On April 21, India had three times more liquid medical oxygen available in the storage tanks of steel plants than the cumulative demand from 12 States with high COVID-19 case load, according to papers filed by the Union Home Ministry in the Supreme Court earlier this week.
Ten days after this assessment, hospitals in Delhi, Uttar Pradesh, Haryana and other States continue to complain of shortage of oxygen supply with relatives of patients sending distress calls for cylinders as hospitals ran out of beds.
Around 16,000 metric ton liquid oxygen for medical use was available in storage tanks of steel plants on April 21, though on April 20, the demand from 12 States with high case load including Delhi, cumulatively stood at 4,880 MT.
According to an assessment by the Delhi government on an average, a patient occupying an oxygen bed requires 10 litre oxygen per minute and those in the ICUs require 24 litre oxygen per minute.
India so far only has 1,224 tankers with a capacity of 16,732 MT to carry medical oxygen. The government is in the process of manufacturing more cryogenic tankers, with some foreign countries also sending such tankers on lease through commercial agreements.
The disbursal of medical oxygen has been taken over by an empowered group of officers under the Central government through an order issued under the Disaster Management Act. Though the empowered group was constituted in September 2020, the mapping exercise of availability was done in meetings from April 11-14, at the height of the crisis.
“….Apart from the current generation of liquid medical oxygen, the steel sector has made available the liquid oxygen in its storage tanks for medical use [approximately 16,000 MT LMO is available as on April 21]. ….Till date the steel industry has supplied 1,43,000 MT of LMO since September, 2020. As such, in April 2021, supplies of LMO by the steel sector have increased from 1000 MT per day in the first week of April 2021 to around 2600 MT on April 21,” the Ministry said in an affidavit.
Steel plants use oxygen in gaseous form but they can also produce a specific quantity of liquid oxygen for medical use. Steel plants are the main suppliers of medical and industrial oxygen in India.
Guidelines on judicious use
The affidavit also includes guidelines on “judicious use of oxygen” by the Union Health Ministry issued on April 22 that claims that out of 100 COVID-19 patients, only three require admission in the ICU and around 17 with “moderate disease” will need oxygen beds.
The Health Ministry asked States to ensure that the “flow of oxygen should be adjusted to the lowest permissible level to target an oxygen saturation of 92%-94% for the hospitalised COVID-19 patients”.
It warned hospitals of indiscriminate use of non-invasive ventilation methods on patients and said Bilevel Positive Airway Pressure (BIPAP) should be preferred to High Flow Nasal cannula (HFNC) as the latter consumes enormous amount of oxygen.
