COVID 19 APOCALYPSE - OXYGEN CONUNDRUM - THE LESSONS LEARNT

 A lot has been manifested about the grim battle between that the Indian healthcare system and COVID in the year 2021. The second bout came with newer and unimaginable implications of the disease, which has left numerous ineradicable impressions. The most precarious conversation has definitely been about the medical oxygen and the sense of predicament around it.

Social media and news channels reported numerous instances of worried relatives of the COVID-19 patients in hospitals trying to enter the ICUs to check if their family member is being provided oxygen supply or not. Further, not only individuals but even hospitals were posting SOS messages on social platforms asking for help in replenishing the fast-depleting oxygen supply.

As compared to approximately 10 million getting infected in over 10 months during the first wave, the country witnessed more than 11 million being infected in just 10 weeks during the second wave. This sudden rapid rise in daily number of cases resulted in a massive demand for oxygen for treatment, and immediate lack of supply created an emergency situation in the country. What followed was a lot of disarray and turmoil, eventually being overcome by stupendous sacrifices and decisive innovations.

But it is important for the country to understand what led to the conundrum, how we overcame it and what we need to do to be better prepared for a third bout with COVID.

Factors exacerbating the Crisis situation

The country has been fighting continuously and relentlessly against the virus since its outbreak in early 2020. Interventions like extended lockdowns, stringent health safety measures, fast-tracking the vaccination rollouts, etc., had put India in a relatively better position as compared to many other countries across the world. However, the mammoth crisis of the second wave sweeping across the nation, blew all our learnings into the wind.

Some of the major factors that created a sense of panic during the second wave included:

Oxygen demand-supply mismatch: The impact of the second wave was much more widespread, hitting different regions almost simultaneously. This raised an abrupt and urgent demand for oxygen across different geographies almost at the same time. Further, the oxygen production is disproportionately spread across India with about 70% of the supply concentrated in the eastern and western part, 20% in southern, and 10% in the northern region. And the most number of infected cases were being reported from the north. With news of oxygen shortage amidst rising number of critical cases spreading like wildfire, people began panic buying of oxygen cylinders and machines like oxygen concentrators even when not required, which added pressure to the already depleting stock.

Inadequate cryogenic infrastructure: The existing liquid oxygen supply chain network faces many challenges, including inadequate number of oxygen tankers for moving oxygen from distant production facilities to meet the demand across different regions. Also, where a hospital would usually require a weekly refill from a 1000-liter tank, the demand spiked to a refill on a daily basis, putting immense pressure on the supply chain.

Less-equipped healthcare infrastructure: The healthcare infrastructure was not prepared to meet the sudden surge in critical cases that required oxygenated beds, especially in case of a prolonged stay. Hospitals in both public and private sector were found lacking the resources to cater to unexpected increase in oxygen consumption.

Nation Unified by a Single Objective: Dealing with the Oxygen Crisis

While the second wave brought to the surface the stark inadequacies in our resources and strategies to deal with the challenges of the pandemic, the stakeholders – the Government, the states, corporates, individuals, and our allies from across the world came together to offer resilient support and assistance.

Role of the government: The 6 empowered groups established in early 2020 to deal with the various challenges of the pandemic reconstituted into ten groups to tackle the issues arising in the second wave. Additionally, the Commerce Ministry adopted game changing strategies, including utilizing industrial oxygen as medical oxygen, converting the nitrogen and argon tankers into oxygen tankers thus increasing the number of cryogenic tankers by 50%, utilizing all available resources to hasten the supply of oxygen, etc. The state-owned steel plants reduced their safety stock from 3.5 days’ worth of oxygen to 0.5 day to help reduce the oxygen shortage.

Commendable feat by the Indian Railways that launched “Oxygen Express” to transport oxygen tankers from farthest parts of the country to places in need.

The Indian Air Force (IAF), Indian Railways, Indian Army, Navy, and the State Police, all pooled their resources and collaborated their efforts to ensure ease of movement of oxygen, setting up of medical facilities, storage facilities, green corridor, etc. The Supreme Court set up a National Task Force to ensure effective and transparent allocation of liquid medical oxygen across the country.

Private sector: The steel Industry pitched in by increasing the country’s output by 30% in just one month. Also, within the healthcare sector, not only the frontliners but “back in the line” workers like ambulance drivers, oxygen tank drivers, etc. worked 24/7 to help in oxygen reaching the patients.

Rest of the World: Countries including the UK, the US, Russia, and China assisted with medical supplies such as raw materials needed for vaccines, critical COVID-related medical supplies, oxygen generation equipment, and an enhanced capability for smoother transportation and storage of oxygen.

Prepare Proactively

The past few months have taught us some highly vital lessons to meet any furtue waves in a more streamlined and effective manner. The need of the hour is to strengthen the country’s last mile cryogenic infrastructure. As ASUs take years to set up, reinforcing storage facilities is essential to meet the oxygen requirements at the farthest parts of the country. Moreover, we need to lay down viable strategies to increase the storage capacity at district level, such as the Hub and Spoke model. Also, it has become important to enhance state-wise fleet of cryogenic tankers to meet the sudden demand to transport oxygen across geographies. Lastly, the healthcare system needs to be encouraged be judicious in its use of oxygen through  regular audits.

While the second wave tested the nation’s prowess and we proved the mettle in the end, the brutality of it highlighted some major bottlenecks and shortcomings in our existing action plan to fight the pandemic. However, having learnt our lesson, the hard way, we are geared up to face the next wave. The key to combating this virus is to accelerate mass vaccination efforts as we believe 

More Vaccination = Less Need of Oxygen.