Introduction
India is facing an acute Oxygen crisis in the backdrop of the raging COVID-19 pandemic. A few days ago, more than twenty patients died in Maharashtra due to Oxygen leakage. In Gujarat, five patients died as the Oxygen supply ran out. The same happened in Aligarh, Uttar Pradesh. The situation is dire, and the Indian Government might have to start keeping a tab of patients who die because of Oxygen shortage rather than the virus itself.
In the last few days, the average number of total cases (officially) per day is close to 3.5 Lakhs, with the number of active cases being above 28 Lakhs. It is estimated that about 5-10 percent of the patients end up needing Oxygen. But, with so many active cases, even 5-10 percent translates to huge absolute numbers. How bad is the Oxygen crisis? And how does India plan to tackle it?
India’s Production Capacity
India’s daily oxygen production capacity is 7,127 Metric Tonnes, and it is used for both medical and industrial purposes. Before the pandemic hit India, only 750-800 MT of this Oxygen was used for medical purposes, while the rest was used in various industries. However, demand for medical Oxygen has risen rapidly. In the last two weeks itself, it has increased by more than 75 %, from 3,842 MT on 12th April to 6,785 MT on 22nd April. Thus, India’s daily production, at least for now, is enough to meet its demand. It also has a buffer stock of 50,000 MT of Oxygen.
The Empowered Group-II (EG2), comprising of officials from all the states and representatives of all major Oxygen manufacturers in the country, is responsible for allocating medical Oxygen to different states. Last week, it allocated 6,822 MT of liquid Oxygen per day to the badly affected states against their demand of 6,785 MT per day.
Where lies the problem, if not for production? Firstly, even production needs to be ramped up as the demand for medical Oxygen will increase exponentially in the next few weeks. As per a projection made by IIT scientists, active cases may peak at 38-48 Lakhs by mid-May. But currently, states are facing an Oxygen crisis due to transportation bottlenecks.
Reasons for Oxygen Crisis
We need to understand how Oxygen is produced and transported. Liquid Medical Oxygen (LMO) is produced in large plants in liquid form. Some of the major companies producing Oxygen are Inox Air Products, Linde India, Goyal M G Gases, National Oxygen Ltd, etc. The Oxygen produced in the liquid form has a 99.5 % purity. The Oxygen is stored in large tanks, from where it is transported to distributors using special vehicles known as Cryogenic Tankers. The distributors then convert the liquid Oxygen into the gaseous form again, fill it in cylinders, and supply it to the hospitals and small vendors. As per Government data, there are 1,172 cryogenic tankers in India for carrying LMO. These are proving to be inadequate currently, and hence, Oxygen supplies have not reached their destinations on time. The problem is exacerbated due to inter-state travel delays.
But why does it need to be transported to far-flung areas? That’s mainly because the states that are overburdened with cases do not have the requisite production capacity of their own. They need to obtain supplies from other states where demand is low, but production is adequate. Take the example of Delhi. As per a Mint report, “The facilities from where Delhi will now receive oxygen are spread across seven states, some more than 1,000 km (625 miles) away.” Last Wednesday, they received just 177 MT of Oxygen against the allocated 378 MT due to transportation issues.
Similarly, states like Madhya Pradesh and Delhi, where cases are sky-rocketing, have no significant production of their own and depend on neighbouring states for their supplies. Most of India’s Oxygen (close to 80 %) is produced in “Maharashtra, Gujarat, Jharkhand, Odisha, Tamil Nadu, Karnataka, Kerala, and West Bengal.” In some of these states, the situation is still under control.
Further, the shortage has also been created because of black-marketing and hoarding. Consider this from the Indian Express–
“A small 100-litre cylinder now costs Rs 8,000 and above, up from Rs 4,500-5,000, and its refilling cost has risen from Rs 150-250 to Rs 500-800 in Delhi, Mumbai, Pune and other cities. In Tier-II and Tier-III cities, refilling costs range from Rs 400 to Rs 600.
A 5-litre oxygen concentrator, which until two months ago cost Rs 45,000-50,000, now costs Rs 80,000-90,000, its monthly rent up from Rs 5,000 to Rs 10,000-20,000.”
There have been various reports from Delhi, Kolkata, Gurgaon, etc., where the police have raided black-marketeers, selling Oxygen and drugs such as Remdesivir at exorbitant rates. People have hoarded supplies as a precautionary measure, and many fail to return the cylinders after their purpose is fulfilled. Thus, an artificial shortage has been created.
Finally, India’s medical infrastructure is underdeveloped in terms of using pipelines to supply Oxygen to hospitals, especially Government hospitals. Hence, they have to use cylinders as an alternative. But the over-dependence on cylinders is not a good sign since cylinders cannot provide an uninterrupted Oxygen supply and have to be replaced now and then (especially for critical patients). The problem is further amplified because we don’t have enough cylinders to supply Oxygen.
How does the Government plan to resolve the Oxygen crisis and prevent deaths directly linked to the shortfall in Oxygen supplies?
Steps Taken by the Government
The Government had anticipated this exponential increase in demand for medical Oxygen last year, when on 7th April, the Drug Control General of India (DGCI) sent a letter to all State and UT Drug Controllers to grant expedited approval for the manufacture of medical Oxygen to plants which were already producing industrial Oxygen.
The process throughout the year was smooth, and no significant roadblocks were reported. In May 2020, for instance, the Maharashtra FDA approved seven more manufacturers of industrial Oxygen to produce medical Oxygen (after granting two in April), while Gujarat FDA granted 12 licenses in June 2020. It was also successful in increasing its capacity from 800 MT per day to 970 MT per day, as reported in December. Last week, the Government allocated 6,822 MT of liquid Oxygen per day to the badly affected states against their demand of 6,785 MT per day, which shows that converting industrial Oxygen to medical was not difficult for the manufacturers.
However, with rising COVID cases in the country, the Oxygen demand will further increase in the coming weeks, for which Oxygen supply has to be ramped up dramatically. On 18th April, the Central Government removed all legal roadblocks for converting industrial Oxygen to medical Oxygen by issuing an Order under the Disaster Management Act. It was further modified on 25th April, and all States/UTs were directed to use the existing stock of Oxygen for medical purposes only, and all manufacturing units were given permission to maximise the production of medical Oxygen. In the last few days, the Central Government claims to have increased the production of Medical Oxygen by 3,300 MT by converting the industrial-use Oxygen.
The plant that can make a tangible difference to India’s Oxygen production is Vedanta’s Sterlite Copper Plant which was closed in May 2018 by the Tamil Nadu High Court for violating environmental norms. It has a production capacity of 1050 MT per day, which is more than 1/7th of India’s current production per day. Yesterday, the company was given permission by the Tamil Nadu State Government to restart its plant to produce medical Oxygen only.
Further, the Government plans to import 50,000 MT of LMO. It also sanctioned “the installation of 162 Pressure Swing Adsorption (PSA) plants to directly use atmospheric air and separate it under pressure to filter out nitrogen.” The Oxygen filtered is not as pure as LMO but adequate for moderately affected patients. This will ensure the supply of Oxygen in far-flung areas as well. On 25th April, the number of PSA plants was further increased 551 “in identified government hospitals in district headquarters.”
The Government is also expediting the conversion of Nitrogen and Argon tankers for carrying Oxygen, importing tankers using the Indian Air Force, using trains to speed up Oxygen delivery, and planes to carry empty cylinders and expedite one-way travel. It plans to increase the number of cryogenic tankers by 2,000. Today, 20 tankers were imported and allocated to the States by the Health Ministry. Further, orders were placed for 1,27,000 Oxygen cylinders whose delivery will start from 30th April.
Finally, the Government also invoked the Disaster Management Act a few days ago and directed the states to ensure “that no restriction is imposed on the inter-state or intra-state movement of medical oxygen and oxygen carrying vehicles.”
Hopefully, the intensity of the current wave will be behind us quickly, and the current Oxygen crisis will not exacerbate further.
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