Covid-19 and the Medical Oxygen Predicament

The demand for medical or supplemental oxygen has grown exponentially since the start of the pandemic. Why is it so crucial in tackling Covid-19?

On 23 April, as India continued to battle a virulent second outbreak of Covid-19, 25 patients died in a hospital in the national capital due to low oxygen pressure. Similar incidents followed in Haryana and Chandigarh, all allegedly due to a shortage of medical oxygen. 

The demand for medical or supplemental oxygen has grown exponentially since the start of the pandemic, and with the increasing rate of daily infections, it shows no signs of slowing down. But why is it such an important component in tackling Covid-19?

Oxygen therapy is the treatment by which is oxygen is delivered to a patient who finds it difficult to breathe. Some patients with Covid-19 experience low oxygen levels in their blood due to lung damage and to maintain optimum levels, they have to be given a purer and concentrated form of the gas.

Medical oxygen has always played a prime role in healthcare, especially in the treatment of lung diseases. It is on the World Health Organisation’s list of essential medicines. What is unprecedented is the all-time high demand for it from medical institutions around the globe during the pandemic. India particularly has been left in the lurch due to lack of this humble medicine.

The origin

The scientific community has still not reached an agreement as to whom to credit with the discovery of Oxygen – the English Chemist Joseph Priestley who published his findings in 1774 or the Swedish chemist Wilhelm Scheele who is said to have discovered it years before in 1771. It took a couple of decades more for its use in medical treatment to begin.

In 1798, the gas was used for the treatment of asthma, congestive heart failure and other ailments, and by the 1850s, several scientists had noted its use in relieving breathing difficulties caused by pneumonia and other chronic lung diseases. In 1885, physician George Holtzapple was the first to use it to manage a young patient with pneumonia. The first cylinders for storing oxygen were developed in 1868, and by 1917, the use of medical oxygen in healthcare had become widespread.

The global shortage

While the shortage in India is critical, it isn’t the only country dealing with an oxygen supply crisis. According to several reports, the global medical oxygen supply was already strained. 

Health facilities in low and middle-income countries have an inconsistent supply of the gas or lack it entirely. Low and middle-income countries currently need around 9,000,000 cubic meters of oxygen every day, reports suggest.

Hospitals in developed countries like the US, Canada and the UK also faced a crunch when they struggled with high infection rates. Medical professionals from across the world have been seen imploring on social media for oxygen cylinders over the course of the pandemic.

However, the shortage crisis is more than a demand versus supply problem; it’s also a logistics problem.

Take the case of India. Even if the supply of medical oxygen manages to meet demand, there aren’t enough cylinders and tankers to store and transport it.

Then, there is the issue of moving it across states. Oxygen, when transported from one state to another, can take several days to reach. Hospitals in remote locations are at a further disadvantage.

The state of Kerala, however, is an exception. According to recent reports, Kerala’s oxygen production is at 199 metric tonnes per day (MTPD), while its domestic demand currently stands at 35 MTPD. This surplus is what makes the state unique. It is, at present, the only state capable of exporting supplies to other oxygen-deprived states like Tamil Nadu, Goa and Karnataka.

The setting up of a 70-tonne-a-day day oxygen plant in October last year is one of the prime reasons behind this surplus. Officials in the state have reiterated that they had anticipated a rise in demand last year and the plant was set up to meet this need.

The medical oxygen market

A report published on grandviewresearch.com has stated that the global medical oxygen concentrators and cylinders market size was valued at USD 2.9bn in 2019 and is expected to grow at a compound annual growth rate (CAGR) of 4.2 per cent between 2020 and 2026.

The report pointed out that the market is directly affected by the Covid-19 outbreak as most of the critical cases of the disease require some form of artificial ventilation. 

Hoarding, wastage and black market 

In India, reports have pointed out several instances of families holding on to and refusing to part with ‘spare’ cylinders. Hoarded during this period of panic as a safety measure, they end up being wasted and unused, meanwhile those with real need are denied access to what could potentially save their lives. 

Oxygen wastage at hospitals due to poor infrastructure and bad piping facilities which cause leakage is another cause of concern. India’s Health Ministry has advised against the unnecessary use of oxygen and has directed that only those Covid patients with oxygen saturation levels below 94 per cent should be put on oxygen support.

Then comes the age-old problem of black markets. The sale and purchaser of medical oxygen in the black market are proving to be a huge challenge for the country during these hours of crisis. Understandably, with the current state of affairs, there is no dearth of buyers. According to recent reports, the average cost of a cylinder is currently around Rs 25,000 in the black market. Together, it paints a grim picture, and as always, the poor and the marginalised bear the brunt of being denied basic facilities that come with high price tags.

Then comes the age-old problem of black markets. The sale and purchaser of medical oxygen in the black market are proving to be a huge challenge for the country during these hours of crisis. Understandably, with the current state of affairs, there is no dearth of buyers. According to recent reports, the average cost of a cylinder is currently around Rs 25,000 in the black market. Together, it paints a grim picture, and as always, the poor and the marginalised bear the brunt of being denied basic facilities that come with high price tags.

What’s the way forward?

As medical oxygen is one of the most essential medicines for emergency Covid-19 care, gas companies and industrial and medical gas suppliers around the world are doing their best to improve supplies.

The Indian government, as part of its efforts to bring the situation under control, has now banned the supply of oxygen for industrial purposes, except for nine specified industries. 

To cater to the high demand, the railways has introduced Oxygen Express trains to transport liquid medical oxygen cylinders across the country, while Maharashtra Chief Minister Uddhav Thackeray has suggested airlifting oxygen supply from one state to another.

Meanwhile, hospitals are improving the capacity of their storage tanks to store supplies for over a week.

Read: What Links Climate Change and Covid-19

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