In the last two weeks, Bengaluru hospitals have seen horrifying cases of COVID deaths due to the lack of oxygen supply. One such case was that of 35-year-old Subramanya. The first hospital Subramanya was admitted to was running out of oxygen, and for a long time, he was unable to find an ICU bed in another hospital. He was eventually admitted to Prashanth Hospital near Bommanahalli, but his oxygen saturation level had deteriorated so much that he couldn’t be saved.
Dr Vishwanath Reddy, Managing Director of Prashanth Hospital, says his hospital has been suffering from oxygen shortage too. “Our regular supplier in Bengaluru has not been supplying properly now; they say there’s no oxygen. So I have to get it from another supplier in Hosur.” There are 150 beds in the hospital, of which 100 were reserved for COVID patients. “Of those 100 beds, only 10 are normal beds. The rest are HDU and ICU beds which need oxygen. Nearly all COVID patients who come in now, need oxygen,” says Dr Vishwanath.
While the daily oxygen requirement of the hospital was 500-800 litres per day in the first wave of COVID, as of April 22, it was 1500 litres per day. Dr Vishwanath says even the new supplier is unable to give as much oxygen as needed, and hence he is looking for other sources. On April 22, he could get supply twice with the intervention of Health Minister Dr K Sudhakar, and was hopeful that the situation would improve. Like Prashanth Hospital, many hospitals in Bengaluru have been sending their staff to queue up in front of suppliers’ officers and get their oxygen cylinders refilled.
“Oxygen situation may improve if cases don’t surge further”
Steel plants in Bellary form the majority of oxygen manufacturers in Karnataka, in addition to some independent units. While medical oxygen requires only 93% purity, that produced in steel plants has purity of around 99%.
According to the health minister’s statements, Karnataka has the capacity to manufacture 812 tonnes of oxygen per day, including from industrial sources. But until Saturday, the Centre had capped Karnataka’s usage to 300 tonnes per day. The state’s steel plants were sending some oxygen to Maharashtra, as per Centre’s orders. But as the state’s own demand grew over the past week, it started using more. For example, in a video conference with the prime minister on Friday, Chief Minister B S Yediyurappa said the state’s use had exceeded 500 tonnes the day before. Given the rapidly increasing COVID cases, Yediyurappa requested the PM to increase Karnataka’s allocation to 1,471 tonnes per day.
On Saturday night, the Centre increased Karnataka’s allocation to 800 tonnes. With this, Karnataka may be able to manage the oxygen shortage better, provided the COVID cases don’t keep surging again, says K R Sahasranam, Vice President of AIIGMA (All India Industrial Gases Manufacturers Association).
Sahasranam says that as of Saturday, of the total production in Karnataka, around 660 tonnes was being set aside for the State’s own use. “Of this, about 250 tonnes would be for Bengaluru’s use, and around 400 tonnes would be for all other districts combined.” The biggest contributors included Air Water India Ltd, Jindal Steel Works, along with two Bengaluru-based plants Universal Air Ltd and Bhuruka Gases Ltd. (The two Bengaluru plants together manufacture about 120 tonnes, and this is used largely within the city.)
There has been a lot of movement of oxygen from Karnataka to other states, and vice versa, says Sahasranam. While Karnataka has been sending oxygen to Maharashtra, it has also been receiving 30-40 tonnes of oxygen per day from states like Tamil Nadu and Kerala. While some states had appealed to the Centre to stop export of oxygen to other states, yesterday, the Centre released a circular saying it would retain control of oxygen allocation. Allocation across state borders is not as per Centre’s orders alone, but also from procurement by individual entities. For example, Universal Air Ltd in Bengaluru manufactures only about 40 litres of oxygen, but is selling 80-90 tonnes, procuring from JSW and plants in other states.
“The current availability of oxygen in Karnataka is enough to meet the state’s needs. But COVID numbers are also going up quickly. We have to see if the numbers will come down in another week with the lockdown,” says Sahasranam. If the State actually comes to a requirement of nearly 1,500 tonnes as Yediyurappa said, it’s not clear where the oxygen can come from.
Though steel industries do manufacture more oxygen, this is in gas form and there is no mechanism to capture it, says Sahasranam. “90% of the oxygen produced in steel plants is gas, and only 10% is liquid oxygen. This is kept as a backup or for emergencies. It’s from this 10% that steel plants are now supplying oxygen – they’ve kept their own reserve stock minimal and sending the rest. At the most, they can increase production by another 2-3%, not more,” he says.
Why smaller hospitals bear the brunt
The majority of deaths in Bengaluru owing to oxygen shortage occurred in smaller hospitals. Why is this so?
There are several ways in which hospitals arrange oxygen for patients:
- From their own oxygen-manufacturing plants: Very few Bengaluru hospitals have this
- Having suppliers transfer liquid oxygen to huge cryogenic storage tanks in the hospital premises, and deliver it in gas form to patients through centralised piped supply: Only large hospitals have this facility
- Having suppliers transfer liquid oxygen to smaller transportable cryogenic cylinders (Dura cylinders usually of 250 cubic meters), and deliver in gas form through centralised piped supply: Smaller hospitals resort to this
- Directly supply of oxygen gas to patients through cylinders by the bedside: Small hospitals use this as an additional measure; it’s also used in ambulances, for stretchers, etc.
- Oxygen concentrators, a device that generates oxygen from ambient air: They are commonly used for home care, and are difficult to scale up for hospitals.
As mentioned above, big hospitals have cryogenic tanks that can store large quantities of oxygen. This makes supply easier for them compared to smaller hospitals, says Subasish Guha Roy, MD of Universal Air Ltd. “We can supply to the tanks in big hospitals at any time. Even if we reach 4-5 hours late, it’s fine because they would have buffer stock for a couple of days. But smaller hospitals have Dura cylinders which get exhausted quickly, and demand rises again. Suppose their oxygen is going to be over in 3-4 hours, it would be difficult to supply on time, given the time taken for the tanker to reach our filling station, get filled and then deliver to the hospital.”
Volunteers coordinating oxygen supply say that all hospitals have contracts with oxygen suppliers, but big hospitals also have longstanding major contracts because of which they get preference. “Suppliers don’t want to lose these major customers. Besides, big hospitals are also able to put political pressure or use government channels,” says Sabeel Nazir of the NGO Naasih Foundation.
Sabeel says this situation disproportionately affects patients from low-income groups. “Smaller hospitals with 50-100 beds are catering to the poor who are unable to get government hospitals beds and can’t afford corporate hospitals. These hospitals also fear taking in critical patients just in case they don’t get oxygen supply on time,” says Sabeel. Over the past weeks, many small hospitals, it was reported, bought oxygen from the black market at several times the actual rate.
Hosur Abdul Bari, a volunteer with the group ERT (Emergency Response Team), says they have gone to plants as far as Krishnagiri, Tumkur, Salem and Hosur to procure oxygen. “Also, the small hospitals have been helping each other. Since we work with a network of hospitals now, if one has shortage, we request cylinders from another as a favour. We are using these two options now,” he says.