Coronaviruses: India faces a shortage of oxygen as cases rise.


Soutik Biswas
India correspondent

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image CaptionDoctors say oxygen is key to survival of Kovid-19 patients

Ankit Sethia spent a night on the outskirts of India’s commercial capital Mumbai on Friday night while trying to buy oxygen for his 50-bed hospital.

Only two out of four tanks of liquid oxygen were filled at the SS Hospital and Research Center at Sri Sethia in Bhiwandi. Forty of the hospital’s 50 beds were occupied by Kovid-19 patients, many of whom required oxygen from tanks to breathe.

Each small tank was being depleted in six hours instead of the usual nine hours, as patients increased. Both Mr. Sethia’s dealers were out of supply.

At night, he called 10 dealers and four hospitals in and around Mumbai for oxygen. Nobody could help. At around 2 am, he finally managed to get 20 large cylinders from another hospital, about 18 miles (30 km) away. There were no vehicles available, so his ambulance made five trips overnight to pick up the cylinder. Four people now work round-the-clock at the hospital to get supplies from any manufacturer who can send a tank of liquid oxygen to a tank or any dealer who can shut down a cylinder.

“Now I have enough oxygen for the next 12 hours,” Mr. Sethia said on Sunday evening. “We are firefighting every day. The fight is to get some oxygen somehow.”

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According to the World Health Organization (WHO), some 15% of Kovid-19 patients require help with breathing. Some people see no apparent respiratory distress, but dangerously low oxygen levels are found – a condition known as silent hypoxia. A fraction of critically ill patients require ventilators.

Around 500 factories are spread all over India and purify oxygen from the air. Oxygen for medical use is typically 15% of the total supply. The rest – industrial oxygen – is mainly supplied to the steel and automobile industries for running blast furnaces.

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image CaptionIndia has the second largest Kovid-19 Cassiolad in the world.

Factories in tankers send oxygen to hospitals in liquid form, which is then converted into gas and delivered directly to beds. Some hospitals also use steel and aluminum cylinders that store oxygen as a gas – but this requires frequent changes of the cylinder for each bed.

As India opens up its economy and people return to work, Kovid-19 cases are increasing in small towns and cities. With more than 4.8 million confirmed infections, India’s caseload is second in the world after the US. Some 600,000 cases were added last week, and more than 90,000 cases were reported only on Saturday. One newspaper calls it the “scary, fugitive phase” of the infection.

Not surprisingly, oxygen demand has increased rapidly. According to data received from the All India Industrial Gases Manufacturers Association, hospitals and care centers consume around 2,700 tonnes of oxygen every day this month, compared to 750 tonnes in April.

Oxygen manufacturers say demand for industrial oxygen has also increased as more factories are reopening. Maharashtra, Madhya Pradesh, Gujarat, Rajasthan, Telangana, Andhra Pradesh – are seeing worrisome situation in transition. This is a life-versus-livelihood question that India is still grappling with.

Saket Tikku, president of the All India Industrial Gases Manufacturers Association, said, “45% of the oxygen we are producing now is going to industries, while 55% is going to hospitals and nursing homes.” “The government is somewhat constrained. If we cut the supply of industrial oxygen to factories, the industry will suffer. On the other hand, if we are not able to increase the supply of medical oxygen, life will be in danger ,” ” he said.

India will now need to increase capacity to ensure that both industry and patients do not suffer. And that is not all.

Most oxygen plants are built near cities and big cities. So supplies go to remote districts, where Kovid-19 patients are filling hospitals, to be dispatched by special trucks carrying cryogenic tanks – there are about 1,500 such trucks in India. Many states – the capital, Delhi, for example – do not have a single oxygen producer, and all supplies come from neighboring areas.

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image CaptionLarge hospitals rely on liquid oxygen with backup cylinders

Price controls on life-saving gas have not helped and created a black market in oxygen. “, The government has capped the price of oxygen in the cylinder, but has not capped the price of liquid oxygen. It is like fixing the price of the finished product, but not the price of raw materials.”

India has recorded more than 79,000 fatalities since Kovid-19. The death rate can easily increase due to lack of oxygen. Last week, there were reports of four Kovid-19 patients dying at a hospital in the state of Madhya Pradesh, due to lack of sufficient oxygen, a claim that authorities have rejected.

Memories are still fresh in August 2017 when some 70 children died due to cuts in shipments by an oxygen supplier at a government hospital in the state of Uttar Pradesh, northern India, as their bills went unpaid.

But what is clear is that Madhya Pradesh is struggling with acute supply shortage. In Chhindwara district, a businessman told me over the weekend that he had not received any supplies for a week now. Piyush Bhatt, who runs a five-year-old refilling company, said that the monthly demand for cylinders in the district has increased more than four times in the last month.

The 1,000-bed government hospital in the district is overflowing with Kovid-19 patients, and Mr. Bhatt, who is the main supplier, is inactive as the supply of liquid oxygen from plants in Maharashtra some 125 km away has come to a standstill.

Maharashtra has the most reported infection in India, with one million recorded cases. Frightened by the lack of oxygen, officials have limited supplies from local factories to other states. “My supply has stopped because trucks have stopped coming from across the border,” Mr Bhatt said. “I have never faced such a crisis in my life.”

On Monday, Mr. Bhatt was still waiting for supplies. “If the government does not solve this oxygen crisis then we will have a situation like Italy at the peak of the epidemic,” he said.

Image copyrightReuters
image CaptionMedical oxygen demand has increased fourfold since April

At a private hospital in Chhindwara, doctors were finding it difficult to provide oxygen to regular patients. “It’s a very stressful situation,” Dr. Danish Khan, who works at the 60-bed Glory hospital, said. “If we can’t get enough oxygen on time, then we have to stop taking patients.”

The 960-bed All India Institute of Medical Sciences was slowly getting overwhelmed by Kovid-19 patients hundreds of miles away in Jodhpur city of Rajasthan. Most of the 400 reserved beds were full on Monday morning, and 100 of the 110 intensive care beds were occupied. Two liquid oxygen tanks of the hospital are empty due to supply shortage. “We are supplying cylinders from many dealers, even putting in patients,” said NR Bishnoi, a senior hospital official.

Back in Bhiwandi, Ankit Sethia is fielding desperate hospital owners begging for oxygen. Over the weekend, he delivered a jumbo cylinder to a neighboring private hospital.

“Sethia said,” The hospital owner told me that five of his patients would have died if he had not found a cylinder to need 30 minutes before delaying supply. “” The situation is grave. “

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