As a result of a mammoth surge in cases during a catastrophic second wave of COVID-19, Indian citizens are now scavenging for medical facilities and access to critical medication and equipment to curtail the severe symptoms of the deadly new strain of the virus. What comes as a shock is that, despite India being one of the largest producers of oxygen, several hospitals across the country facing oxygen shortages, which in New Delhi’s Jaipur Golden Hospital and Sri Ganga Ram Hospital respectively caused 20 and 25 deaths. Against this backdrop, it becomes crucial to ask whether India could have avoided or at least mitigated this catastrophe through better planning and forecasting by central and state authorities.
With several states reporting severe shortages of oxygen supplies, the central government has stepped up to introduce a number of new measures. To begin with, it has allocated funds to set up 551 dedicated Pressure Swing Absorption Medical Oxygen Generation Plants, which help separate atmospheric gases and create concentrated oxygen. It has also set up “oxygen express trains” with the specific aim of transporting liquified oxygen. This helped Delhi, one of the worst-hit cities by both the second wave of the pandemic and the oxygen shortage, acquire 70 MT of medical oxygen from Raigarh. The government has also suspended the commercial use of liquified oxygen and ordered that all supplies be used for medical purposes, which successfully increased oxygen supply by 3,300 MT. Moreover, it has also used its diplomatic relations to secure 50,000 MT of oxygen from the United States, the United Kingdom, the European Union, and Saudi Arabia.
However, there is a compelling argument that instead of resorting to such reactionary measures, Indian authorities, both at the centre and state level, could have pre-empted this calamity. The signs of this impending crisis were visible from a distance and Indian authorities should have learnt from the experience of other countries, such as Jordan, Mexico, and Egypt, where oxygen shortages hampered their ability to curb the spread of COVID-19.
In fact, India even has its own experience from the first wave to learn from. In mid-September, when India was reporting 90,000 new cases every day, several states were facing oxygen shortages. During the first wave, 54.5% of hospitalised patients reportedly required access to oxygen. Moreover, several experts, such as Bhramar Mukherjee, a biostatistician at the University of Michigan, had repeatedly called upon Indian authorities to use the period between the two waves when there was a drop in cases to ramp up oxygen production and storage.
However, these warning signs of an impending crisis were ignored by political leaders, who continued to participate in large-scale election rallies and even signed off on massive religious gatherings. In fact, in March 2021, even as Maharashtra was reporting a surge in cases and was witnessing a three-fold increase in the weekly infections as compared to February, the Indian Union Health Minister Harsh Vardhan boldly proclaimed that India was in the “end game” of the pandemic.
While calling for the 68-day long lockdown last year, the government justified its decision by citing the need to strengthen medical capabilities. However, despite showing some success in ramping up healthcare infrastructure, stocking up on ventilators, and producing PPE kits, it failed to enhance its oxygen production capabilities. In fact, it was only around eight months later, on October 21, 2020, that the Union Ministry called for tenders to set up Pressure Swing Oxygen plants in 150 hospitals across the country.
This delay is particularly concerning because the authorities had both the ability and the capacity to set up these plants much earlier. In January 2021, according to the release by the prime minister’s office, Rs. 201.58 crore from the PM Cares fund was allocated for the construction of 162 Pressure Swing Absorption plants. While this decision was welcome and much-needed, it must be asked whether the PM Cares fund, which received over Rs 3000 crore in donations within just five days of being set up in March 2020, could have taken this step earlier. Owing to this delay, at this stage, merely 11 plants have been installed and just five are operational. Given the time required to set up these Pressure Swing Absorption plants, the government could have installed small-scale oxygen generation plants in the interim, which take just 4-5 weeks to set up, with each plant requiring roughly Rs. 1.25 crore for construction. Considering that India has over six years of experience in the construction and installation of oxygen plants, it is clear that state and central authorities could have better utilised the country’s strong oxygen production capabilities more effectively in order to avoid the current disaster.
It is telling that the regions of the country that did take such a pro-active approach have been much more successful in containing the virus. For example, authorities in Kerala closely monitored the rise in demand for oxygen during the first wave and duly scaled up production to increase the state’s capacity from 148 MT to 199 MT. As a result, Kerala currently faces no shortage of oxygen supplies and has in fact been supplying surplus oxygen to neighbouring states, including Karnataka and Tamil Nadu. Another example is that of Madurai, where the district authorities enhanced their storage facilities from 6000 litres to 20,000 litres, through which they are now able to provide 700 additional oxygen beds to patients. Hence, if such measures had been undertaken on a large scale, India could have enhanced its capacity to mitigate the impact of the second wave.
Furthermore, the central government also failed to use its powers under the Natural Disaster Management Act to take control over oxygen production and distribution. Oxygen is not a controlled commodity, meaning that hospitals and governments could have entered into independent contracts to secure supplies. As a result, several states with oxygen production plants have adopted a protectionist approach and urged production plants to meet local demand on priority. This has, for example, enabled states like Haryana and Rajasthan to block oxygen supplies from reaching Delhi as they continue to struggle to meet their own local demand. According to reports, Delhi is only receiving 177 MT out of the 378 MT that it had signed contracts for.
More concerningly, unregulated distribution has also resulted in several private actors, including distributors, hoarding oxygen cylinders and illegally selling them at exorbitant prices. Hence, a 100-litre oxygen cylinder, which originally cost Rs. 4,500-5,000, is now officially priced at over Rs 8,000. Moreover, there have been reports of families of patients paying up to Rs two lakh to procure two oxygen cylinders after being unable to secure them through government-owned or private distribution facilities.
That being said, the central government is not solely responsible for these shortages. State authorities also failed to pre-empt the severity of this crisis and have been unable to establish reasonable timelines and distribution networks to account for this surge in cases. For example, Delhi receives oxygen supplies from seven states, with some even situated over 1,000 kilometres from the capital city. Consequently, the state authorities should have accounted for the delays in transportation, especially considering that liquid oxygen can only be transported in a certain type of container that can only travel at a maximum speed of 45 kilometres per hour. Hence, expecting oxygen supplies to arrive overnight while the entire country faces an oxygen shortage is short-sighted and highlights authorities’ lack of preparedness.
Admittedly, there are certain situations that no country can predict and the highly transmissible and damaging nature of the new variant could suggest that India would have had to deal with a severe second wave regardless of however well it prepared for such an eventuality. Nevertheless, centre and state government authorities clearly failed to adequately heed the warning signs of experts, data, and the experiences of other countries. There are concerning reports that if everyone is not vaccinated by the end of the year, then the virus could have mutated to a point where current vaccines no longer work. Therefore, given the fact that a large proportion of India’s population remains unvaccinated, authorities must prepare for a possible third wave of COVID-19 cases by increasing oxygen production, storage, and distribution capacities, enhancing response capabilities, and expanding distribution networks. Failure to do so may cause untold economic and social consequences that could take years to overcome.
How Could India’s Oxygen Shortage Have Been Avoided?
India’s oxygen shortage is primarily because of the inability of the Indian authorities to pre-empt the impending crisis and take precautionary measures to mitigate the impact of this deadly wave.
April 29, 2021
SOURCE: FINANCIAL TIMES