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Covid-19: What will it take to make India breathe?

Dubai - An in-depth look at the oxygen crisis across the country’s length and breadth due to the Covid-19 scourge.

The ‘apocalyptic’ second wave of Covid-19 outbreak in India has touched a grim milestone of 20 million (m) cases and the worst is not yet over, as daily infections are expected to peak in the coming weeks in the world’s second-most populous country.

The country’s overtaxed healthcare system has broken as the contagion has overwhelmed across some of the most populous states.

Is India losing its battle to breathe?

A liquid medial oxygen (LMO) cylinder is precipitating another horrific tragedy, as private hospitals are still facing a crippling shortage of the lifeline gas and are forced into turning away patients.

Most hospitals do not have an oxygen storage tank and depend on the lifeline gas from a private vendor.

Families are running helter-skelters to arrange oxygen cylinders at exorbitant prices ranging from Dh2,000 and above.

On Sunday (May 2), 24 people died in Karnataka’s Chamarajanagar district hospital – the latest in a string of ‘oxygen deaths’ in the country.

On the previous day, 12 Covid-19 patients, including a senior doctor, died at south Delhi’s Batra Hospital after the facility ran out of medical oxygen for around 80 minutes in the afternoon.

Another 20 patients died at Jaipur Golden Hospital in West Delhi without oxygen, and another 25 died at Sir Ganga Ram Hospital in Central Delhi around two weeks ago.

A growing plea for oxygen on social media by hapless families gets only amplified by hospitals that are helplessly turning to Twitter to save our soul (SOS) messages when they run short of the lifeline gas.

The authorities at Bhagwan Mahavir Hospital in Pitampura, West Delhi, said on Tuesday (May 3), that it has oxygen available only for 30 minutes. “Let's not wait for another tragedy to happen and then react,” read a tweet.

On the previous day, Dr Pankaj Solanki, the head of 50-bed Dharamveer Solanki Hospital in Rohini, said it has become “difficult to manage even 10 patients now,” due to an acute shortage of oxygen.

It is not just the national capital that is grappling with an oxygen crisis.

Several deaths were reported in Gujarat last week, which is reporting a surge in Covid-19 infections.

In Uttar Pradesh (UP), the ruling Bharatiya Janata Party (BJP) lawmaker Arvind Giri, was quoted as saying, “In the past 10 days, hundreds of people including two dozen friends lost their lives due to lack of oxygen. This is the ground reality.”

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In Maharashtra, consumption of oxygen has reached the state’s full production capacity of 1,250 metric (M) tonnes (T).

Why is India running short of oxygen?

What’s the reason behind the country running short on oxygen at a time it is facing the worst medical crisis in its recent history?

Industry experts say that India has the capacity to produce more than 7,000MT of oxygen. The major manufacturers are Inox Air Products, Linde India, Goyal MG Gases Pvt Ltd and National Oxygen Limited.

Most of the oxygen manufacturing units are located in the northern and eastern parts of the country, where there is a concentration of steel plants -- the main consumers of the medical gas.

India needed 700MT of oxygen per day during the pre-Covid-19 times. But the demand increased exponentially, as the Covid-19 infection cases skyrocketed in India. According to INOX AIR, which produces 60 per cent of India’s oxygen, the demand for the lifeline gas increased by up to four times to 2,800MT per day (MTPD) during the first wave of Covid-19 last year. Further, with the resurgence of the second Covid-19 wave, the demand has gone up seven folds to more than 5,000 MTPD.

The Indian government is insisting that the country’s oxygen crisis is driven not by a dearth in production, but due to logistical challenges.

"India has enough oxygen available, the challenge is to transport it to hospitals. Using real-time tracking, we’re monitoring the movement of oxygen tankers," an additional secretary, the Ministry of Home Affairs (MHA), said in a recent press conference in Delhi.

Industry experts whom Khaleej Times spoke to endorse a similar argument.

“We believe that India has enough oxygen production to meet existing demand. There is an immediate need to transport oxygen from areas where it is in surplus, to areas where it is required for medical purposes,” Siddharth Jain, Director – INOX Air Products, told Khaleej Times.

“The supply chain has to be tweaked to move the medical oxygen product from certain regions which have excess supply to certain regions, which needs more supply,” he said.

Jain said India increased its oxygen production by 30 per cent from 5,000MT to 9,200MT, in just a month, which is “nothing short of a miracle”.

“I can tell you that all our plants and also other manufacturers have been running 120 per cent of their capacity for months,” he added.

India was producing 7,200MT of oxygen a day and only 15 per cent was required as medical oxygen in the pre-Covid-19 days. Now, industrial consumption has been reduced to nil and the entire capacity has been converted to produce oxygen.

Who is responsible for the oxygen supply in India?

Earlier, the government was not involved in oxygen supply to hospitals. But since the start of the pandemic in 2020, the government has formed empowered groups (EGs) to monitor the supply and availability of oxygen and other medical supplies in hospitals in all states.

Currently, the supply of medical oxygen is currently being allocated centrally and monitored by the empowered group, (EG-II), headed by the secretary in the Department for Promotion of Industry and Internal Trade, mandated by the Union government’s Ministry of Commerce and Industry.

EG-II allocates oxygen to states, which, in turn, distributes among various hospitals.

The EG-II has members nominated from all the states, along with all major oxygen manufactures, All India Industrial Gases Manufacturers’ Association (AIIGMA), Petroleum and Explosives Safety Organisation (PESO), the Ministry of Road Transport, and the Indian Railways. While oxygen is not a controlled commodity, the prices are controlled by the National Pharma Pricing Authority (NPPA).

EG-II allocates oxygen to states, who then earmark certain quantities to hospitals based on demand.

According to the Union Ministry of Health & Family Welfare (MoH&FW), the EG-II has estimated that 12 states will require a total of 4,880 MT, 5619 MT and 6,593 MT on 20 April, 25 April and 30 April, respectively. Maharashtra, Madhya Pradesh (MP), Gujarat, Uttar Pradesh (UP), Delhi, Chhattisgarh, Karnataka, Kerala, Tamil Nadu (TN), Punjab, Haryana and Rajasthan.

Supply chain nightmare

Jain attributed India’s oxygen problem to its supply chain.

Most of India’s oxygen production occurs in the eastern and northern parts of the country, where many steel manufacturing companies are located.

“We've got enough oxygen. But the turnaround time is higher as they have to be transported to far-flung areas. For instance, states like Delhi and MP do not have a single manufacturing unit. It needs a massive fleet to meet its oxygen demand.”

Dr Harish Pillai, Chief Executive Officer (CEO) – Aster India, said one of the big challenges that disrupted the supply chain is state governments giving orders to stop the movement of oxygen to other states.

“With an unprecedented surge in Covid-19 cases, they’re also anticipating a huge demand for the life-saving oxygen and stopped moving across the states. That created a logistical nightmare.”

Besides, India does not have enough specialised cryogenic tankers --- temperature-controlled vehicles --- to ensure transportation of oxygen by road.

There are about 1,171 cryogenic tanks in the country for oxygen and another 800 for nitrogen and argon. Tankers have varying capacities, from 2 to 30MT.

According to experts, the transportation time from manufacturing units to patients’ beds has increased from 24 hours up to three days.

“The primary issue was in the supply chain as liquid medical oxygen has to be transported in cryogenic tankers, which normally cater to a 200-kilometre (km) radius. With the increased demand even in remote areas, now tankers have to cater to over 1,000-km radius,” said Jain.

How logistical challenges are addressed

Jain said as India’s oxygen crisis could soon be resolved, as the oxygen supply has been increased to 9,200MT a day along with Covid-19 cases marginally coming down in the most-affected states like Maharashtra and Gujarat.

He said the number of oxygen tankers has also been increased, as the government has given permission to convert another 1,200 nitrogen and argon carrying tankers to transport medical oxygen. This will add to the existing 1,200 tankers the country has in addition to the 40 plus such tankers that have been imported.

Dr Pillai said if current supplies could be increased with the help of oxygen concentrators and ease protocol that allows hospitals to increase their oxygen stock.

“The Indian government is using the Indian Air Force (IAF) and Armed Forces to ease logistical challenges too. IAF has been doing a tremendous job by using C-17 Galaxy aircraft to airlift cryogenic tankers across the country. Also, railways have been running oxygen ‘roll on roll’ truck that can be onboarded goods trains and delivered across the country. We can see that the pace of transportation has dramatically increased in the past week. So, it is a matter of a few more days that I think this current media coverage on the oxygen shortage will come down,” he added.

Pillai said with the Covid-19 cases expected to peak mid-May, it is still a struggle “as sheer numbers are huge.”

“But long as the supply chain system is faster, the crisis can be overcome soon,” he added.

Delhi continues to choke

Delhi, which is the worst hit by the shortage of oxygen, has no manufacturing units and is counting on timely deliveries. The Delhi government has been demanding 976MT of oxygen from the Centre against the existing allotted 490MT quota.

The Supreme Court (SC), the country's apex court, had directed the Centre to rectify the deficit in the supply of oxygen before Monday (May 3) midnight. “Enough is enough. Much water has gone above the head,” said the top court pointing out to the dire state of Delhi.

But Raghav Chadha, the Aam Aadmi Party’s (AAP) spokesperson and a lawmaker, said Delhi has received only 40 per cent of the total demand. “We need 976MT of oxygen, while what we received on May 3 from the Centre was only 433MT. This is only 44 per cent of what we need and what we have demanded from them.”

Chaddha said Delhi received 41 save our soul (SOS) calls on May 3. “We addressed all of these 41 SOS calls and ensured that oxygen was supplied to them by hook or crook. The 56 per cent gap between demand and supply in oxygen still exists, and the faster we overcome the gap, the faster the SOS calls will decrease,” he added.

Delhi has got its first Covid-19 care centre with its own oxygen plant at the Commonwealth Games (CWG) village in East Delhi. The oxygen plant has a capacity to produce about 1,500 litres (l) of oxygen daily.

Bid to tackle the O2 crisis

Stopped industrial use of oxygen and has diverted it for LMO

The government has plans to set up 10,000 oxygenated beds in a brief span of time by making temporary hospitals near industrial units that produce LMO

Plan to convert existing nitrogen plants to produce LMO

The Indian government has introduced Oxygen Express

India plans to import 50,000MT of LMO to cater to the growing demand

IAF pressed into action to airlift oxygen tankers to enable faster transportation of gases to areas with greater requirements

''Oxygen on Wheels'' project rolled out to ease the transportation of oxygen from producing plants to hospitals and homes

The Central Railway has handed over isolation coaches to set up a care centre for Covid-19 patients with oxygen cylinders in each coach

The armed forces have launched operation “CO-JEET” to strengthen oxygen supply chains.

The government has allowed imports of oxygen concentrators for personal use through by post, courier or e-commerce portals under the gift category amid increasing demand for oxygen

80 oxygen plants to be built by the end of May.