Medical oxygen in India has been in severe shortage as the country grapples with a deadly second wave of the pandemic. But bureaucratic hurdles are delaying delivery of critical resource to those in need.
By Sanjenbam Jugeshwor Singh
Indian’s tally of Coronavirus infection surged past 25, 486, 00 on Tuesday the 18 th May 2021, becoming the second nation after the United States to pass that grim milestones. Up to the evening of Wednesday, the 19th May, India reported 274,030 new cases over the last 24 hours while new death cases is reported at 3,825 for a toll of 287,101,as indicated by health ministry data. Currently, the country has 3,138,066 active cases. Health experts say the actual numbers in India could be 5 to 10 times higher than those reported. Cases started rising in February but the second wave accelerated in April. The resurgence overwhelmed hospitals which are struggling with bed shortages as well as a limited supply of Oxygen and medicines to treat patients. The exponential surge in India’s coronavirus infections over the past few weeks has swamped the healthcare system seen patients dying in ambulance and parking lots outside hospitals and overwhelmed crematoriums.
Medical oxygen in India has been in severe shortage as the country grapples with a deadly second wave of the pandemic. But bureaucratic hurdles are delaying delivery of critical resource to those in need. It has also drained supplies of medical oxygen which is vital for those who have been infected. The dire shortage has turned out to be a major challenge facing hospitals in many states across the country. Dozens of hospitals in a number of Indian cities and towns have runs short of the gas, sending relatives of patients scrambling for oxygen cylinders, sometimes in vain. Twenty four people died in one hospital overnight on 4th may 2021, in the southern state of Karnataka after the hospital ran out of Oxygen, according to press reports and sources, though the district administration denied that shortages had caused the deaths. Another 12 people died on 3rd May 2021 in the capital, New Delhi, after a hospital ran out of Oxygen, reports said. Several hospitals sent out desperate appeals for oxygen and social media, with delivering arriving only in the nick of time. One children’s clinic in Delhi raised the alarm on twitter over a shortage of oxygen that has reportedly left around 25 to 30 newborns and children at risk. Oxygen therapy is crucial for severe Covid patients with hypoxemia-when oxygen levels in the blood are too low. Experts say, India is producing enough oxygen, at just over 7,000 tons a day. Most is for industrial use, but can be diverted for medical purposes. The Indian government has now directed most of the country’s supplies of industrially produced oxygen towards the health care system. Amid high demand, supplies have been ramping up capacity to be able to produce more than 9,000 tons by mid-May. However, most oxygen producers are based in India’s east, while the soaring demand has been in cities in the western and northern parts of the country. There is no centralized coordination of oxygen supply and distribution. It is completely haphazard and “Red Tape has held back timely delivery”, said by Kumar Rahul, Secretary in the health Department of Punjab state. To get the supplies, where they are needed, Prime Minister has launched “Oxygen Express” trains to ship the gas from production unit to locations that need in nationwide. The Indian air force has also been airlifting oxygen from military bases. Nevertheless, the country lacks enough transport and storage capacity. Liquid oxygen at very low temperatures has to be transported in cryogenic tankers to distributors which then convert it into gas for filling cylinders. But India is short of cryogenic tankers. There are only a finite numbers of oxygen tankers and cylinders around. So the logistics of refining them and bringing them to the destination is a severe bottleneck. The Oxygen shortage has been a huge problem not only in cities but also in small towns and villages where the health infrastructure is already extremely week. Worryingly, there is little discussion about a Covid-19 strategy which factors in rural India’s myriad constraints including oxygen availability. Over the past few days, emergency medical aid from foreign donors to alleviate the dire oxygen shortage has been arriving in shortage has been arriving in India. On 4th May, U.S delivered the third of six aid shipments, including 1,000 oxygen cylinders. The U.K donated more than 400 oxygenated concentrators and France sent eight oxygen generators, each of which can serve 250 hospitalized patients. A German military aircraft with 120 ventilators also reached India on 3rd May 2021 and officials said, plans were being made for additional flights with more supplies while the emergency aid could save lives, it seems not to have reached those who are gasping for oxygen. So far, around 20 flights have arrived with aid but the shipments have been stuck at customs for weeks, according to local media reports. Indian officials told that no domestic flights have taken off to carry the supplies to other parts of the country. Many states have not been informed by New-Delhi about their share and what they will receive. State allocations have yet to be decided, according to a senior official of aviation.
Amid sharp and widespread criticism of Modi Government’s handling of the health crisis the – Delhi high Court said, it would start punishing his government officials, if they failed to provide steady oxygen supply. The Court warned that it would start contempt proceedings if there was no compliance. The international community has pledged to send medical aid in the form of oxygen cylinders, concentrators and other medical supplies. Some of those aid shipments have started arriving in India, according to reports from media. The situation, however, has not eased because the number of cases is moving up as is the severity of those cases. Typically an ICU requires two-and-a-half to three times the amount of oxygen a ward or a patient in a bed requires. So as critically moves up, as mortality moves up, you are going to see the requirements of oxygen also moves up. Many stricken with coronavirus are dying while they wait for a bed and the oxygen to support their breath. Hospitals are struggling to accommodate breathless patients or even keep alive those who were lucky enough to find a bed. Social media feeds and WhatsApp groups are full of frantic pleas for oxygen cylinders. Maharashtra and Gujarat in the west, Haryana in the north and Madhya Pradesh in central India are all facing oxygen shortage. In the northern states of Uttar Pradesh, some hospitals have put “Oxygen out of stock” board outside and in the state capital Lucknow, hospitals have asked patients to move elsewhere. Smaller hospitals and nursing homes in Delhi are doing the same. Desperate relatives in several cities are lining up outside oxygen refilling centers. One plant in the southern city of Hyderabad hired bouncers to manage crowd. Manipur too is facing acute crisis of medical oxygen shortage. The HVs oxygen plants at Patsoi produced 220 D Type cylinders per day and as for the M/S Manipur Gas Pvt. Ltd, Bishnupur produced 50% of the total needs of the state. RIMS, JNIMS and SHIJA hospitals are also producing medical oxygen, however it’s not enough to meet the requirement, as reported. A private hospital in Imphal, on 14th May indefinitely suspended admission of new patients due to shortage of medical oxygen amid a surge in coronavirus caseload.
Before the crunch of the oxygen crisis, the federal government was already facing criticism for allowing election rallies and a massive Hindu Festival and failing to expand the vaccination drive quickly enough. Critics have accused various sate governments of doing too little to prepare for the devastating second wave, now washing through the country. According to them a sharp drop in cases by January lulled the country into a false sense of safety, creating the conditions for a terrible second wave. This should not have happened. As the saying goes” dig the well before you’re thirsty”. But we didn’t do that.
(Sanjenbam Jugeshwor Singh is Asst Prof JCRE Global College, Babupara, Imphal. He can be reached at [email protected])