Critical oxygen shortage underlines severity of India’s crisis

St Stephen’s Hospital in New Delhi was on the brink last week as it was inundated by victims of India’s unfolding coronavirus crisis.

With its beds filled with patients in acute respiratory distress, the hospital’s oxygen supplies ran perilously low. At one point, its giant oxygen tank had just four to six hours of piped oxygen left for 300 seriously ill patients. Calamity was only averted after frantic calls to the supplier and desperate public appeals. Days later, the piped oxygen ran out and St Stephen’s had to rely for several hours on oxygen cylinders.

“There’s no oxygen,” said Mathew Varghese, one of the hospital’s senior doctors. “The system is broken down and we’re losing patients. We don’t know what to do. We’re used to saving lives and we’re watching people die.”

The crisis at St Stephen’s reflects how India’s brutal second wave has overwhelmed heath infrastructure and pushed its complex medical oxygen supply chain to breaking point. India is reporting 300,000 infections and close to 3,000 deaths every day, with the real figures undoubtedly higher.

As patient numbers surge, families across India have engaged in desperate hunts for oxygen cylinders or hospital beds for ailing loved ones. More than 20 patients died last week after oxygen supplies ran out at another New Delhi hospital.

The catastrophic shortages have fuelled accusations that Narendra Modi’s government failed to prepare the country for a second wave, after seeing off the first last year.

“It was perceived at many levels [of government] that the pandemic was over. So there was no urgency,” said Chandrakant Lahariya, a New Delhi public health expert. “In nearly every aspect this seems to have been the scenario.”

India is a significant oxygen producer, turning out roughly 7,000 metric tons a day. But most of its plants are located in eastern industrial states — far from urban hubs such as Delhi or Mumbai — and supply industry, with only a sliver destined for healthcare.

While hospitals in developed countries often produce their own oxygen, those in India typically rely on trucks that travel long distances to replenish their liquefied oxygen tanks or even cylinders.

This complex logistics network has crumbled as Covid-19 patient numbers have surged in virus hotspots such as Delhi. Normally, about 5 per cent of hospital inpatients’ require oxygen support. The majority of hospitalised Covid-19 patients need oxygen, requiring hospitals to replenish far more frequently.

Inox Air Products, a local joint-venture of the US gas supplier, estimates India’s pre-pandemic medical oxygen demand hovered at about 700 tonnes per day. That rose to 2,800 during the first wave and has soared past 5,000 in recent days.

India’s truck fleet has been unable to cope, prompting a frantic scramble by officials, hospitals and families for oxygen supplies. So fierce is the competition for oxygen that local governments in Delhi and neighbouring Haryana accused each other of commandeering deliveries and sent police escorts to guard tankers.

“India now has the worst oxygen crisis in the world,” said Leith Greenslade, co-ordinator of the Every Breath Counts Coalition, which advocates for improved oxygen provision. 

She argued governments should have established an international funding mechanism for oxygen similar to the WHO-backed Covax scheme for equitable vaccine distribution. “We didn’t get ahead of this,” she said. “The international community was so focused on vaccines and diagnostic tests, they’ve missed oxygen.”

The Modi government has also been accused of wasting valuable time in bolstering India’s medical oxygen infrastructure. It announced last year plans to build over 150 “pressure swing adsorption” generators at hospitals. These are small production units that are relatively quick to install.

But the health ministry revealed last week that just 33 had been completed, with a total of 80 due to be finished by the end of May. New Delhi is also planning to build a further 551 using money from a fund set up last year by the prime minister.

Other countries are trying to help. Singapore, the UK and US are among those sending planeloads of tankers, concentrators — which remove nitrogen from the air to leave purified oxygen — as well as parts to boost production.

Air Products is attempting to send cryogenic containers that can be filled with liquid oxygen to areas of need.

Harsh Vardhan, India’s health minister, said the government was moving “heaven and earth” to tackle the challenges. It is importing oxygen, transporting tankers by train and plane and has barred non-emergency use of liquid oxygen.

Industry has also weighed in by providing more oxygen for medical use and oxygen-related logistics equipment

Sangita Reddy, joint managing director at the Apollo hospital chain, said she felt the oxygen crisis in Delhi — which went into strict lockdown a week ago — had eased but that steps should be taken to prevent similar tragedies elsewhere.

“After our success in handling the first wave everybody got complacent and took their eye off the ball,” she said. “That’s the sad reality.”

Amarpreet Rai of Sanrai International, an oxygen concentrator distributor, said India would struggle to import the devices quickly enough to alleviate the current crisis. “There isn’t enough to scale it up. The entire industry has been strained for a whole year,” she said.

The unpreparedness continues to take a heavy toll. Jayant Malhotra, who runs a volunteer group that helps families with cremation, said he was receiving about 30 bodies per daily compared with about two before the pandemic.

“Whenever I ask, ‘How come they died?’, they say, ‘They didn’t get treatment. They didn’t get oxygen’.”