In September, as the number of Covid-19 cases in India continued to surge, hospitals in various states began to run out of oxygen.

That month, the number of new Covid-19 cases hit an all-time high, accounting for 41.5% of the total coronavirus cases reported in the country since the start of the pandemic. Though the graph has since trended downward, experts have warned that the country needs to be prepared for fresh spikes and more waves of the virus.

As hospitals began to run short on oxygen, so did the industrial sector.

Sectors such as steel, glass and pharmaceuticals require industrial oxygen for their production processes. But in September, as the demand for medical oxygen shot up to 3,000 metric tonne per day with the coroanvirus surge, India’s supply of oxygen was diverted for medical use – even as the country’s capacity to produce the gas stayed the same, said Rajeev Gupta of the All India Industrial Gases Manufacturers’ Association.

Before the pandemic struck, India had the capacity to manufacture 6,400 metric tonnes of oxygen daily, according to the health ministry. Out of this, the daily consumption of medical oxygen would normally be less than 1,000 metric tonne.

“Our primary concern was to meet the medical demand,” Gupta said.

The demand for oxygen for industrial purposes is usually stable and is nearly 70% to 80% of the production capacity, said RS Sachdeva of Hitech Industries, an oxygen manufacturer in Punjab.

The diversion of this for medical purposes meant that some industries faced production losses, he said. “Those who needed just one or two cylinders managed but those who had more requirements, and got cylinders in bulk were not able to get oxygen,” said Sachdeva.

Use of oxygen

As of October 29, India has recorded a total of 8.04 million cases of the novel coronavirus. While there has been a decline in the number of cases recorded for a few days since mid-October, experts have warned of a surge in infections as the festive season begins.

This could impact the availability of oxygen. All of India “is starving for medical oxygen”, said Anthony Joseph of Manorama Gases in Kerala. “Whatever we produce will not be sufficient for all states.”

To meet the current needs and possible spike in demand during the winter months, the Union Health Ministry floated a tender on October 14 through HLL Life care, a public sector undertaking, inviting bids for the procurement of 1 lakh metric tonnes of liquid oxygen for hospitals run by the Centre and states.

Medical oxygen is used in Covid-19 treatment to address breathlessness caused by a dip in oxygen levels.

In a press briefing in April, Dr Randeep Guleria, director of All India Institute of Medical Sciences, said that around 15% of all coronavirus cases in India could be treated with supportive care and oxygen therapy, while less than 5% would require ventilator support and critical care.

In May, reported how the epidemic had sparked a rush by district hospitals to stock up on oxygen cylinders after the Minister of Health and Family Welfare had asked states and Union Territories to maintain adequate supplies.

In a press briefing that month, the ministry said India had capacity to manufacture 6,400 metric tonnes of oxygen daily of which 1,000 metric tonnes was used as medical oxygen.

At the time, the demand for medical oxygen was low but manufacturers said they were equipped to produce greater quantities if the demand rose. Importing oxygen did not seem necessary.

However, in the last six months, the number of Covid-19 cases have increased significantly and this has led to shortages in oxygen.

A medical worker checks an oxygen cylinder at the Jawahar Lal Nehru Medical College and Hospital in Bhagalpur, Bihar on August 12. Credit: Danish Siddiqui/Reuters

‘Heavy shortage’

Why is India planning to import such a large amount?

In September, India recorded more than 26 lakh new coronavirus infections – and also a shortage of oxygen.

Joseph said that “heavy shortages” had been reported from various states. Another manufacturer, RS Srikrishnan of Popular Carbonic, an oxygen manufacturer in Kerala, said that shortages had been reported in some parts of Maharashtra, Karnataka, Tamil Nadu and Kerala.

There was a shortage reported in Punjab as well, said RS Sachdeva of Hitech Industries. “It started at the end of August and continued till September,” he said.

Joseph said that the consumption of medical oxygen went up five to eight times since it began to be used to treat Covid-19.

But there were other factors at play as well. ome manufacturers claimed that the shortages occurred because oxygen plants had been running continuously since the lockdown, without shutting down for their annual maintenance. Joseph said that some plants had a breakdown and were under maintenance.

The massive spike in demand, and production issues at some plants, are not easy to address because increasing capacity for production of oxygen is not simple. It takes at least two years to set up new manufacturing units to pump out the gas, making imports necessary in the short run. Doing so ensures there is sufficient supply for industries as well as hospitals.

“If the government depends on our capacities [for oxygen that can be used medically], then industrial productivity gets affected,” Sachdeva said. “It is happening in many states like Maharashtra, Punjab. The government wants a [medical oxygen] buffer to be available.”

Availability of medical oxygen

The Union health ministry stated that on September 1 it had recorded a total of 43,022 patients across the country who were on oxygen support. This number grew gradually and shot up to 75,098 cases on September 25. On October 1, this figure decreased marginally to 72,575 and fell gradually to 57,357 cases on October 19.

The screenshot of the number of Covid-19 cases on oxygen support from the Union health ministry's press briefing on October 20.

The ministry added that between September 2 to September 8, 2,397 metric tonnes of medical oxygen per day was supplied throughout the country. The demand rose to 2,791 metric tonnes per day between September 9 to September 15 and decreased gradually to 2,503 metric tonnes per day between October 6 to 14. By then, the ministry said that its medical oxygen stock was 17,103 metric tonnes.

Furthermore, it added that the oxygen production capacity increased from 5,913 metric tonnes on a daily basis in April to 6,862 metric tonnes daily in September. It aims to increase the capacity to 7,191 metric tonnes in October. The ministry said that it expects the number of cryogenic oxygen tanks installed in hospitals to be increased from 606 in April to 775 by the end of October.

On the availability of infrastructure, the ministry provided a comparison for the number of oxygen-supported beds, ICU beds and ventilator beds that were created as on October 19 since April.

In April, there were 57,924 oxygen-supported beds and this number increased to 265,046 in October. There were 23,815 ICU beds in April and 77,136 ICU beds in October that are connected with oxygen supply. The number of ventilator beds increased from 11,993 in April to 39,527 in October, the ministry stated.

The data on the number of oxygen supported beds available as per the health ministry's press briefing on October 20.

This reporting was supported by a grant from the Thakur Family Foundation. Thakur Family Foundation has not exercised any editorial control over the contents of this article.