New Delhi: With the continuing surge in Covid-19 cases in India, the demand for medical oxygen has hit a record high.
The industry, which has already quadrupled production to 2,700 tonnes per day from 750 tonnes a day in the last six months, is now juggling to match the ever growing demand.
Even the ramped-up production, however, isn’t helping prevent a shortfall and some states have started to experience a shortage of oxygen cylinders. Over the last week, Madhya Pradesh, Gujarat and Mumbai have all reported shortage of medical oxygen resulting in the death of Covid-19 patients.
As oxygen therapy has become critical in the country’s fight against coronavirus, ThePrint explains what ‘medical oxygen’ is, how it is manufactured and used in the treatment of Covid- 19.
What is medical oxygen
Collecting oxygen in cylinders is not as simple as it may sound. According to industry experts, the natural air around us carries approximately 21 per cent oxygen, 78 per cent nitrogen, 1 per cent argon and other gases such as neon and xenon.
To collect pure oxygen, a special technique is deployed to separate oxygen from the atmosphere, which leads to separation and distillation of atmospheric air.
Once the oxygen is collected, it is inspected and packaged into different grades. These grades are then divided into several categories such as welding oxygen, aviation breathing oxygen, research grade oxygen and medical oxygen.
What is the use of medical oxygen?
Medical oxygen is one that is used for treatment in hospitals, and it is considered on par with a drug or a pharmaceutical product.
According to BOC Healthcare, the supplier of medical gases in the United Kingdom, medical oxygen is used to “restore tissue oxygen tension by improving oxygen availability in a wide range of conditions such as Chronic obstructive pulmonary disease (COPD), cyanosis, shock, severe hemorrhage, carbon monoxide poisoning, major trauma or cardiac and respiratory arrest”.
During Covid-19, the requirement of medical oxygen is enhanced. Covid-19, according to Bengaluru-based hospital chain Narayana Health, primarily infects the lungs in the affected individuals and in severe cases, causes death due to Acute Respiratory Distress Syndrome (ARDS) and pneumonia.
As Covid induces shortage of oxygen in the body due to its impact on lungs, patients are immediately shifted into oxygen therapy or put on ventilators, in critical cases, to keep their vital functions active. Oxygen acts as a life-saver for Covid patients.
According to the All India Industrial Gases Manufacturers’ Association (AIIGMA), the industry was producing 750 tonnes of medical oxygen every day in March, when the pandemic was gaining ground in India.
Today, the industry is supplying 2,700 tonnes of medical oxygen per day — almost four times of what it was supplying six months ago.
“In April, when lockdown was imposed, the industrial operations were closed and hence, we were able to divert the production of industrial oxygen into medical supplies by using the idle quantities. While both oxygen types are more or less the same, some impurities found in industrial oxygen were taken care of,” said Saket Tiku, president, All India Industrial Gases Manufacturers Association (AIIGMA), which is an apex body representing companies producing industrial and medicinal gases.
Before the resumption of industrial activity, the industry was supplying around 70-80 per cent of the oxygen to hospitals and just 20-30 per cent of the production was going for industrial use.
Overall, according to the estimates of AIIGMA, the industry is now producing 5,000 tonnes of oxygen every day, of which 2,300 tonnes are for industrial use while 2,700 tonnes are supplied to hospitals.
“There is a lot of stress on the entire infrastructure right now. We don’t know for how long we can sustain,” Tiku said. “Moreover, the surge in cases is phenomenal, which indicates that the requirement is not going to be under control anytime soon.”
In India, there are about 10-12 big manufacturers of medical oxygen, whereas over 500 players own small gas-plants.
Gujarat-based Inox Air Products is the biggest manufacturer of medical oxygen in India, followed by the Delhi-based Goyal MG Cases, Kolkata’s Linde India and Chennai-headquartered National Oxygen.
When the Narendra Modi government was procuring ventilators at the start of the pandemic in March, it checked the capacity of medical oxygen production in India. “At that time, the industry was confident that it would be able to meet the demand by diverting the industrial oxygen to medical use,” said a manufacturer, requesting anonymity.
According to Rajiv Nath, forum coordinator, Association of Indian Medical Device Industry (AiMeD), the oxygen manufacturers had in March assured the government of surplus capacity and that industrial supplies could be used to augment medical ones.
“Seemingly with depressed industrial activity from March to June, the oxygen manufacturers had over capacity but now industry activity is picking up in the July-September quarter and so they are finding capacity constraints. But instead of expanding capacity, some manufacturers are using opportunity to jack up prices substantially, which is being protested by their industrial buyers as well,” Nath said.
How much oxygen is required for a Covid patient?
According to an estimate by Dr Kamna Kakkar, senior resident, Department of Pulmonary and Critical Care Medicine at PGIMS Rohtak, who has been treating Covid-19 patients, a single patient on high flow nasal cannula (HFNC) uses over 86,000 litres of oxygen per day.
“It is certainly a lot of oxygen but it saves lives,” Kakkar told ThePrint. “Let’s say there is a patient on HFNC who requires 100 per cent oxygen at 60 litres per minute. So, that would amount to 3,600 litres of oxygen required per hour.”
She, however, highlighted that if 100 people are infected by Covid, 90 do not need oxygen. “Just 10 need oxygen. Out of 10, one or two might need support on HFNC or ventilators. The burden on oxygen supply will surge phenomenally if cases rise to 1 lakh per day,” she said.
According to a statement by Health Minister Dr Harsh Vardhan in the Lok Sabha Monday, “only about 5.8 per cent of cases (in India) required oxygen therapy and the disease may be severe enough to require intensive care in only 1.7 per cent cases”.
“As on 11th September, 32,109 ventilators have been allocated to states of which 30,170 have been delivered. The country is self-sufficient in oxygen and oxygen cylinders,” he added. “The ministry of health and family welfare has procured & supplied 1,02,400 oxygen cylinders to various states/UTs so far. In addition, oxygen concentrators are also being supplied to states.”