Corona Daily 115: Running on Empty Cylinders

India reported 315,000 new cases yesterday, a pandemic record. More than 2100 officially died of covid-19, an Indian record. Many deaths are attributed to the shortage of oxygen. Doctors are required to play god by choosing whom to give oxygen to and letting the others die.

On 16 April, Vijay Shrivastava, 65, a journalist, posted on twitter a photo of his oxymeter showing 52, instead of the required 90 plus. The Uttar Pradesh Chief Minister’s advisor replied asking him to provide full details. By then his oxygen level had fallen to 31. On 17 April, he died. His son said he tried to get an oxygen cylinder everywhere but couldn’t.

Yesterday, in a city of Maharashtra, at least 24 patients died in a matter of minutes when the oxygen supply to their ventilators suddenly stopped due to a leak.

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Six hospitals have gone to the Delhi High court. On 21 April, the high court judge said, “this is ridiculous. We want to know what the center is doing with regard to oxygen supply across India.”

Today, India’s Supreme Court has entered the battleground. Beg, borrow, steal but get the oxygen, a judge reportedly said to the government. The court wants the government to show the national plan for oxygen supply.

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Oxygen is used in industries. It is used in hospitals. We are familiar with oxygen cylinders traditionally used in hospitals. But there is a relatively modern technology called “pressure swing adsorption (PSA)”. Broadly speaking, this production process uses the normal air, and by applying changes in pressure separates the oxygen. This oxygen is supplied continuously to the hospital through pipes. The technology avoids the complications of storage and transport of liquid oxygen. The PSA plants are built close to a hospital or are attached to it.

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Last year, on 14 March, India declared covid-19 to be the national health emergency. It was known India was likely to experience huge shortages of beds, PPE, ventilators and oxygen. The central government decided to build 162 Pressure Swing Adsorption Oxygen plants in 162 district hospitals across the country. India then went into a national lockdown.

For reasons never explained, the tender was issued on 21 October. It took more than seven months to prepare a tender in a national emergency.

These plants are relatively inexpensive. The 162 plants would cost Rs 200 crore ($27 million). They were going to be financed by the PM-CARES fund, an opaque instrument that uses the photo of the prime minister, government website domain, but is kind of private, not open to public scrutiny. Indians had donated Rs 3,000 crore ($400 million) to that fund in the first four days. Money, therefore, was not a problem to build the oxygen plants.

The website of the PM-CARES fund, till today, doesn’t mention how the collected funds have been allocated. It doesn’t mention the plan to build the PSA oxygen plants.

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Scroll, an independent online newspaper carried out an independent investigation by calling the potential hospitals. They called over 60 hospitals across 14 states, and found that only 11 units were installed, and five were operational.

After Scroll’s article was published, India’s health ministry hurriedly issued a series of tweets. They confirmed that out of 162 planned oxygen plants, 33 have been installed. Before May-end, the plan is to install another 47.

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India has now gone into management by crisis mode. Production and supply need to match. A big state like Madhya Pradesh has no oxygen manufacturing. More cryogenic tankers will need to be produced. Their production can take up to four months. Though an oxygen exporter, India plans to import 50,000 MT of oxygen. The logistics of import and distribution around the country are challenging. Industries have been asked to divert oxygen to hospitals.

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Journalist Shrivastava who died on 17 April lived seven km from the Shyama Prasad Mukherjee Civil hospital. It was one of the 162 hospitals waiting for the oxygen generation plant. Had it got one as was planned a year ago, Mr Shrivastava might be alive today. Along with thousands of others.

Ravi