We are continuing to be under the grip of the pandemic "COVID 19" with staggering numbers. Seventeen million for the country, one million in the capital city Delhi and 1,60,000 in our Union territory of Jammu and Kashmir. Though the recovery rates are very high but till date we have lost 1,92,000 of our citizen's due to this scourge in the country. Everything has come to a standstill with curfews being imposed by the helpless authorities.
While we are facing the onslaught of a disease which though low in mortality (less than 1.3%) and has no definitive curative treatment against the virus to offer. It has exposed our reserves to handle people who actually need care especially of oxygen administration. The figures of the country till date suggest that less than 4% patients actually needed oxygen supplying beds in hospitals and just 0.4% are on ventilators. Oxygen is indicated in patients who become short of breath and have oxygen saturations as measured on finger oximeters to less than 90% or successively showing a declining trend. The shortage of oxygen in the country for treating these patients especially in the capital NCR region has become the most talked about news. Is India short of oxygen production as is being made to believe by many responsible citizens? It seems to be lack of foresight and planning by the administrators of the hospitals who have been making people shiver with fright when they say in press conferences "in 2 hours there would be no oxygen for the ICU patients".
India has a daily production of oxygen at least around 7,127 metric tons every day from official sources and there is absolutely no shortage of this important gas. It is well known that, there is no difference between medical grade oxygen and industrial oxygen. In fact, Industrial oxygen has to be 99.5% pure while as per the pharmacopeia's all-over medical oxygen should be only 93+ 3% pure. Less than 1% oxygen is used for medical purposes. Even in these CORONA days with a pandemic the need may increase up to 4 or 5%. More than 80 % of oxygen production capacities are with iron and steel companies.
Most of the production plants are in East India (Assam itself has 8 plants producing 5,27 MT's per day in West (Mumbai and Gujarat) and some in Karnataka. Typically, these plants produce 5-10% as liquid which is stored in large storage tanks. This liquid is used as a back up for any exigencies or to meet the peak demand.
The liquid oxygen plants owned by gas companies like Linde gas and Inox produce liquid oxygen and sell to various companies by tankers. These are put into cylinders after vaporising the liquid. Oxygen to end users is distributed by 3 methods. Directly through pipeline from the plant to the end user (About 80%). 15% is delivered in liquid form through tankers and only 5% through cylinders.
Why the Crisis?
A combination of factors has been responsible. There has been a shortage of distribution through road tankers, storage tanks and cylinders. All these are expensive. Each road tanker costs Rs 45 lacks on road and a cylinder which carries Rs 300 worth of oxygen costs Rs 10,000. All these assets have been built by gas companies.
Most of the plants are located in selected geographies and distribution has been slow. Travel fare, distances to deliver it to the customers has been the issue. Even with good, roads a tanker takes around 8 to 10 days to make a round trip. This is coupled with the fact that the gas companies focus on what maximizes their profit. The 2nd wave of the pandemic came so fast that all the stakeholders were taken by a big surprise and with total unpreparedness and hence this man-made crisis. Common sense would have dictated the heightened demand with increasing admissions and requirements of oxygen for patients who are unable to breathe because of Covid pneumonia.
The suggestions to combat this crisis are: strict advisory to gas companies to use all distribution assets for medical purposes only, immediately. Govt could provide compensation to gas companies just like MSP for food grains. The production plants should not use any liquid oxygen for their processes until these are full. Expeditious transport using the Railways through green door tracks, which are un impeded during their journey to reach the high consumption states.
All hospitals should instal Pressure Swing Adsorption (PSA) medical grade oxygen plants. PMO has announced 200 crores for all district hospitals and they could have 500 plants. This should be made mandatory.
The Chief Executives of large hospitals who were making most of the noise on media are equally responsible. They should have been prepared for this in anticipation. These hospitals charge exorbitantly from these patients, often in advance and this is what they provide in terms of supporting them, when they become sick. Some of these hospitals are getting undertakings from these patients absolving the hospital of its responsibilities in case the patient dies. This is not at all acceptable. Once this crisis is over enquiries need to be made and the responsible administrators of these large hospitals need to be shunted out, so as to set a precedence.
The problem faced in the last week has been solely due to lack of anticipation, un-preparedness and tardiness in mobilizing resources to distribute oxygen, which was available in plenty. It is a shame that with so much of surplus oxygen available at home, European countries and tiny places like Dubai and Abu Dhabi, are offering to supply oxygen to us.
Prof Upendra Kaul Cardiologist, founder Director Gauri Kaul Foundation, A recipient of Padma Shri and DR B C Roy Award