Oxygen Crisis: How Hosps Manage Their Supply Amid a Raging COVID

Delhi is being supplied with 480 tonnes of oxygen per day. But its requirement is 700 tonnes, CM Kejriwal said.

Though ICU beds are available in government hospitals, many people are preferring private hospitals for COVID-19 related admissions.

(Image Courtesy: iStock)

Saurabh Bharadwaj’s oxygen was dangerously low as he tweeted a video at 3:30 pm on 22 April, pleading the central and Haryana governments to supply the required oxygen to hospitals.

According to the video, the hospital he was admitted to had only three hours of oxygen left at that time.

New Delhi hospitals have been witnessing an unprecedented oxygen-supply shortage since COVID-19 cases started spiking in the country early this month. With oxygen supplies depleting by the minute, Delhi CM Arvind Kejriwal at a press conference on 22 April stated that the UT required 700 tonnes of medical oxygen every day to sustain the demand.

Its currently being supplied with only 480 tonnes of the life-saving gas. Which means several hospitals will continue to face a shortage in the coming days.

These figures raise a few pertinent questions: How do hospitals manage and predict medical oxygen supplies? What options does a hospital have for the supply of medical oxygen and what can they do when the stock is depleted?

To answer these and more, we spoke with several hospital management professionals in India and abroad. Here are their inputs:

How much oxygen does a COVID-19 patient consume? And does the rate fluctuate according to the severity of the patient?

A COVID-19 patient with mild symptoms will consume 2-4 litres of oxygen per minute. A patient with moderate symptoms will consume 4-8 litres per minute and a patient with severe symptoms will consume 8-15 litres per minute.

It is important to note that a COVID-19 patient is usually admitted for a minimum of 5-6 hours and their stay at a hospital can be extended to several days based on the severity of their symptoms.

What are the avenues of oxygen supply and production in India?

There are primarily three ways that hospitals can access medical oxygen:

• A bank of 44 medical oxygen cylinders: This is the most common option and used by a majority of hospitals across India. These cylinders are rented out to hospitals who then get them refilled as per requirement.
• Liquid Oxygen Cryogenic Storage tanks: These are specialised tanks used mainly by large hospitals and can store upto 13,000 litres of oxygen.
• Oxygen General Plants: These are only a few in number in India and are not present in every state.

How many oxygen cylinders or how much liquid oxygen is required by a hospital?

Oxygen cylinders are rented from suppliers in a “bank” of 44 cylinders. A typical 50-100-bed hospital will require two-three banks of cylinders and these need to be replenished every three days during non-COVID times. Hospitals are currently running out of this stock on a daily basis.

However, these cylinder banks are no longer available due to shortages and hospitals are relying on any cylinder they get access to.

When compared to liquid oxygen supplies, a 50-100 bed hospital will require 3-4 tonnes. Big hospitals, like a 1,000-bed facility, require 13,000 litres of oxygen every day.

Are there different types of oxygen cylinders? What is the capacity of a cylinder?

Oxygen cylinder sizes are categorised alphabetically – ‘A’ being the smallest size and ‘H’ being the largest.

‘A-B’ category size cylinders are very small and their capacity ranges from 42 litres to 198 litres. Depending on the condition of the patient, these cylinders are used primarily for personal use or emergency care, like on airplanes or ambulances.

Hospitals usually stock ‘D-G’ category  oxygen cylinders. The capacity of these cylinders range from 425 litres to 3,455 litres. However, ‘F’ and ‘G’ type cylinders are not portable and require special machinery to unload from trucks due to their weight.

How long does it take to refill a cylinder or a bank of cylinders?

According to experts, refilling a bank of cylinders can take 5-12 hours, depending on the oxygen suppliers’ capacity. Refilling and restocking tanks on time is crucial since hospitals need to have 24×7 oxygen supply.

What are the critical issues that hospitals face when it comes to oxygen supply?

The biggest issue is timely supply and safe transportation. Depending on the oxygen supplier, the oxygen cylinders will either arrive by trucks or in specialised cryogenic tanks.

Delay in supply is the biggest problem since oxygen production plants are not present in every state. For example, Inox Air Products, which caters to 50 percent of India’s oxygen requirement, is also facing supply issues as production units are not set up in every state.

What option or alternative do hospitals have if they do run out of oxygen?

There are very few options available if that unfortunate day does come. But here are some measures that can be taken:

The hospital administration can ask the district government or state government to divert oxygen stocks from industries to facilities in critical need.

Patients can be moved to oxygen concentrators. These are mid-size devices which produce oxygen, but not in the purest breathable form. This is a short-term alternative.

Manually ventilating a patient is another option. This is usually used in emergency cases, like an accident, but can be used as a last resort in case of oxygen supply crunch.

Can India Cater to the Rising Cases?

In an interview with Moneycontrol dated 20 April, Siddharth Jain, Director of Inox Air Products, stated that the current demand for oxygen in India is 5,000 metric tonnes per day (MTPD). The current manufacturing capacity in India is 7,200 MTPD.

In the interview, he stated that if the cases increase from 2,50,000 per day to 5,00,000 per day, “we could have a problem”.

He further stated that Inox’s current capacity is 2,300 MTPD and that it had also lined up additional funds to set up eight new plants across the country to meet the growing demand.

Has the Centre Taken Any Step to Ensure Timely Oxygen Supply?

The Indian Railways has joined hands with Inox to ensure oxygen reaches different parts of the country through the new “Oxygen Express” trains.

The service was announced by Railways Minister Piyush Goyal on 18 April and a ramp was built by the Central Railway at Kalamboli overnight to facilitate loading of the roll-on/roll-off oxygen trucks on the trains.