The first alarm bell rang on the afternoon of April 12 at Shree Ashirwad Hospital, a Covid-19 nursing home in Badlapur, a satellite town 50 km east of Mumbai.
For over a month, six giant oxygen cylinders have been stationed on the footpath outside the hospital entrance, and many smaller ones have been jostling for space in the narrow corridors of the hospital. That day, most were empty, awaiting replacement, but the vendor had no stock to supply. The hospital had 47 Covid-19 patients, all on oxygen support, and six hours of oxygen left.
One doctor began making frantic calls to families of six ICU patients, asking them to find another hospital, and another began calling hospitals to check if they had spare cylinders or beds. As it turned out, 50 hospitals in Badlapur, Ambernath, Ulhasnagar, Kalyan and Dombivali (all municipal corporations in Thane) were fast running out of oxygen. Their common supplier, S K Agencies, was making desperate calls to his vendors for liquid medical oxygen (LMO).
“We were under stress for hours. Patients could die without oxygen and no other hospital had bed or oxygen to take our patients,” said Dr Datta Baikare.
By late evening, the hospital found a vendor after agreeing to a higher price — Rs 21-25 per cubic metre, instead of the usual Rs 17-18 — but at that point, little else mattered.
That day passed, but amid a rising Covid curve, fear of oxygen shortage looms over private and government Covid hospitals in Maharashtra, specially rural areas, where nursing homes and smaller government hospitals are now scrambling to create space for oxygen cylinders.
Vicky Punjabi, owner of S K Agencies that supplies oxygen in Thane, said daily demand has gone up from 6 MT a month ago to 21 MT in the 50 hospitals that he supplies to.
With a capacity to produce over 7,000 MT oxygen per day across the country, the Centre plans to float a tender to import 50,000 MT to meet the surge in oxygen demand in 12 high-burden states: Maharashtra, Madhya Pradesh, Gujarat, Rajasthan, Karnataka, Uttar Pradesh, Delhi, Chhattisgarh, Kerala, Tamil Nadu, Punjab and Haryana.
In Maharashtra, the worst-hit state in the second wave, with over 6.38 lakh active cases (40% of India’s Covid disease burden), demand for medical oxygen far exceeds the state’s production capacity of 1,250 MT per day. Despite the entire production now diverted for medical use, it is still not enough, with the demand 1,200-1,300 MT a day and rising.
Maharashtra has over 60,000 people on oxygen support in hospitals and many others on oxygen support at home. The state is getting 50 MT a day of liquid medical oxygen from Chhattisgarh, and another 50 MT a day from Gujarat.
D R Gahane, Joint Commissioner (Drug), Maharashtra Food and Drug Administration (FDA), says, “If cases don’t dip, we may need to totally depend on other states for oxygen.”
“We need restraint (in oxygen use) to avoid panic. Panic and anxiety increase demand,” said Maharashtra Health Secretary Dr Pradeep Vyas.
Oxygen shortage has forced Siddhivinayak Multispecialty Hospital in Badlapur to stop new admissions since April 12. Until January, the hospital could easily sustain 10 jumbo cylinders over two days, but now the 10 cylinders barely last five hours. Doctors say Covid patients in ICU require 10-50 litres of oxygen per minute. A jumbo cylinder with 7 cubic metre oxygen can run out in 30-40 minutes. A dura cylinder, 22 times larger than jumbo, is the new alternative for smaller hospitals.
In an attempt to plug the shortage, the Centre’s Empowered Group-2 has decided to divert over 17,000 MT of LMO to the 12 surge states in three phases between April 20-30. But the oxygen supply chain has many more knots to untangle.
“Logistics of transport is the biggest challenge,” says Saket Tiku, president of the All India Industrial Gases Manufacturers’ Association.
Vicky Punjabi of S K Agencies says that with demand going up, he needs more drivers, vehicles and cylinders. “We don’t have that kind of resources.”
An industry official said oxygen is transported in liquid form in cryogenic tankers, before being converted into gas and stored in jumbo or dura cylinders.
An official from Inox Air Products, one of India’s top oxygen manufacturers, that caters to 60 per cent of the country’s LMO demand, said the company has 550 tankers, each with a capacity of 5,000-10,000 litres. The company has diverted its resources from nitrogen and argon gas production to oxygen, the official said. “There are enough suppliers in urban areas. The challenge is in satellite towns and rural areas where there are no storage tankers,” he added.
Maharashtra has over 100 cryogenic tankers to transport oxygen. In an ideal situation, it takes 3-5 days for oxygen to journey from a manufacturer to the patient’s bed. But with resources stretched, rural hospitals are having to wait 6-7 days before they get their supplies. On Maharashtra’s request, the Ministry of Railways is formulating a plan to transport cryogenic tankers in trains to speed up delivery.
At the Kulgaon-Badlapur Municipal Corporation Hospital in Thane, administrator Deepak Pujari said that with 400 Covid-19 patients on oxygen support, he needs 5 MT oxygen daily. “Supply is prioritised to big cities and bigger centres. That is why smaller centres like ours face issues. It will be sorted soon, our collector is working on it,” he said.
In each district, a team with members of the FDA, collectorate and health department has been tasked to assess the needs of hospitals and track down suppliers to monitor the flow.
Back in Badlapur, on April 14, two days after hospitals ran out of oxygen, a truck full of dura cylinders stops outside Shree Ashirvad Hospital. Three doctors rush outside to monitor the unloading. “Oxygen is the most prized commodity right now,” says one of them.