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India’s healthcare infrastructure has been brutally exposed by the covid-19 pandemic. There are not enough beds, doctors and other medical resources. With the post-Diwali surge in Covid cases and increase in deaths, once again the focus was on the crumbling health care infrastructure in the country. Shortage of oxygen has continued to be concern. There have been reports of shortage of oxygen in numerous states including Uttar Pradesh, Madhya Pradesh, Gujarat, West Bengal, etc.
Even in pre-covid-19 times, there were many times when patients died because of lack of medical oxygen. For example, death of 70 children in a government hospital because supply was cut off due to unpaid bills. Breakout of the pandemic simply worsened an already bad situation. Oxygen has been in medical use for over a century but medical oxygen has never been adequate. Neither has it received sufficient attention despite sporadic incidents where patients died directly because of unavailability of medical oxygen. Even after medical oxygen was included in the WHO’s model list of essential medicines in 2017, there was no concerted effort to build up the capacity.
As the protocols for Covid-19 evolved after the outbreak in March, there emerged a consensus that medical oxygen is critical for treating covid-19 patients with as invasive ventilation and low- and high-flow oxygen therapies. The surge in demand with steep rise of covid-19 underlined the preexisting gas in the supply resulting in substantial shortage of oxygen.
How Hospital Get Their Oxygen
Logistics of supplying medical oxygen to hospitals involve delivery in bulk through cryogenic storage or in smaller quantities through pressurized oxygen cylinders depending on the specific requirements of the hospital and their infrastructure. After delivery of liquid oxygen at the hospital, it is distributed to patients through a piping system. However, the hospitals need to have the requisite infrastructure like piping system covering the entire building combined with a cryogenic tank and vaporizer. With medical oxygen cylinder there is no need of having hospital piping system. Hospitals not having sophisticated infrastructure can get their supplies though the cylinders. Most of the hospitals in India do not have the required infrastructure so they rely on supply through cylinders.
Current Status of Medical Oxygen Supply in India
At the outset of the pandemic, India was producing 900 tonnes of oxygen per day. Seeing the surge in covid-19 cases, the government repurposed the supply from health care centers where there was not much need of oxygen. Most oxygen produced in India also goes into running various processes in steel, paper and chemical industries. This was repurposed to meet the surge in demand for oxygen taking care of the impurities present in medical oxygen. Now India is producing 5000 tonnes of oxygen out of which 2700 tonnes is meant for medical consumption, the rest for industrial purposes.
As a result of shortage of oxygen, the prices have turned predatory and increased manifold despite the cap on prices by the National Pharmaceutical Pricing Authority last year at Rs.17 per cubic meter. It is a sorry state that requires immediate action on the part of the government. Prices of oxygen cylinders and liquid oxygen must be capped. It requires a long-term solution as medical oxygen is vital for healthcare sector, especially in contexts like the one we are facing. If the government had been proactive and had expanded capacity, we might have been able to save a lot more lives. It is an eye opener to be prepared for similar situations arising in the future.