On Monday, the cumulative Covid-19 case count in India surpassed the 50 lakh mark as the increase in daily cases continued unabated with the addition of another 90,123 new cases. The sustained and record increase in the number of cases over the past two weeks has put pressure on the medical oxygen supply in some states. Although the situation has not gotten out of control, this week the Center became aware of the problem of medical oxygen shortages in some states and ordered them not to impose restrictions on the interstate movement of life-saving commodities.
The central government directive came amid trouble between the Madhya Pradesh and Maharashtra governments following the latter’s decision to restrict the movement of medical oxygen in the wake of an increase in cases. In fact, the matter reached the High Court of Madhya Pradesh, which ordered the Maharashtra government to guarantee the uninterrupted supply of oxygen to Madhya Pradesh. There have also been similar cases of restrictions placed on the movement of oxygen between districts.
News18 explains the issues related to medical oxygen, its use, production capabilities and procurement.
What is medical oxygen?
Medical oxygen is an essential medicine used to treat a variety of ailments and in various medical procedures. It is featured on the National Essential Medicines List of India, 2015, and on the World Health Organization (WHO) essential medicines list. Its medical uses mainly include, but are not limited to, the treatment of respiratory diseases, the prevention of hypoxemia (low blood oxygen levels), neonatal care and emergency care. According to the WHO, medical oxygen contains at least 82% pure oxygen and is free from contamination. Only medical grade oxygen is used as medicine.
Medical oxygen is produced using various methods, such as the cryogenic distillation process to produce liquid oxygen and in oxygen-generating plants. Cryogenic distillation involves separating oxygen from nitrogen and argon after condensing atmospheric air by separating the air.
Why is it crucial as a line of treatment against Covid-19?
Once Covid-19 disease appears, it affects the patient’s lungs and causes a drop in the level of oxygen in the blood. This can negatively affect other vital organs as well. In the absence of a single effective line of treatment, drug or vaccine against Covid-19, oxygen therapy has proven to be the most effective in treating patients with moderate and severe illnesses. However, it is used more often in moderately ill patients, according to doctors.
“Covid-19 poses serious problems for the lungs and if the oxygen level in the patient’s blood or the oxygen saturation begins to drop below normal levels, we start oxygen therapy. It has been found to be effective, especially if therapy is timely. Out of 10 patients, only two require oxygen therapy, ”said Dr. Suresh Kumar, Director of Lok Nayak Jai Prakash Narayan Hospital. (LNJP). LNJP is Delhi’s largest public hospital for Covid-19.
According to the Ministry of Health, six percent of patients in the country required oxygen support on September 15. This included those in intensive care units, on ventilator support, and in regular Covid-19 wards.
Who makes medical oxygen?
In India, oxygen is produced commercially largely for use in manufacturing industries such as steel plants, manufacturing units, chemical industries, glass making, and pulp and paper industries. In pre-Covid-19 times, industrial customers accounted for the majority of oxygen use. However, in April this year, the central government allowed industrial oxygen-producing companies to produce their medical variant to meet the demand created by the Covid-19 crisis.
There are four or five big manufacturers in India, which include Linde India, Inox Air Products and Goyal MG Gases. These companies produce liquid oxygen. There are also other companies that operate oxygen generation plants and many are based in Gujarat, Maharashtra and Tamil Nadu.
How do hospitals do it?
In large, medium, and small hospitals and nursing homes, medical oxygen is obtained in two or three different ways. Many hospitals have oxygen generating plants on site that are piped to the wards, intensive care units, and critical care units where it is administered to patients. However, this installation requires an uninterrupted power supply.
Hospitals that do not have their own oxygen generation plants obtain it from companies such as Inox and Linde in liquefied form and store it in liquid oxygen tanks at the hospital facilities. Even this system requires the laying of a central pipe, which needs regular maintenance. Refillable cylinders, which can be filled in oxygen generating plants, are one of the most widely used methods of obtaining medical oxygen. The oxygen is stored in the cylinder in compressed form and can be connected to a patient’s bed or a central line.
Once the cylinders are used up, they need to be refilled. In most cases, the distributors who run oxygen cylinder businesses also fill them for hospitals. However, the use of cylinders is highly dependent on transportation.
Following supply problems and to meet high demand, some districts in Maharashtra are also installing new oxygen generating plants.
Why is there a shortage?
As previously stated, in April, the government allowed industrial oxygen producers to also produce medical oxygen. However, that was during a nationwide lockdown and industries were shut down. The upturn in cases has coincided with the resumption of economic activities, including industrial. This has meant that industrial oxygen demand is slowly returning to normal, but state governments have mandated that medical oxygen be a priority and that supply to industries be kept low.
The relentless increase in the number of cases, however, has raised the demand for the medical oxygen manifold. With increasing demand, problems of delays and setbacks arise in supply chains. Therein lies the main cause of shortages. There are delays in the supply chain, at the end of both liquid oxygen producers and oxygen generating plants. These are compounded by the limited availability of tanker trucks to transport the product. In some cases, as is being seen in Marathwada, cylinder filling is taking time due to overwhelming demand.
Madhav Biradar runs an agency that deals with oxygen cylinders in the city of Osmanabad, in the Marathwada region of Maharashtra. Biradar said the demand is so high that oxygen that was used for six days is now running out in a day or two. This has also put stress on generating plants, he said.
“Two months ago, my clients needed 25 to 30 cylinders per day that had a capacity of 6,000 to 7,000 liters of oxygen. Now, the demand is for almost 100 cylinders per day. When I go to refill the cylinder, sometimes I have to wait half a day. Plants outside my district ask me not to even try to come and this is the situation only in the city. I also have no choice but to pass on the transportation overhead and delays to the buyers, ”Biradar said.
What is the national production capacity and how much is consumed?
Union health secretary Rajesh Bhushan said on Tuesday that India produces 6,000 metric tons of oxygen every day. Of this, 2,800 MT are used for medical purposes, including the treatment of Covid-19, while 2,200 are used in industries. “There is a headroom of 1,000 MT and, nationally, there is no shortage of oxygen. Like Tuesday morning, we had a 1,900 MT surplus.
Bhushan urged hospitals and other medical facilities to maintain inventory management. “The problem arises when there is no oxygen inventory management and when there is a possible shortage of alert generation mechanism at the hospital level that must be monitored by the states and UT, so that the replenishment can be carried out in a timely manner. The Ministry of Health has held detailed meetings with the states, in which it has been recommended to set up a control room to monitor the supply and oxygen needs on a daily basis, “said the union’s health secretary.
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