With India consistently reporting over 90,000 daily cases of COVID-19 in the past few days, shortages of medical oxygen are becoming increasingly apparent. The fact that the novel coronavirus has now spread to rural areas as well, as seen from a nationwide sero-survey, only serves to heighten these concerns.
The Centre as well as various state governments have expressed concern on this issue in the past few days. On Sunday, the health ministry urged seven states " Maharashtra, Andhra Pradesh, Karnataka, Telangana, Gujarat, Rajasthan and Madhya Pradesh " to ensure adequate oxygen availability in all healthcare facilities. The ministry also held a meeting with the DPIIT Secretary, Pharmaceuticals Secretary and the Health Secretaries and Industries Secretaries of the above-mentioned seven states to discuss ways to ensure adequate oxygen availability in all healthcare facilities and unrestricted intra- and inter-state movement of oxygen.
Uddhav Thackeray, chief minister of Maharashtra "which has reported the most cases till now " has also acknowledged that the state is facing a shortage of oxygen, but added that the authorities are working towards addressing the shortage.
Here is a look at how such shortfalls can pose severe challenges to India's fight against COVID-19.
Why oxygen supply for COVID-19 patients is vital
On Monday, health minister Harsh Vardhan told Parliament that till now, oxygen therapy was required for 5.8 percent of the reported cases, while intensive care was required in 1.7 percent cases. Earlier, AIIMS director Randeep Guleria also cited oxygen therapy and the use of steroids as the two COVID-19 treatment methods that appear to be working.
It is little surprise that the demand for medical oxygen has shot up during the pandemic. According to BBC, hospitals and care centres were consuming up to 1,300 tonnes of oxygen every day, compared to 900 tonnes per day before the pandemic. At present, with the country reporting even more cases per day, the demand is likely to be even higher.
But ensuring the supply of oxygen is a steep task, particularly in rural areas, where health infrastructure is weaker.
As an article by Bloomberg Quint notes, there are several mechanisms to supply medical oxygen. In places which have better-developed health infrastructure, liquid oxygen is filled into large tanks built into the ground and then supplied through a network of pipelines to the patient's bed. However, this requires a network of pipelines for this purpose, which is often not available in small towns and villages and cannot be constructed in a short period of time. At such places, medical establishments rely on either 'jumbo' oxygen cylinders or smaller ones which can be used for individual patients.
A guideline by the National Health Mission notes several challenges in the use of oxygen cylinders, but states that this is the most adaptable method in short-term and emergency situations. It states that piped supply to hospitals is a "far better, cheaper, safer method than supply through cylinders", but adds that it needs infrastructure such as pipelines and a storage tank. On oxygen cylinders, the guideline, states, "It is a labour intensive, logistically challenging, unsafe, unhygienic (chances of carrying infection from hospital) and expensive method."
A Firstpost report on the situation in Maharashtra's Palghar sheds some light on just how 'labour intensive' and 'logistically challenging' such cylinders can be. The jumbo cylinders are just over four feet in height and weigh about 50 kilos when they are empty. The report quotes a hospital employee as stating that carrying the cylinders from one place to another is 'back-breaking' work and two people are needed for it.
This only adds to the several inadequacies of medical facilities in rural areas, that have existed prior to the coronavirus pandemic as well. People in villages also have to contend with a health care system characterised by shortages of doctors, lack of medical supplies and other infrastructure, as per the Economic Survey for 2018-19.
Deaths due to 'oxygen shortages'
Across the country, there have been several instances where low or delayed oxygen supply may have contributed to coronavirus patients' deaths, according to media reports. However, authorities have denied that the deaths occurred due to inadequate oxygen supply.
Four patients died at a hospital in Madhya Pradesh's Dewas last week following a shortage of oxygen cylinders, as per an NDTV report. This was after neighbouring Maharashtra limited the supply of oxygen to Madhya Pradesh. The report quoted a medical officer as saying that the deaths were not due to a delayed oxygen supply. The official, however, claimed that there was 'miscommunication' while loading cylinders headed for the district from Bhopal, which may have caused a crisis.
But it's not just the absence of oxygen supply but also low oxygen pressure that can cause deaths. In May, doctors at a Mumbai hospital alleged that 12 people died in two weeks there because of this reason. A Mumbai Mirror report had quoted a resident doctor as saying that 15 oxygen supply machines in a 25-bed ICU showed 'Low O2 pressure.' While the medical superintendent of the hospital admitted that there was a shortage of oxygen, she denied that there had been any death due to this reason.
As the demand for medical oxygen spirals, several states have begun taking measures to meet the shortfall. In Maharashtra, several districts are in the process of installing their own oxygen generation plants to cut dependence on suppliers. These districts include Osmanabad, Beed, Nandurbar and Pune, according to The Indian Express. The state government has also directed suppliers to ensure that 80 percent of the supplies go to hospitals, and only a maximum of 20 percent can go to industries. Earlier, about 40 percent of the oxygen supply was diverted for industrial supply.
In Madhya Pradesh, Chief Minister Shivraj Singh Chouhan has said that the Centre has agreed to supply 50 tonnes of oxygen per day to the state.
In the wake of a rise in respiratory disease cases, Madhya Pradesh needs 110 tonnes of oxygen per day, a release from the state public relations department said.
Chouhan has also asked oxygen plants in Madhya Pradesh to increase their production to full capacity from the present 50 to 60 percent.
The Gujarat health department has also directed oxygen manufacturing units to ramp up production to maximum capacity and ensure that 50 percent of it is "medical oxygen" meant for hospitals.
There are around 53 licenced medical oxygen-producing units and the notification has been issued as a precautionary measure to ensure that people of Gujarat do not face a shortage of oxygen, commissioner of state Food and Drugs Control Administration (FDCA) HM Koshia said.
Gujarat produces enough medical and industrial oxygen and even supplies it to other states, he said.
In Ludhiana " one of the worst-affected districts in Punjab " Deputy Commissioner Varinder Kumar Sharma has asked industrialists to immediately start the supply of medical oxygen for the hospitals.
Punjab health minister Balbir Singh Sidhu has said, "There is no shortage of medical oxygen in Punjab. Elaborate arrangements for manufacturing and refilling oxygen cylinders have been made to ensure uninterrupted supply."
These announcements " all of them made in the past week " indicate that ensuring adequate oxygen supply is going to be the next big challenge for administrations to defeat COVID-19. The success or failure of these efforts will determine how soon the country can tide over the pandemic, and how many critically ill patients can be saved.
With inputs from PTI