Critical oxygen shortage highlights severity of Covid crisis in India
St Stephen’s Hospital in New Delhi was near breaking point last week as it was flooded by victims of India’s coronavirus crisis.
While its beds were filled with patients in acute respiratory distress, the hospital’s oxygen supplies were dangerously low. At one point, his giant oxygen tank only had four to six hours of piped oxygen for 300 critically ill patients. The calamity was only averted after frantic appeals to the hospital supplier and desperate public appeals. But a few days later the channeled oxygen ran out and St Stephen had to rely on oxygen cylinders for several hours.
“There is no oxygen,” said Mathew Varghese, one of the hospital’s senior doctors. “The system is down and we are losing patients. We don’t know what to do. We are used to saving lives and we watch people die.
The crisis in St Stephen’s mirrored how India’s brutal second wave overwhelmed healthcare infrastructure and pushed the complex medical oxygen supply chain beyond its limits. India reports 300,000 infections and nearly 3,000 deaths every day, the real numbers undoubtedly being higher.
As the number of patients grows, families across India have embarked on desperate hunts for oxygen cylinders or hospital beds for sick loved ones. More than 20 patients died last week after oxygen supplies were depleted at another hospital in New Delhi. Experts say the shortages are largely due to logistical problems and bureaucratic mismanagement, with supplies in some parts of the country not reaching the areas most in need.
The catastrophic shortages have fueled accusations that Narendra Modi’s government failed to prepare the country for a second wave, after seeing the first last year.
“This was seen on several levels [of government] that the pandemic was over. So there was no emergency, ”said Chandrakant Lahariya, a public health expert from New Delhi. “In almost every aspect, that seems to have been the script.”
India is a major producer of oxygen, producing around 7,000 metric tons per day. But most of its factories are located in industrial states in the east – far from urban centers such as Delhi or Mumbai – and supply industry, with only a slice earmarked for health care.
While hospitals in developed countries often produce their own oxygen, those in India typically rely on trucks that travel long distances to replenish their liquefied oxygen tanks or even cylinders.
This complex logistics network has collapsed as the number of Covid-19 patients has increased in viral hotspots such as Delhi. Normally, about 5% of hospitalized patients require an oxygen supply. The majority of Covid-19 hospital patients require oxygen, forcing hospitals to replenish much more frequently.
Inox Air Products, a local joint venture of the US gas supplier, estimates India’s demand for pre-pandemic medical oxygen has hovered around 700 tonnes per day. This figure rose to 2,800 in the first wave and has exceeded 5,000 in recent days.
India’s truck fleet was unable to cope, causing officials, hospitals and families to scramble for oxygen supplies. Competition for oxygen is so fierce that local governments in Delhi and neighboring Haryana have accused each other of requisitioning deliveries and sent police escorts to guard the tankers.
“India now has the world’s worst oxygen crisis,” said Leith Greenslade, coordinator of the Every Breath Counts Coalition, which advocates for better oxygen supply.
She argued that governments should have established an international funding mechanism for oxygen similar to the WHO-backed Covax program for equitable vaccine distribution. “We haven’t taken the lead,” she said. “The international community was so focused on vaccines and diagnostic tests that it ran out of oxygen.”
The Modi government has also been accused of wasting precious time strengthening the medical oxygen infrastructure in India. It announced last year its intention to build more than 150 “pressure swing adsorption” generators in hospitals. These are small production units that are relatively quick to install.
But the health ministry revealed last week that only 33 had been completed, with a total of 80 due to be completed by the end of May. New Delhi also plans to build an additional 551 using money from a fund created by the prime minister last year.
Other countries are trying to help. Singapore, the UK, and the US are among those sending airplanes of tankers, concentrators – which remove nitrogen from the air to leave purified oxygen – as well as parts to boost the production.
Air Products attempts to send cryogenic containers that can be filled with liquid oxygen to areas of need.
Harsh Vardhan, Indian Minister of Health, said the government was moving “heaven and earth” to meet the challenges. It imports oxygen, transports tankers by train and plane, and has banned the non-emergency use of liquid oxygen.
Industry has also weighed in providing more oxygen for medical purposes and oxygen related logistics equipment.
Sangita Reddy, deputy general manager of the Apollo hospital chain, said she believes the oxygen crisis in Delhi – which was severe a week ago – has eased, but that action should be taken to avoid similar tragedies elsewhere.
“After our success in handling the first wave, everyone got complacent and looked away from the ball,” she said. “It’s the sad truth.”
Amarpreet Rai of Sanrai International, a distributor of oxygen concentrators, said India would struggle to import the devices quickly enough to ease the crisis. “There isn’t enough to escalate it. The whole industry was put to the test for an entire year, ”she said.
Lack of preparation continues to take its toll. Jayant Malhotra, who leads a group of volunteers helping families with cremation, said he receives around 30 bodies a day, up from around two before the pandemic.
“Every time I ask, ‘How come they died? “They say,” They weren’t treated. They did not receive oxygen ”.”