How oxygen-ready is India as Omicron threat looms?

With rising number of cases, the Union government has asked the States be prepared for a possible Omicron spread. Among the suggested measures are mock drills at oxygen plants to make sure they are working at full capacity, with the concentrators and medical gas pipelines in good condition.

When required, the facilities should be able to reach oxygen to hospitals and other healthcare centres in the required quantities, with adequate pressure and purity, said the Union Health Ministry. Health Secretary Rajesh Bhushan further asked States and Union Territories to carry out oxygen audit reports and submit them through a Central portal that facilitates monitoring and live-tracking.

This comes in the backdrop of the severe scarcity of oxygen and ventilator beds when the second wave of COVID struck India mid-2021. Hundreds of lives were lost and hardships endured, both by the medical fraternity and patients and their kin, due to the country’s lack of preparedness for the intensity of the pandemic. Governments at all levels are keen to avoid a recurrence.

Lessons from the recent crisis

When acute COIVD induces hypoxaemia, oxygen is the only therapy for, with worse cases requiring ventilators, too.  As India went through the second wave in March-May this year, the daily demand for medical oxygen spiralled 12 times the normal.

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Neither government hospitals not private ones could cope with the demand. The sector, a victim of decades-long neglect in terms of funds, could not ramp up critical care facilities at the speed that the situation required. While most government agencies and healthcare facilities were overwhelmed, some State governments (notably Kerala) had planned in advance and were therefore better prepared.

“Demand for oxygen far exceeded the immediate availability, and existing hospitals and crematoriums were completely swamped and overwhelmed,” observed the Centre for Global Development (CGD), a global thinktank that operates out of London and Washington DC. “Most oxygen disasters across India could have been avoided.”

The situation was salvaged with the help of private citizens and NGOs that deployed technology to reach oxygen to hospitals in critical need of it, and various companies including PSUs that repurposed their industrial oxygen facilities and diverted it for medical use.

A disaster waiting to happen

Most of India’s medical oxygen is sourced by private and government hospitals from the open market. While sufficient for a normal day, it was a disaster waiting to happen, as seen in the Gorakhpur tragedy, where several lives were lost due to oxygen scarcity — what was available in the market was insufficient to meet the demand surge.

When the pandemic struck, the market mechanism that came sans safeguards and stewardship was the primary reason for the oxygen crisis. “Because supplies are fixed in the very short term, prices may rise manifold, making oxygen unaffordable and leading to a high mortality rate among the very poor. Other outcomes could include hoarding in anticipation of future price rises. Sadly, we have witnessed all of this,” said CGD.

PSA (pressure swing adsorption) plants host machines that condense oxygen from the air, and can be a life-saver in crisis situations. In 2020, the Centre had invited bids to set up 162 such plants for government hospitals. Very few of them were functional when the second wave struck.

Logistics issues made it worse

The crisis was also due to logistics issues. “The reason (for the crisis) is not a lack of medical oxygen, per se, but the inadequacy of the distribution network of tankers to transport liquid oxygen from the point of manufacture, to the hospitals,” said ORF (Observer Research Foundation), a New Delhi-based thinktank.

Oxygen for medical use is sourced from cryogenic liquid oxygen, which is produced offsite. Around 4,000 tonnes are produced a day, mostly in the eastern parts of the nation. Scaling up the production in existing plants and reaching the gas to the rest of the country proved arduous. This was made worse by the lockdowns imposed by various States — though they all allowed the movement of medical supplies, the procedure was longer than usual.

At the height of the COVID crisis, the nation required about 8,000 tonnes of medical oxygen a day, against the 4,000 tonnes produced on an average. An overwhelmed Centre banned exports and diverted industrial oxygen to medical use. It also rationed the supply of oxygen to the States under a formula that pleased none.

The way forward

While the pandemic may present an emergency, the planning ought to be meticulous, and made well in advance, say healthcare and administration experts. The Centre, in June 2021, launched the Project O2 For India to address similar crises in the future.

A first step would be to predict the demand with different variables — medium increase or high increase, national, State or district level, and so on.  The logistics need to be worked out, so that the oxygen can move freely from the sourcing facilities to the State capitals to the cities that need it.

Private companies and PSUs have already stepped in, contributing to the development of PSA plants.

Source: ORF

Enterprises can be encouraged along these lines with the help of tax rebates and other policy support.

Large hospitals should be mandated to set up PSA plants and produce oxygen on-site; they can be urged to give any surplus to other hospitals, even for a price. The Defence Research and Development Organisation (DRDO) has already developed technology for this. Some States, such as Maharashtra and Haryana, have already brought in such mandates.