On Friday morning, 25 families in Delhi, the capital of India, woke up to the news that their loved one had passed away at Sir Ganga Ram Hospital in the city. According to reports, this was because coronavirus patients could not get enough oxygen.
The hospital’s medical director said that the severe shortage caused a slowdown in oxygen supply to the 25 most severely ill patients, who needed a high-pressure, stable supply.
The tragedy happened at the end of the week. Several major hospitals in Delhi were close to hypoxia on many occasions, which can help virus patients who need respiratory support stay vigorous.
On Tuesday, the Indian central government organized a late-night supply that required the desperate public request of the Chief Minister and the intervention of the High Court.
On Friday morning, an oxygen tank finally arrived at Sir Henggaram Hospital, after receiving a terrible warning shortly before that 60 patients were dying.
But India’s rising wave of cases is pushing its healthcare system to the edge — from the country’s wealthiest cities to the most remote corners.
The states of Maharashtra and Gujarat in the west, Haryana in the north, and Madhya Pradesh in central India all face oxygen shortages.
In the northern state of Uttar Pradesh, some hospitals have placed “hypoxic” boards outside. In Lucknow, the state’s capital, hospitals require patients to be transferred to other places.
Small hospitals and nursing homes in Delhi are doing the same thing. Desperate relatives in several cities are lining up outside the oxygen replenishment center. A factory in the southern city of Hyderabad hired bodyguards to manage the crowd.
Many people infected with the coronavirus died while waiting. The hospital is trying to accommodate patients who have difficulty breathing, and even those who are lucky enough to find a bed to survive. Social media feeds and WhatsApp groups are full of crazy requests for oxygen cylinders.
For a week, India has been reliving this nightmare, waiting for the terrible moment when there is no oxygen at all.
For anyone who has seen a pandemic unfold here—from doctors to officials to reporters—it feels like deja vu. Seven months ago, with the rapid increase in the number of cases, the country faced similar oxygen shortages. But this time, the situation is much worse.
Generally, healthcare facilities consume approximately 15% of the oxygen supply, and the rest is used for industrial purposes. But according to senior health official Rajesh Bhushan, during the second wave of the outbreak in India, nearly 90% of the country’s oxygen supply—7,500 metric tons per day—was diverted for medical purposes.
This is almost three times the daily consumption at the peak of the first wave in mid-September last year.
Then, India added about 90,000 cases every day. Just two weeks ago, in early April, the single-day peak was about 144,000. Now, the number of cases per day has more than doubled to more than 300,000.
“The situation is very bad. We have to treat some patients in a cardiac ambulance for 12 hours until they can get an ICU bed,” said Dr. Siddheshwar Shinde, who runs the Covid Hospital in Pune, India’s second-highest western region. The number of active cases and the third highest number of deaths caused by the virus.
Last week, when there were no ventilators, Dr. Sind began to transfer patients to other cities—unheard of in Pune, where patients usually come from nearby areas to seek treatment.
The state of Maharashtra, where Pune is located, is one of the hardest-hit areas in India and currently accounts for more than one-third of active cases. The state produces approximately 1,200 metric tons of oxygen per day, but all oxygen has been used for Covid patients.
“Usually hospitals like ours have enough oxygen supply. But in the past two weeks, keeping people breathing has become a task. Patients as young as 22 years old need oxygen support,” Dr. Shinde said.
Doctors and epidemiologists believe that a large number of cases have delayed testing and consultation, causing many people to be admitted to hospitals when they are seriously ill. Therefore the demand for high flow oxygen-and therefore more oxygen-is higher than during the previous wave.
“No one knows when this will end,” Dr. Sind said. “I think even the government did not foresee this.”
Some governments have done it. The southern state of Kerala has increased supply by closely monitoring demand and planning for an increase in cases. Kerala now has excess oxygen that can be transported to other states.
The Supreme Court has stepped in and asked the government of Prime Minister Narendra Modi to develop a national Covid plan to address oxygen shortages.
The Federal Ministry of Health invited bids for a new oxygen plant in October last year-eight months after the pandemic began in India. The ministry stated that of the 162 sanctions, only 33 have been installed so far-59 will be installed at the end of April, and another 80 will be installed at the end of May.
Liquid oxygen, light blue, extremely cold, with a temperature around -183C, is a low-temperature gas, and can only be stored and transported in special steel cylinders and tankers.
About 500 factories in India extract and purify oxygen from the air and send it to hospitals in liquid form. Most of it is supplied through tankers.
Large hospitals usually have their own oxygen storage tanks, which are used to store oxygen, which is then directly transported to the beds through pipelines. Smaller temporary hospitals rely on steel and aluminum cylinders.
Oxygen tank trucks often line up outside the factory for several hours, and it takes about two hours to fill an oxygen tank. It takes several hours for these tankers to reach various towns in or between states.
Tankers must also comply with specific speed limits—no more than 25 mph (40 km/h)—and they usually don’t drive at night to avoid accidents.
The person in charge of one of India’s largest oxygen suppliers stated that part of the difficulty lies in moving from eastern India (high supply in industrial states such as Orissa and Jharkhand) to western or northern India (such as Maharashtra). Bang or Delhi) getting oxygen rises quickly.
The demand for oxygen in individual facilities is unpredictable, which makes it difficult to measure the needs of the hospital and adequately supply it where needed.
Dr. Om Shrivastav, an infectious disease expert at a hospital in Mumbai, said: “Not every patient needs the same amount of oxygen at the same time. How many patients in the hospital need to change oxygen every hour.”
Before the oxygen crisis broke out, the federal government had already faced criticism for allowing election rallies and large-scale Hindu festivals, and failing to expand vaccination campaigns fast enough. Critics accuse the state governments of doing too little to prepare for the devastating second wave that is now sweeping the county.
Doctors and virologists interviewed by the BBC stated that oxygen shortage is not so much the cause of the crisis as a symptom—effective safety protocols and strong public information could have allowed more people to stay at home, and Stop the virus from spreading.
But they said that by January, the number of cases had dropped sharply, which plunged the country into a false sense of security and created the conditions for a terrible second wave of epidemics.
The Modi government has now launched the “Oxygen Express”, which transports tankers to places where there is demand, and the Indian Air Force is airlifting oxygen from military bases. They are also considering plans to import 50,000 metric tons of liquid oxygen.
“We have been telling the authorities that we are willing to increase production capacity, but for this we need financial assistance,” said Rajabhau Shinde, who runs a small oxygen plant in Maharashtra.
“No one said anything, now suddenly, the hospital and doctors are begging for more cylinders,” he said.
“This shouldn’t happen. As the saying goes, dig a well before you get thirsty. But we didn’t do that.”
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Post time: Dec-20-2021