Explained: Shortage of medical oxygen and what is being done to fix it

In Delhi, oxygen tankers reach hospitals in the morning. And by evening, they scramble again for breathable air as cases keep rising.

India reported over 3.14 lakh new COVID-19 cases on Wednesday – a record high for single-day cases. The last time a number this large was reported was on January 8, 2021, in the US.

Medical oxygen is a critical component in the treatment of COVID-19. In the early stages of the outbreak, it was recognised as one of the essential commodities in our fight against COVID-19. But as India grapples with a second wave, its patients suffer from a lack of breathable air. But why? Let's find out.

Shortages are usually characterized by demand-supply mismatch, but this time, it’s different. The demand for medical oxygen has risen nearly exponentially since the outbreak.

Before the outbreak in 2020, demand was about 700 MT/day. It spiked to 2,800 MT/day after the outbreak. Currently, it is 5,500 MT/day, according to a report in TOI.

On the supply front, according to Empowered Group 2, India can produce over 7100 MT/day. And the group keeps a buffer stock of 50,000 MT.

According to the numbers, it looks like we couldn't map demand and supply accurately, a function that comes under the purview of EG2.

Empowered Group 2 (EG2) was constituted in March 2020 to ensure the availability of essential medical equipment, including oxygen. It comes under the Department of Promotion of Industries and Internal Trade (DPIIT). It has representatives from all states and oxygen manufacturers. Being new, the group could not map demand-supply numbers.

The big problem right now is that the excess supply that is there in the market is in East India like in Odisha and Jharkhand, whereas the demand is mostly coming from Western India – Maharashtra, Gujarat and Madhya Pradesh, according to Inox Air Products' Director Sidharth Jain.

Now, demand has also started picking up in Delhi and Uttar Pradesh. The issue is that supply is available in places that are very far away from the demand, he said.

Oxygen has industrial as well as medical uses. Now, most states have directed their entire oxygen production for medical use. But, there are not enough cylinders and tankers to store and transport the oxygen.

Oxygen is an inflammable gas. To prevent accidents, it is stored and transported in cryogenic cylinders. But India does not have enough cryogenic cylinders.

“Oxygen is a flammable material and it cannot be transported regularly. You need cryogenic tankers for it. The fact that there is an explosion in the number of people who want oxygen and essentially the demand for oxygen is just 2-3x of the usual requirements, is definitely a logistical issue as well. The throughput that needs to be there is not as fast," Vineet Agarwal, President of ASSOCHAM told CNBC-TV18.

Recently, Tata Group announced that it will import 24 cryogenic cylinders to ease the shortage issues. But, this is just one of the issues.

"We do not have enough trucks to transport these cylinders in," Saket Tiku of All India Industrial Gas Manufacturers Association (AIIGMA) told CNBC-TV18.

Plus, transporting oxygen cylinders requires top-notch safety measures. And we need trucks, cylinders, and bullets to follow those measures.

We have to be on a war footing, create oxygen cylinders, transportation capabilities, purification capabilities, and bullets, MS Unnikrishnan, former MD, and CEO of Thermax told CNBC-TV18 in an interview.

“The biggest challenge is oxygen is stored in liquefied condition (in industries) and not in the gaseous condition. So liquefied oxygen will be transported in bullets and especially trucks. Large hospitals may have bullets, but most small and medium-sized hospitals (where there is a dire need of oxygen) use cylinders,” he added.

Another challenge is the lack of proper infrastructure. Most government hospitals don’t have a copper pipeline to connect and supply oxygen. They use cylinders to supply oxygen. And not only changing cylinders is a laborious task, but there is also a shortage of cylinders.

In the absence of cylinders, hospitals have to wait for 6-8 days for oxygen. Even then, remote hospitals have to wait longer.

Furthermore, the increased cost of transport and logistics have increased the cost of refilling the containers. Refilling used to cost Rs 100-150 earlier, but now it costs anywhere between Rs 500-2,000.

India floated tenders for oxygen generation plants in October to create units that can produce medical oxygen on site. But six months hence, the plants are still on paper, reported Scroll.

Even when it became clear in the early months of the outbreak that oxygen would be one of the most precious commodities in our battle, the government took over eight months to invite bids for oxygen generation plants.

It is unlikely that delay in kickstarting the tender process was caused by a lack of funds, Scroll said. The outlay for 162 plants (+12 added later) is just a little over Rs 200 crore.

In most states, either the plants are not functional or the hospitals can’t provide the infrastructure needed to connect the generation units to beds.

India Inc is coming forward to provide a helping hand to states reeling from oxygen shortage. Reliance Industries has increased its oxygen supply to COVID-19 hit states. Vedanta has offered to supply 1,000 tonnes of oxygen from its shuttered copper plant in Tuticorin.

According to a PTI report, Cooperative fertilizer major IFFCO will set up four medical oxygen plants in Uttar Pradesh, Gujarat, and Odisha and supply free oxygen to hospitals.

EG2 has directed Health Ministry to identify 100 hospitals in remote locations for installation of Pressure Swing Adsorption (PSA) plants, Business Line reported. These plants help hospitals become self-sufficient in fulfilling their oxygen requirements.

The Empowered Group has also set the ball rolling for floating a tender to import 50,000 tonnes of medical oxygen. Health Ministry is identifying the sources and would be responsible for finalizing the tenders.

Industries manufacturing oxygen are now manufacturing oxygen for medical use. EG2 has also directed industries to use argon and nitrogen tankers for oxygen transportation, Indian Express reported.

Hospitals are also setting up storage tanks to store supplies. Several hospitals had already set up such tanks to avoid waiting for cylinders.

Delhi is also preparing to airlift oxygen from Orissa as the state grapples with an acute shortage. Sangeeta Reddy, MD of Apollo Hospitals has also requested the Centre to declare oxygen tankers as ambulances and allowing them to move freely as Delhi’s tankers stay stuck at the Haryana border.