Oxygen Crisis in India
Updated: May 10, 2021
A number of states are reporting a shortage of medical oxygen after an increase in the number of Covid-19 patients. The second wave of the Covid-19 has left infected patients gasping for breath as hospitals in some states continue to face an acute shortage of medical oxygen. So, India is planning to import at least 50,000 metric tonnes of medical oxygen to cater to the rising demand. With the Covid-19 cases increasing day by day, the demand for medical oxygen is going to increase in near future.
What is Medical Oxygen?
Medical oxygen is high purity oxygen suitable for use in the human body. So, it is used for medical treatments.
The Medical Oxygen cylinders contain a high purity of oxygen gas(99.5% purity). No other types of gases are present in the medical oxygen cylinder. This is to prevent contamination.
This oxygen provides a basis for virtually all modern anesthetic techniques, restores tissue oxygen tension by increasing oxygen availability, aids cardiovascular stability, etc.
The World Health Organisation includes this on their List of Essential Medicines. According to the Drug Prices Control Order, 2013, LMO is placed under the National List of Essential Medicines (NLEM).
The cylinders previously used for other purposes have to be evacuated, thoroughly cleaned, and labeled appropriately before filling up oxygen.
Medical Oxygen production in India
India has a daily production capacity of at least 7,100 Metric Tonnes (MT) of oxygen, including for industrial use, which appears to be enough to meet current demand.
States are typically allocated supplies by an inter-ministerial group of bureaucrats mandated to monitor and facilitate the flow of essential medical kits during the pandemic.
Due to the crisis, the production has been increased to 8,922 MT. And approximately daily sale is 7,017 MT.
The domestic production is expected to cross 9,250 MT per day by the end of April 2021.
Therefore, India appears to be producing sufficient oxygen to meet the current need.
Reasons for crisis
Distance of Production Plants: Most of the Liquid Medical Oxygen plants are located in the east, leading to long transportation hauls and a turnaround time of at least 6-7 days for each tanker. Add to this the problem of states holding up tankers on the way.
Limited Tankers: At present, India has 1,224 Liquid Medical Oxygen( LMO) tankers with a cumulative capacity of 16,732 MT of LMO. This is grossly inadequate because, at any given point, there are only 200 tankers in transit to meet a demand of 3,500-4,000 MT.
Companies not Buying Cryogenic Tankers: Cryogenic tankers cost around Rs. 50 lakh each. Companies are not buying these tankers because once this wave is over, that investment will turn into losses.
Cryogenic Tankers: These are tankers which store medical oxygen at -180 degrees C, have double-skin vacuum-insulated containers, including an inner vessel made of stainless steel.
Leakage and Irrational Use: In the past, the Health Ministry repeatedly demanded hospitals to reduce wastage and unnecessary oxygen use in Hospitals. Industrial experts also raised concerns over possible leakages in hospital pipelines that supply oxygen.
Black marketing of oxygen cylinders is another issue.
Heavy dependency on private players: Of the total medical oxygen supply, nearly 60% is manufactured by only one private firm.
Regulatory Provisions of LMO in India
According to the Drug Prices Control Order, 2013, Medical oxygen is placed under the National List of Essential Medicines (NLEM).
The National Pharmaceutical Pricing Authority (NPPA) will monitor and control the prices of the National List of Essential Medicines (NLEM).
So, the NPPA controls and monitors the medical oxygen prices in India.
Initiatives by Government
Oxygen Express: Trains to transport LMO and oxygen cylinders across the country have been started to fight the ongoing crisis.
Disaster Management Act 2005: The Ministry of Home Affairs invoked Disaster Management Act, 2005 (DM Act) and ordered free inter-state movement of oxygen-carrying vehicles.
Restarting Plants: The government is restarting many closed plants to increase the supply of LMO, for example, the Sterlite plant in Tamil Nadu will be reopened for 4 months to provide oxygen supply.
Use of Air Force: To speed up transportation, the Indian Air Force (IAF) is airlifting empty oxygen tankers and taking them to industrial units that have switched to producing medical-grade oxygen.
Oxygen Enrichment Unit (OEU): It is developed by scientists of the Council of Scientific and Industrial Research-National Chemical Laboratory (CSIR-NCL), and will help reduce the requirement of ventilators and oxygen cylinders in homecare, villages, and remote places.
Way Forward
Fixing the PSA Plants in remote locations: This will make hospitals manufacture their own oxygen and make the hospitals self-reliant. Further, it will reduce transportation costs and delays in oxygen supply.
Exploring alternate mode of oxygen transportation: At present, oxygen transportation relies primarily on road transport. Industry experts suggest using trains to transport oxygen faster.
Converting surplus industrial oxygen into medical oxygen: Empowered Group-2 suggested using argon and nitrogen tankers in oxygen transport to fulfil the demand. It also suggested using industrial cylinders for refilling. The government can implement the suggestions.
Curbing oxygen wastage and unnecessary use in hospitals: The MOHFW repeatedly warned against this. The health ministry even appointed an expert committee to fix medical oxygen for patients. The committee suggested the following:-
Firstly, fixing the oxygen supply to 40 liters in intensive care units and 15 liters in normal wards per patient per minute.
Secondly, providing oxygen only to patients having oxygen saturation levels below 94%. (Oxygen saturation in the blood below the level of 94 is considered as a matter of concern for people suffering from Covid-19).
The hospitals have to follow this limit as it will reduce wastage. Oxygen is essential for hospital care. India is improving its capacity drastically. But till then it is the responsibility of doctors to use the oxygen effectively.