Breathless

 Yesterday was a day of desperate messages on our neighbourhood e-group:

13:50: "Does anybody know where oxygen cylinders can be purchased right now? "

19:02: "Mr. B needs a ventilator immediately...his hospital does not have one to spare.."

01:14: "Very, very sorry to inform you that Mr. B is no more..."

The same tragic sequence of events is being played out in thousands of places across the country now. As the "Second Wave" of Covid-19 infections sweeps across India a major crisis of medical supply-chain inefficiencies has hit India. There has been such a sharp spike in Covid cases that 54.5% of patients during second wave required supplemental oxygen during treatment - a 13.4% increase from the peak during September and November 2020.

The irony of the situation is that there is no shortage of O2 production in the country - India has a total production capacity of more than 100,000 tons/day (7,100 tpd of medical O2 as per HT), of which over 80% goes for steel-making. According to HL Meghnani, an industry veteran, industrial O2 has to be 99.5% pure while medical O2 needs to be only 93% pure, and less than 1% of O2 produced is used for medical purposes. Yet the scale of crisis currently unfolding is mind-boggling.

India's clinical management protocol recommends oxygen therapy as the primary form of treatment: the target is to achieve 92-96% SpO2, or 88-92% in patients with COPD. While proportion of those requiring oxygen beds is still hovering around under 10%, this number is at an all time high with India's active caseload crossing 26 lakh (2.6 million). The demand for medical oxygen has increased by 18% over the last 6 days across 12 states which account for 83% of India's active cases.

Where did we go wrong? What will it take to bring this situation under control? 

One of the points made by Meghnani brings out the nature of the complexities involved rather nicely - "The current crisis arises because of a shortage of road tankers, storage tanks and cylinders... each tanker costs INR 4.5 million and a cylinder costs INR 10,000 in which you sell O2 worth just INR 300" (!) Add to this the location of the O2 plants -  mostly in Western  and Eastern India -  and the decision taken by major hospitals to outsource O2 supply instead of having captive plants, and you begin to understand why the supply-chains collapsed last week.

We are now in the process of rushing in extra cryogenic O2 tankers from abroad, and penalising those who have been profiteering during this crisis by hoarding O2, and driving up the prices.

What remains unclear is a more granular picture of O2 demand and consumption in our hospitals. How many O2 tankers are needed every day to service all the hospitals in our cities and towns? Can some of the shortage be handled by portable O2 concentrators? 

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REFERENCES & LINKS

* 28Apr21 - Gurumurthy S, New Indian Express - Missing Facts, Misdirected Course - https://www.hindustantimes.com/india-news/why-india-is-facing-an-oxygen-crisis-as-covid-19-cases-mount-101619268862048.html

* 25Apr21 IEexplained - What changed in the second wave? - https://indianexpress.com/article/explained/explained-whats-changed-in-second-wave-7289002/

* 25Apr21 IESunday - Falling Short O2 - https://indianexpress.com/article/opinion/editorials/nirmala-sitharaman-economic-package-migrant-workers-one-nation-one-ration-card-coronavirus-6410303/

* 24Apr21 - HT - Why India is facing an oxygen crisis - https://www.hindustantimes.com/india-news/why-india-is-facing-an-oxygen-crisis-as-covid-19-cases-mount-101619268862048.html