Afzal Shaikh always sleeps at his shop ‘All India Health Medical Equipment’ in Jogeshwari, a suburb of Mumbai.
Around him are cylinders, concentrators, BiPAP, and ventilators. For more than fifteen days now, Shake has not had more than two hours of sleep, and his waking hours have been spent assembling medical equipment for Kovit-19 patients. Sometimes, the patient rushes in at midnight to adjust the oxygen cylinder. He says he only goes to her house once every day.
“For the past two days, I have been getting more space to sleep here. All my equipment is for rent or for sale. I rarely get oxygen supply. The phone did not stop ringing. Someone is always crying for oxygen, ”he says.
The second wave of Covid-19 has exposed open gaps in the country’s health infrastructure and the government’s readiness to deal with a crisis that came with adequate warning signs. Even in hospitals in Delhi, Mumbai, and other urban centers, one can see people struggling for basic things like medical oxygen.
Patients under home isolation were unable to obtain cylinders. In the absence of any regulation, the cost of refilling a cylinder or renting an oxygen concentrator has increased.
On April 9, in Kandivali, a suburb of Mumbai, when Vinod Naik complained of shortness of breath, his family tried to find a hospital bed for him. But, they failed at it. A doctor advised them to get an oxygen cylinder at home. Its search led to a cylinder. The rent for this oxygen concentrator is Rs.10,000. This doubled the market price. The hero’s family thought of nothing else. They immediately bought it and saved the elderly patient.
But 10km away, in a Tahisar slum, the story of Ramnath Thupsinder ended differently. On the same night, the oxygen concentration of the 60-year-old dropped to 89. His son rushed to two Govt centers run by the government. But, no bed. “He has no money to buy a concentrate or a cylinder,” says Sandia Fernandez, a social worker. Also, he has sought all the hospitals to find a bed. In this condition, limited oxygen was used in the cardiac ambulance to retain him. Two hours later, Thupsinder suffocated to death.
In Palanpur, Gujarat, on April 21, five patients died at a private hospital due to lack of oxygen. In the north of Uttar Pradesh, five patients died at a private Aligarh hospital before being given fresh oxygen.
India has recorded 35,000 Govt deaths since the start of the second wave in early February. However, Govt did not report any deaths due to lack of oxygen.
Officially, India’s daily oxygen production capacity is 7,127 metric and its medical oxygen demand has increased by 76 percent in 10 days. Also, states complain of severe shortages of a few hundred metrics.
Until 2019, before the epidemic hit the country, India needed just 750-800 metric liquid medical oxygen (LMO). The rest were for industrial use. Since April 18 this year, industrial supply has been completely affected.
Supply chain
India’s major oxygen manufacturers include Inox Air Products, Linde India, Goyal MG Gas, National Oxygen Limited and Dio Nippon Sancho Corporation.
The company meets 60 percent of the country’s LMO demand. It produces 2,000 metric tons a day and supplies 800 hospitals, according to an Inox official. The company has 550 transport tankers and 600 drivers. The officer says they went on a 24 × 7 road.
LMO is produced in large plants using cryogenic filtration techniques to compress atmospheric air, supply it to the filter columns, and obtain liquid oxygen. It has a purity of 99.5 percent. An industry expert says the process could take two and a half days per lakh liters.
Liquid oxygen is filled into jumbo tanks for storage. From there special cryogenic tankers, which maintain a temperature of -180 degrees Celsius, travel hundreds of kilometers to small distributors.
Distributors convert liquid oxygen into gaseous form, compress it, load it into cylinders, and transport it to their final hospitals. Some stock is sold to local dealers. They, in turn, provide home care. Officials say final to final transportation will take five to 10 hours, as there is more distance to deliver.
Government data shows that there are 1,172 oxygen cryogenic tanks in India for road transport. Tankers served this purpose well before the outbreak. But, now they are in short supply. Also, it can take a painful time to cover hundreds of kilometers.
Government data shows that there are 1,172 oxygen cryogenic tanks in India for road transport. Tankers served this purpose well before the outbreak. But, now they are in short supply. Also, it can take painful time to cover hundreds of kilometers.
India converts tanks for nitrogen and argon into oxygen carriers. It uses the Air Force to import tankers, make new ones, and fly empty planes to speed up one-way travel. To speed up the delivery of oxygen, trains were also put into service with funky tankers.
As many states make full use of their oxygen production capacity, they rely on the center to divert oxygen from overcrowded states. This week, Delhi, Uttar Pradesh, Haryana and Gujarat complained that there was less allocation than their daily requirement. Karnataka, Rajasthan and Maharashtra are suffering from oxygen deficiency.
“Production is only an issue. The big problem is transporting oxygen over long distances, especially in rural and remote areas, ”said Saket Dik, president of the All India Industrial Gas Producers Association (AIIGMA).
Then there is the issue of the black market.
Hoarding and rising prices
According to local vendor Sheikh, many families, especially the elderly and others, are at risk for covit. Hoarding of oxygen concentrators and cylinders leads to shortages and rising prices.
A small 100 liter cylinder now costs Rs 8,000 and above, Rs 4,500-5,000. Moreover, its filling cost has gone up from Rs 150-250 to Rs 500-800 in Delhi, Mumbai, Pune and other cities. In Tier-2 and Tier-3 cities, refilling costs range from Rs.400 to Rs.600.
5 liters of oxygen concentration, which cost between Rs 45,000-50,000 two months ago. Now, it costs Rs 80,000-90,000. Its monthly rent ranges from Rs 5,000 to Rs 10,000-20,000.
The role of oxygen therapy
“Atmospheric air contains 21 percent oxygen. The swollen lungs are able to filter out very small amounts of oxygen. Applying 4-5 liters of oxygen per minute to a person with a concentration of 85-90 will improve the oxygen concentration by 26-28 percent. If the oxygen supply is increased to 15 liters, the concentration will rise to 90 percent. Direct delivery of pure oxygen puts less pressure on the alveoli. But. Excessive amounts can scar the lung tissue, ”explains Dr. Sanchalani.
Nursing homes and hospitals reduce oxygen and test it. We now accept those with oxygen concentrations below 85-90 instead of 94. Also, we try to advise people with 90-95 concentration at home to the probable level. But there are not enough oxygen beds, ” said a government doctor.
This news came to us via indianexpress.com
Also read The Events That Led To The Rapid Outbreak Of Coronavirus In India
