinay Srivastava, sent out a desperate plea for oxygen. "The oxygen level in my body has come down to 52. No hospital, lab or doctor is picking up my phone," he tweeted. Nearly 18 hours later, Uttar Pradesh Chief Minister Yogi Adityanath's information advisor Shalabh Mani Tripathi responded, "Please provide full details". The 65-year-old journalist shared a photo of his oximeter reading-- his oxygen level had fallen to 31 then.Srivastava died, unable to find oxygen. Days later, his covid-19 test report came positive.
For the last two weeks, our Twitter timelines have been filled with SOS messages for oxygen. Photographs of patients and their helpless families pleading for help have emerged from across the country. A photograph of a patient sitting outside Lok Nayak Jai Prakash Narayan Hospital in Delhi with an oxygen cylinder went viral. The Al Jazeera journalist who tweeted it wrote that the hospital refused him admission because they don't have beds or oxygen.The images are real and so are the responses from the authorities. Uttar Pradesh Chief Minister Yogi Aditynath denied the oxygen shortage in hospitals and told The Hindu that he has directed his officials to take action under the National Security Act and seize the property of individuals guilty of spreading "rumours".
Is Oxygen Supply Low?
Before the pandemic hit, India's oxygen production capacity was at 7,127 MT (metric tonnes) per day. The health ministry, in a press statement on April 15, said, "On 12th April 2021, the medical oxygen consumption in the country was 3842 MT, that is 54 per cent of the daily production capacity." The ministry claimed there were stocks including the industrial oxygen stocks with the manufacturing plants in excess of 50,000 metric tonnes. The maximum consumption of medical oxygen, the statement said, is in Maharashtra, Gujarat, Madhya Pradesh, Uttar Pradesh, Karnataka, Tamil Nadu, Delhi, followed by Chhattisgarh, Punjab, Rajasthan.
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Although the Health Ministry said that there is an unusual rise in the demand as well as a steep rise in projections in demand for medical oxygen in some states, the numbers show that there is enough supply to meet the rising demand. But the unexpected rise in the number of cases has meant a lot more demand. On April 12, when the health ministry estimated oxygen demand at 3842 MT, India reported 1,61,736 cases. Since then the numbers of Covid cases have tripled. India reported 3,52,991 cases on April 25. The daily demand for oxygen from hospitals tripled and rose to 8,000 metric tonnes, a Central government told Delhi High Court last week.
Oxygen, in fact, has become a contentious issue between the central and many state governments. This morning, in a newspaper advertorial, the Delhi government made yet another plea for oxygen. "Delhi is running out of oxygen. If you or your organisation has oxygen, with tankers to transport oxygen, kindly let us know. It will help us lift oxygen from other places. This is an SOS appeal. Delhi would be ever grateful to you." In a tweet, AAP MLA Raghav Chadha pointed out that while the daily demand for oxygen in Delhi is at 700 MT, the Centre has allocated 480 MT after revising it from 378 MT. Delhi, he said, however, has only received approximately 300 MT. "Therefore the shortage," he tweeted.
Why Are Hospitals Running Out of Oxygen?
On Saturday, two premier hospitals-- Gurugram's Max Hospital and Moolchand Hospital in Delhi sent out an SOS on Twitter over oxygen shortage and said they have less than two hours of oxygen supply left. This was the third consecutive day that hospitals claimed to have run out of oxygen. This morning, yet another hospital in Delhi tweeted, "We are trying to get in touch with INOX @inoxairproducts since morning to ensure our daily Oxygen supply reaches on time. Have not got any response or dispatch note yet. Alerting everyone now in the hope of preventing another Squared sos situation today."
The biggest problem has been that medical oxygen is not reaching hospital beds in time. This seems to be a combined problem of production, distribution and as many point out, 'bad planning'.
The big oxygen manufacturers in India besides Inox Air Products, which produces over 50 per cent of the medical oxygen requirement in the country, are Linde India, Goyal M G Gases, National Oxygen Ltd and Taiyo Nippon Sanso Corporation. Inox Air Products Director Siddharth Jain told Moneycontrol last week that India has enough oxygen production to meet the existing demand but said that some states are facing a shortage due to distribution issues. "The issue is that supply is available in places that are very far away from the demand. We are trying to find a way to transport the same," he said.
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Medical oxygen is manufactured in large plants using cryogenic distillation techniques to compress atmospheric air, feed it into distillation columns and get liquid oxygen. It has 99.5 per cent purity. For storage, that oxygen is filled into jumbo tankers, from where special cryogenic tankers, that maintain temperatures of -180 degrees Celsius, travel to smaller distributors across the country. Hospitals provide oxygen in various ways through a vacuum insulated evaporator which is a large storage system of liquid oxygen, oxygen cylinders which are gas cylinders that hold oxygen under high pressure and oxygen concentrators.
Now, with the rising number of cases leading to unprecedented demand at many states and hospitals at the same time, the logistical issue has become a challenge for companies that manufacture liquid oxygen.
India has 1,172 oxygen cryogenic tankers for road transport--that's not enough for transporting liquid oxygen available 24x7 in multiple states and hospitals. The facilities from where Delhi now receive oxygen are spread across seven states, some more than 1,000 km (625 miles) away, a court document read. It's not easy to transport hazardous oxygen.
A gas industry source told Reuters that all liquid oxygen is transported in a limited number of specialised tankers, requiring advance planning to ensure deliveries are made on time. The official said that Delhi received about 177 tonnes of oxygen on Wednesday against its allocation of 378 tonnes because amid the desperate demand for oxygen, local authorities kept supplies for themselves and disrupted the movement of tankers. But he also blames lack of planning. "This problem wouldn't have happened if they had acted 2-3 weeks ago," the official told Reuters.
How Are We Bringing In More Oxygen Now?
The government decided to cut supply to industries on April 18 and oxygen produced in iron and steel plants were diverted for medical use. It also issued orders to convert argon and nitrogen tankers into oxygen ones. Industrial oxygen manufacturers are being encouraged to produce medical oxygen. The ministry of railways launched the 'Oxygen Express' which is moving oxygen by rail. The first oxygen express was flagged off last week which went from Mumbai to Vizag to pick up material from the Vizag steel plant and bring it back to Mumbai. India is also importing tankers, manufacturing new ones, and using the Air Force to airlift empty ones to speed up one-way travel.
The Indian railways have been tasked to move multiple tankers from refilling plants to where it is most needed. In Maharashtra, the government has tapped four thermal power plants. There are plans to set up 500-bed hospitals near these plants and lay a direct oxygen line to all beds.
The Defence Ministry has said that 23 mobile oxygen generation plants are being airlifted from Germany. These will be deployed in Armed Forces Medical Sciences (AFMS) hospitals catering to COVID patients. These oxygen-generating plants are expected within a week, the ministry said. Several other industries are offering oxygen to hospitals-- the Tata Group said it is importing 24 specialised containers to transport liquid oxygen.
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Meanwhile, over three hundred oxygen concentrators were dispatched on Sunday morning from New York to India. "Just as India sent assistance to the United States as our hospitals were strained early in the pandemic, we are determined to help India in its time of need," US President Joe Biden had earlier tweeted.
While the government is tapping into all resources for oxygen supply, there needs to be a swift ramping up of the production and the distribution without which a lot more Indians will be left gasping for breath.
