Crisis that left India breathless


In the midst of the mist created by fake news and rising Covid cases, the Central Government acted with alacrity to address the surge in oxygen demand. By second week of May 2021, it undertook a plethora of key measures to increase the availability, streamline the distribution and strengthen the oxygen storage infrastructure in the country. Kriti Kalra traces how the situation was tided over and the country could breathe easy again.

The second wave of the Covid-19 infection in India was marked by the acute shortage of oxygen that became a priced commodity overnight due to the manifold rise in oxygen demand for both medical facilities and for home treatment of patients.

With the deepening crisis, government entities such as the Ministry of Power, Ministry of Railways, etc., undertook proactive measures to address the situation. Several stories surfaced where quick thinking administrative officers warded off the crisis in their respective zones by taking swift measures.

During the national crisis, the Fake News factory regularly churned out unsubstantiated, misleading and wrong news. So the government machinery had to work overtime to ensure fake news circulated irrationally among the masses was countered with facts to prevent panic and distress among members of the public.

The importance of medical oxygen

Liquid Medical Oxygen (LMO) is high purity oxygen used for medical treatments and suitable for use in human body. LMO is extensively used in medical procedures as it provides a basis for almost all modern anaesthetic techniques. This oxygen also restores tissue oxygen tension as it increases the availability of oxygen thereby helping in maintaining cardiovascular stability.

A Ministry of Health and Family Welfare (MoHFW) explainer issued in May 2021 elaborated the use and significance of LMO for Covid-19 treatment. It read, ‘Oxygen is crucial for the treatment of patients with severe Covid-19, since the disease affects lung functioning. Shortness of breath or difficulty of breathing is one of the most common symptoms in patients with severe Covid-19. It also hampers the supply of oxygen to various parts of the body. They hence need oxygen therapy to be supplied through medical oxygen. One of the ways in which this oxygen can be supplied is through Liquid Medical Oxygen (LMO).’

The World Health Organisation (WHO) includes LMO on their List of Essential Medicines. The Drug Prices Control Order, 2013 also places LMO under the National List of Essential Medicines (NLEM).

India’s manufacturing prowess

The most common production method is separation of oxygen in what are known as Air Separation Units or ASUs that are plants that separate large volumes of gases by using the Fractional Distillation Method. The process produces pure oxygen from atmospheric air, which consists mostly of nitrogen and oxygen – 78 per cent nitrogen, 21 per cent oxygen and remaining one per cent other gases including argon, carbon dioxide, neon, helium and hydrogen.

India’s daily oxygen production capacity is around 7127 Metric Tons (MTs). Starting April 2021 when the second wave intensified, surplus oxygen available with steel plants was also being utilised for treatment. During the crisis, the production was increased to 8,922 MTs and was set to go even higher to address the situation.

According to a release by the Ministry of Steel on 25 April 2021, Public Sector Undertakings under the Ministry of Steel and other private companies in the steel sector were ramping up efforts to supplement those of the government in making available Liquid Medical Oxygen.

Total daily medical oxygen production capacity of Steel plants in India is 2834 MT. As against 2834 MT of daily LMO production capacity in the steel sector, the production of LMO was 3474 MT as reported on 24 April 2021.With all these efforts, 2894 tonnes were dispatched to different states on 24 April by Steel Plants in Public & Private Sector as against 1500/1700 Metric Tonnes/Day a week earlier.

The average delivery of Liquid Medical Oxygen by SAIL has been raised to more than 800 tonnes per day that has been continuously enhancing LMO supply. In the last FY 20-21, Vizag Steel had supplied 8842 ton of LMO. This FY, between 13 April and 25 April 2021, more than 1300 ton of LMO was dispatched and the first Oxygen Express left Vizag Steel Plant site on 22 April 2021 for Maharashtra carrying 100 tons of LMO to meet the need there.

The reality of the crisis

According to government reports, on 12 April 2021, the medical oxygen consumption in the country was 3,842 MTs that is 54 percent of the daily production capacity. The maximum consumption of medical oxygen in the country is by states of Maharashtra, Gujarat, Madhya Pradesh, Uttar Pradesh, Karnataka, Tamil Nadu, Delhi followed by Chhattisgarh, Punjab and Rajasthan.

The country was producing sufficient oxygen to meet the need of the hour. The ‘crisis’ was triggered by a shortage of oxygen carrying tankers and the overwhelming logistics that came into play for transportation of LMO from distant locations to the second wave hotspots.

On 24 April 2021, several hospitals in Delhi made frantic calls seeking emergency supplies of oxygen. The state does not have sufficient in-house production capacity. At the time, the country was struggling to use all means including air, road and train transport to move medical oxygen to hospital in Delhi that was one of the worst-hit during the second wave.

According to experts, the main hindrance in the supply of LMO was not shortage of oxygen but the logistics that delayed the supply of medical oxygen to hospital beds in time. The distance of production units from Covid hotspots was very large and the distribution network was already stretched delaying the supply chain. Other factors included limited tankers, companies not buying cryogenic tankers, oxygen leakage, black marketing of cylinders and irrational use.

Additionally, with the spread of Covid-19 infection to neighbouring oxygen-producing states, the demand-supply equilibrium got affected as the local demand for oxygen increased multi-fold.

In Maharashtra, Chief Secretary Sitaram Kunte wrote to Union Cabinet Secretary Rajiv Gauba and demanded ‘at least 200MT more liquid oxygen for Maharashtra as 16 districts saw continuous rise in Covid cases. The Centre had allocated 1,814MT medical oxygen to the state of which 1,650 MT had been received.

Proactive government initiatives

To address the surge in oxygen demand, by the second week of May 2021, the Central Government had undertaken several key measures ‘to increase the availability, streamline the distribution and strengthen the oxygen storage infrastructure in the country.’ The steps focussed on the entire oxygen supply chain that included ‘efforts for improving oxygen production, enhancing tanker availability to optimise logistics, improving oxygen storage at the last mile and easing norms of procurement.’

Oxygen production increased from 5,700 MT/day in August 2020 to 9,446 MT/day in May 2021. The production capacity increased from 6,817 MT/day to 7,314 MT/day and the capacity utilisation shot up from 84 per cent to 129 per cent during this period.

Keeping up with the increase in production and demand, LMO sale in India also increased from about 1,300 MT/day in March 2021 to 8,920 MT/day on 6 May 2021. The maximum sale of 3,095 MT/day of LMO during the first wave happened on 29 September 2020. LMO sale grew from 1,559 MT/day on 31 March 2021 to over 8,000 MT on 3 May 2021 – a more than five-fold increase.

The Ministry of External Affairs (MEA) spruced up efforts to secure oxygen from overseas. Till 10 May 2021, 50,000 MT of Liquid Oxygen was being imported from overseas and orders and delivery schedule for 5,800 MT was finalised. LMO was imported from many nations including UAE, Bahrain, Kuwait and France and several Oxygen Concentrators were also procured. Tanker availability was improved too – The capacity and number of tankers increased from 12,480 MT and 1,040 in March 2020 to 23,056 MT and 1,681 respectively.

Efforts by local, state and central government entities in ensuring unrestricted movement of medical oxygen between states and removal of restrictions on oxygen manufacturers and suppliers also helped in ensuring LMO reaches one and all.

Kriti Kalra

Kriti Kalra is an activist and field researcher with – an initiative of DraftCraft International to protect and empower women by bringing on one platform the latest on rights and issues, strategic case studies, state initiatives and informed legal opinions

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