Ankit Sethia spent a sleepless Friday night trying to procure oxygen for her 50-bed hospital on the outskirts of India’s commercial capital, Mumbai.
Only two of the four tanks of liquid oxygen on Mr. Sethias SS Hospital and Research Center in Bhiwandi were full. Forty-four of the hospital’s 50 beds were occupied by Covid-19 patients, many of whom needed oxygen from the tanks to breathe.
Each small tank was being depleted in six hours instead of the usual nine hours due to the increase in patients. Both of Mr Sethia’s dealers had run out of supplies.
During the night, he called 10 dealers and four hospitals in and around Mumbai to ask for oxygen. No one could help. Around 02 o’clock he finally managed to get 20 large cylinders from another hospital, about 30 km away. There were no vehicles available, so his ambulances drove five trips through the night to get the cylinders. Four people now work around the clock in the hospital to procure supplies from any manufacturer that can send a truck with liquid oxygen to tanks or any dealer that can save a cylinder.
“Now I have enough oxygen for the next 12 hours,” Mr Sethia said Sunday night. “We put out fires every day. The struggle is to get some oxygen anyway.”
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About 15% of Covid-19 patients need help with breathing, according to the World Health Organization (WHO). Some people do not appear to have any difficulty breathing, but they have dangerously low oxygen levels – a condition called silent hypoxia. A fraction of the critically ill patients need a ventilator.
About 500 factories spread across India extract and purify oxygen from the air. Oxygen for medical use typically accounts for 15% of the total supply. The rest – industrial oxygen – is mainly supplied to the steel and automotive industries for the operation of blast furnaces.
The factories send oxygen in liquid form to hospitals in tankers, which are then converted into gas and led directly to beds. Some hospitals also use steel and aluminum bottles that store oxygen in gaseous form – but this requires frequent replacement of cylinders for each bed.
Not surprisingly, the demand for oxygen has increased exponentially. Hospitals and care centers are consuming up to about 2,700 tonnes of oxygen every day this month compared to 750 tonnes in April, according to data from the All India Industrial Gases Manufacturers Association.
Oxygen producers say demand for industrial oxygen has also shot up as more factories now reopen. The states that see a worrying increase in infections – Maharashtra, Madhya Pradesh, Gujarat, Rajasthan, Telangana, Andhra Pradesh – suffer the most. It is a life-towards-livelihood issue that India is struggling with now.
“Now 45% of the oxygen we produce goes to industries, while 55% goes to hospitals and nursing homes,” said Saket Tikku, president of the All India Industrial Gases Manufacturers Association. “The government is a bit tied. If we cut supplies of industrial oxygen to factories, the industry will be harmed. On the other hand, if we are not able to increase the supplies of medical oxygen, then lives will be in danger,” he said.
India will now have to increase capacity to ensure that both industries and patients do not suffer. And that’s not all.
Most oxygen plants are built near cities and large cities. So supplies to remote districts where Covid-19 patients fill hospitals must be shipped by special trucks carrying cryogenic tanks – India has about 1,500 such trucks. Many states – such as the capital Delhi – do not have an oxygen producer, and all supplies must come from neighboring countries.
Price regulation on the life-saving gas has not helped and has led to a black oxygen market. “The government has limited the price of oxygen in bottles, but has not limited the price of liquid oxygen. It’s like setting the price of the finished product, but not the price of the raw material,” Mr Tikku said.
The memories are still fresh from August 2017, when about 70 children died at a government hospital in northern Uttar Pradesh after the oxygen supplier interrupted shipments because his bills were unpaid.
But what is clear is that Madhya Pradesh is struggling with a severe shortage of supplies. In Chindwara district, a dealer told me over the weekend that he had not received supplies for a week now. Piyush Bhatt, who runs a five-year-old refilling company, said the monthly demand for cylinders in the district has grown more than four times in the last month.
The government hospital with 1,000 beds in the district has been crowded with Covid-19 patients, and Mr Bhatt, who is the main provider, is inactive because liquid oxygen supply from plants in Maharashtra, about 125 km away, has stalled.
With one million registered cases, Maharashtra has the highest number of reported infections in India. Panicked officials who fear a shortage of oxygen have limited supplies from local factories to other states. “My supplies have stopped because trucks have stopped coming from across the border,” Bhatt said. “I have never faced such a crisis in my life.”
On Monday, Bhatt was still waiting for supplies. “If the government does not resolve this oxygen crisis quickly, we will have a situation like Italy on top of the pandemic,” he said.
At a private hospital in Chindwara, doctors found it difficult to give oxygen to ordinary patients. “It’s a very tense situation,” said Dr. Danish Khan, who works at Glory Hospital with 60 beds. “If we can not get enough oxygen in time, we will have to stop taking patients.”
Hundreds of miles away in the city of Jodhpur, in Rajasthan, the 960-bed All India Institute of Medical Sciences was slowly overwhelmed by Covid-19 patients. Most of the 400 reserved beds were full Monday morning, and 100 of the 110 intensive care beds were occupied. The hospital’s two liquid oxygen tanks are empty due to lack of supply. “We manage cylinder supplies from multiple retailers, even when patients are pouring in,” said NR Bishnoi, a senior hospital official.
Back in Bhiwandi, Ankit Sethia sends calls from desperate hospital owners asking for oxygen. Over the weekend, he gave away a jumbo cylinder to a nearby private hospital.
“The hospital owner told me that five of his patients would die if he did not get a cylinder to cover 30 minutes before delayed supplies were needed,” Mr Sethia said. “The situation is so bleak.”