By Meher Jain

In the summer of 2021, India was engulfed in an unprecedented disaster. Almost 1.6 million cases of COVID-19 were recorded in a single week, bringing the total number of cases to more than 15 million. In just 12 days, the COVID positive rate of the country increased to 17 percent, with Delhi reaching 30 percent. Hospitals around the country were overcrowded, but this time it was mostly the young who were utilising the beds; in Delhi, 65 percent of patients were under the age of 40.

The second wave of the pandemic in India  was marked by news reports of hospitals running out of oxygen. Since hospitals ran out of supplies, patients’ families rushed to arrange oxygen. Social media platforms were overrun with urgent appeals for various oxygen equipment such as cylinders, cans, concentrators, and refilling facilities. Prices for oxygen equipment had skyrocketed, with consumers spending 3-5 times more than the usual price. All of these indicators point to one thing: there was a severe shortage. However, the Government of India recently claimed that there was no shortage of medical supplies in the country during a hearing in the Supreme Court. 

Since the pandemic, India’s need for Liquid Medical Oxygen (LMO) has increased drastically. Pre-COVID LMO consumption was estimated to be at 700 tonnes per day  (TPD), according to industry estimates. In the first wave of the pandemic, this rose fourfold to 2800 TPD. The demand for the second wave grew even greater. The government’s submissions to the courts indicated that  India required 8000 TPD of medical oxygen.To satisfy this rising demand, the government launched measures to accelerate production.

On April 21, the Central government acknowledged to the Delhi High Court that India’s existing LMO manufacturing capacity was 7200 TPD, which was less than the 8000 TPD necessary. The government reported that production had been ramped up to 9000 TPD by the end of the month. This was due to the expansion of existing LMO-producing industrial units’ capability. Furthermore, the government assured that 500 oxygen plants would be built around the country in the next three months. For the time being, the per-day production is sufficient to fulfil the per-day demand.

Government statistics reported that the country did not have a shortage of LMO. However, there was still a shortage of oxygen in the hospitals. While the government was able to meet the manufacturing end of the problem, it struggled with the distribution. The  production of medical oxygen was sufficient to satisfy rising demand, and getting this oxygen to the ultimate user, i.e. the patient proved difficult.

Oxygen is initially produced in industrial units before being put into tankers in liquid form. The oxygen is subsequently transferred to distributors’ liquid tanks. Oxygen cylinders are refilled by distributors. These cylinders are then rented out to hospitals for usage by patients. This straightforward yet complex oxygen delivery mechanism amid the chaos proved rather challenging.

The industrial gas supply system, including liquid oxygen, was not ready to be switched for medicinal usage. Before the advent of COVID-19, there was just a 20% medical need for liquid oxygen. During the second wave, 90% of liquid oxygen production was redirected for medicinal purposes.

India has a total of 1919 trucks for industrial gas delivery. 516 of these 1919 trucks were used only for the delivery of liquid oxygen. There was a scarcity of tankers capable of transporting liquid oxygen from manufacturing facilities to distributors. These tankers take almost 12-14 days to travel from the oxygen-producing regions of Chhattisgarh and Odisha to the states most impacted by the second wave, Maharashtra, Gujarat, and Delhi.

In order to  expedite the process, India planned to transfer tankers via railroads and airlift empty tankers back to manufacturing plants. However, within a week of the Ministry of Railways shipping oxygen, it was able to move a little more than 450 metric tonnes of oxygen. It was all distributed to the states of Maharashtra, Uttar Pradesh, and Delhi.

To put the quantity carried into context, Maharashtra alone required 1550 TPD of medical oxygen to satisfy its needs. The requirements for Delhi were projected to reach 700 TPD. One oxygen tanker typically has a carrying capacity of 14-18 metric tonnes. This limited capacity also contributes to the supply chain bottleneck. Whilst states and the central government attempted to organise more tankers, prominent hospital groups Apollo, Fortis, and Max petitioned the courts to refill their supply. However, there was widespread inequality in the allocation of LMO because large hospitals received the lion’s share, whereas smaller facilities relied on pleas.

While there might not have been a  shortage of oxygen in the country, there was a shortage in the country’s hospitals. The liquid oxygen supply chain was unprepared to provide rapid oxygen for medicinal usage. As a result, individuals died while awaiting the most basic medical care. The government demonstrated a lack of foresight. The centre authorised the construction of 162 oxygen plants in public health facilities in 2020, but only 33 of them are operational. Many fatalities could have been averted with planning and preparation.

To prepare for the future, the central government discreetly changed its method to determine oxygen requirements The average oxygen demand for a patient admitted to an Intensive Care Unit was increased from 24 to 30 litres per minute on June 21 by the National Health Mission. This was done on the advice of the Directorate General of Health Services, which is part of the Ministry of Health.

The number of patients who may need oxygen in the future has also been increased upward by the central government. On July 13, 2021, it sent a letter to all states requesting that they prepare for the third wave of Covid-19 by planning for 1.25 times the number of cases seen during the second wave’s peak. Later that day, an addendum letter was sent out with a case estimate that was 1.5 times higher than the second wave. The Centre has ordered the state governments to prepare for the third wave, expecting that 23% of all Covid-19 patients will need to be admitted to the hospital. Hospitalization was estimated to account for 20% of all cases in 2020, according to a letter dated September 25.

India was engulfed in an unprecedented disaster in the summer of 2021. As hospitals ran short of oxygen, victims’ relatives scrambled to make arrangements. All of these signs point to the same conclusion: there was a major oxygen shortage. India’s lack of preparation for the second wave resulted in this shortage. However, preparations for the anticipated third wave have already begun.

The views expressed in this article are the author’s own, and may not reflect the opinions of The St Andrews Economist.