The price we are paying for taking medical oxygen in hospitals for granted

India has no shortage of oxygen. But people are dying because hospitals do not have oxygen. Even in hospitals, where there is oxygen, you are not sure if you are receiving oxygen. As many as 22 patients on oxygen died in Nashik this week because there was a leakage in the tank. Untrained attendants in hospitals, who do not know how to administer oxygen are compounding the problem.

The World Health Organisation (WHO) holds that 15% of Covid-19 patients require help with breathing. In other words, 22 lakh of the 1.5 crore infected Indians would have required oxygen support. Most of them did not get it. How many died cannot be said with any certainty.

Some people may appear to be in no evident respiratory distress, but are still found to have dangerously low oxygen levels - a condition called silent hypoxia. But while the WHO says only ‘a fraction of the critically ill patients require a ventilator’, the Government’s entire focus last year was on supplying ventilators to the hospitals. A substantial part of the PM CARES fund was reportedly used in paying ventilator manufacturers and in importing ventilators.

There are 500 factories across the country which extract and purify oxygen from the air. Oxygen for medical use before the pandemic accounted for 15% of overall supplies. The rest - industrial oxygen –was supplied to steel and automobile industries. The factories transport oxygen in liquid form to hospitals in cryogenic tankers, which is then converted into gas and piped directly to beds. Some hospitals also use steel and aluminium cylinders which store oxygen in gas form - but this requires frequent change of cylinders for each bed.

But according to industry estimates, India had only 1,500 cryogenic tankers last year. There is no evidence to suggest that the country has taken up manufacture of the tankers on war-footing.

Since the beginning of the pandemic it was known that medical oxygen will be crucial to treat Covid patients. But while demand for oxygen in private hospitals went down because patients stopped visiting private hospitals, the oxygen supplies were not ramped up in government hospitals, which bore the brunt of the rush of Covid patients. Even last year, the demand for medical oxygen had gone up from 750 tonnes per day in April to 2,700 tonnes in July. India is said to have the capacity to produce over 7,000 tonnes of oxygen per day and hence the availability of oxygen was not a concern.

But when the pandemic began even industrial gas manufacturers had no idea how much oxygen was being supplied through cylingers and how much through tanks. Nor did the government. When they finally sat down to take stock, they discovered that the state of Jammu and Kashmir did not have a single liquid oxygen factory, and there were no medical oxygen makers on the island of Andamans, where cylinders were shipped from the mainland. In remote north-eastern states also, supplies were scarce. Most states, including Delhi, didn’t have a single producer and supplies had to be procured from neighbouring areas.

Most of the oxygen plants are built near major cities and big towns. The challenge, therefore, was to ensure supplies to far-flung districts. But the government took eight months to invite bids for setting up 162 oxygen plants in district hospitals in October, 2020. The investment required was low at just Rs 200 Crore. But six months later, in April, 2021, only 32 of these plants had come up, says the government.

But despite such measures, setting up a control room and the decision to use industrial oxygen for medical use -- there is little difference between the two, but medical oxygen is purer and supplied under stricter regulations and has to be properly dispensed— when the second wave of Covid hit, people have been left to die because of the non-availability of oxygen.

Price controls on oxygen have not helped and have led to a black market in oxygen. "The government has capped the price of oxygen in cylinders, but has not capped the price of liquid oxygen. It is like fixing the price of the finished product, but not the price of the raw material," said one of the manufacturers.

It was clear by the middle of 2020 that making sure the country has enough beds with access to high-flow oxygen would be the biggest challenge. “Pushing oxygen into smaller cities and villages will be a challenge. Facilities are bad. There are not enough cylinders or piped oxygen and no liquid oxygen makers," a spokesman of Linde India, a leading manufacturer was quoted as saying then. "It is going to be tricky. We need to prepare now," he had warned. But the government still dropped the ball.

It took 15 months for the government to change the rules and allow cryogenic tankers licensed to carry nitrogen to also carry oxygen, and a week later they issued guidelines for unrestricted movement of tankers. The railways have been roped in now for the transportation of oxygen, points out Congress leader Ajay Maken.

“Instead of planning for logistics to provide oxygen to hospitals all over the country, we doubled the export in 2020-21 in comparison with 2019-20. This, despite the knowledge that oxygen is crucial in treating critical patients,” he added. The country wasted 15 months and even the storage capacity in hospitals was not increased.

At 7.52 pm on April 16, Vinay Srivastava, a 65-year-old journalist in Lucknow, tagged state’s chief minister Yogi Adityanath in his tweet that his oxygen levels had fallen to 52, but no hospital, doctor or lab was picking up the phone. His symptoms pointed to Covid-19, but he was unable to get a test, and his son went from hospital to hospital through the night, pleading in vain for a bed for his father.

At 3.15 pm the next day, Srivastava tagged another tweet to the chief minister’s media adviser, saying, “Now my oxygen is 31; when some will come.” The media advisor replied later, seeking more details which were available already on Srivastava’s Twitter thread. But by then he had passed away.

He had never been tested, and his family waited for hours for an ambulance to take his body away