How grave is India’s oxygen emergency? Worse than the government admits

The past 48 hours have seen an escalation of India’s oxygen emergency.

On Thursday, major hospitals in the national capital nearly ran out of oxygen for the third consecutive day. Oxygen cylinders were looted in a Madhya Pradesh town. Uttar Pradesh put restrictions on individual purchase of oxygen cylinders at a time when breathless Covid-19 patients have been unable to find hospital beds. An oxygen leakage in Maharashtra left 22 patients dead. States traded charges over oxygen blockades.

In the dramatic late night hearing on Wednesday, precipitated by a top private hospital in Delhi pleading that it had just two hours of oxygen left, the Delhi High Court ordered the Central government to deploy paramilitary forces to provide safe passage to oxygen tankers headed to the capital.

Why has India’s oxygen crisis turned so grave?

Just a week ago, the Central government had said India was consuming less than 60% of its daily oxygen production for medical use.

“The country has a daily production capacity of 7127 MT [metric tonnes] of oxygen per day,” said the health ministry in a press statement on April 15. “On 12th April 2021, the medical oxygen consumption in the country was 3842 MT [metric tonnes], that is 54 percent of the daily production capacity.” Additionally, the ministry claimed there were stocks in excess of 50,000 metric tonnes.

What then explains the desperate pleas from hospitals and state governments requesting oxygen from the Centre?

Demand outstrips supply

For one, the actual availability is more complicated than what the binary of production and requirement suggests.

India’s total daily production of oxygen is 7,127 metric tonnes. A bulk of this is produced in dedicated cryogenic air separator units that manufacture oxygen of high purity. The science behind these plants is simple: ambient air is cooled such that nitrogen and oxygen, the two main constituents, separate based on their boiling points.

But not all the oxygen produced by cryogenic air separator units is meant for medical use. A significant part is earmarked for industrial use.

On April 18, the Central government prohibited manufacturers from supplying oxygen for non-medical use, but exempted nine industries: ampoules and vials, pharmaceuticals, steel plants, petroleum refineries, nuclear energy facilities, oxygen cylinder manufacturers, waste-water treatment plants, food and water purification – process industries that require uninterrupted operation of furnaces.

These nine industries use around 2,500 metric tonnes of oxygen, according to an official at the Petroleum and Explosives Safety Organisation, who spoke on the condition of anonymity. The organisation, part of the department for Promotion of Industry and Internal Trade under the Commerce and Industries Ministry, is monitoring the distribution of oxygen in the country.

Effectively, this leaves just over 4,600 metric tonnes for medical use. Scroll.in sent an email to the ministry of commerce to confirm this number but there was no response till the time of publication. The article will be updated if there is a response.

This makes for an ominous picture.

On April 12, when the Central government said India’s medical oxygen requirement was 3,842 metric tonnes, there were just over 12,64,000 active coronavirus cases in the country. That number has since shot up by over 70% to over 21,57,000.

On April 21, an official of the Central government told Delhi High Court that the daily demand for medical oxygen in the country had risen to 8,000 metric tonnes.

This means that India’s daily requirement of medical oxygen is currently about 70% more than the amount that has been exempted from industrial use – 4,600 metric tonnes, as per an official at the government agency monitoring oxygen use.

If India’s current reserves of 50,000 metric tonnes were used to fill the gap between demand and supply of medical oxygen – 3,400 metric tonnes – they would cover barely two weeks of need, based on current demand. This is assuming the reserves are entirely used for medical purposes and the demand does not rise.

On Wednesday, the Delhi High Court urged the Central government to stop all industrial use of oxygen and divert it to medical purposes. But it did not pass any orders to this effect.

On Thursday, however, the Prime Minister’s office released a statement that said: “...In the last few days, availability of Liquid Medical Oxygen has been increased by about 3,300 MT/ day with contributions from private and public steel plants, industries, oxygen manufacturers as well as through prohibition of supply of oxygen for non-essential industries.”

It added: “Against the present demand from 20 states of 6,785 MT/ day of Liquid Medical Oxygen, Government of India has from 21st April, allocated 6,822 MT/ day to these states.” It did not give the data for aggregate demand for medical oxygen from all 28 states and nine Union territories.

This follows a flurry of announcements from large corporate groups over the last couple of days saying they had diverted oxygen from their industrial plants to medical use.

But even if India’s entire daily production of 7,127 metric tonnes of oxygen is diverted to medical use, the country is still likely to face a shortfall. The current level of demand for medical oxygen (8,000 metric tonnes) already outstrips combined daily production of industrial and medical oxygen (7,127 metric tonnes) by 870 metric tonnes, as per the Central government’s own admission in court.

If this were the case, the reserves of 50,000 metric tonnes could be used to fill the gap for two months – assuming none of it is used for industrial purposes and the demand remains the same.

However, demand is likely to rise since coronavirus cases are growing exponentially. With the reproduction number – or the average number of people one coronavirus patient is likely to infect – at more than two in several large states, experts are predicting a tsunami of cases in the coming weeks.

The government floated an emergency import tender on Wednesday for 50,000 metric tonnes of oxygen. It is not clear when the imports will reach the country.

Scroll.in emailed both the ministries of health and commerce asking them about the current and projected demand and how long reserves are expected to last. The story will be updated if they respond.

A problem of geography and logistics

India’s oxygen crisis isn’t just about a growing demand-supply gap.

Even if the Indian government diverts all oxygen production in the country to medical uses and the coronavirus case count does not rise in the coming weeks, the country will face a massive logistical challenge to transport and store the oxygen.

This is because oxygen production is unevenly distributed across the country.

Government records show that some of the high Covid-19 case-load states in North and Central India such as Delhi, Madhya Pradesh and Bihar have no significant production capacities of their own. According to official data compiled in April 2020, reviewed by Scroll.in, the eight states of Maharashtra, Gujarat, Jharkhand, Odisha, Tamil Nadu, Karnataka, Kerala and West Bengal account for nearly 80% of India’s total dedicated oxygen production.

India has since ramped up its capacity by around 20%, but the geographical skew remains, said officials who spoke on the condition of anonymity. The expansion is largely a result of increasing the productivity of the existing plants, although some defunct units, mostly in western India, have also been made functional.

Transporting liquid medical oxygen comes with several logistical challenges. It requires cryogenic tankers, which are in short supply. This has meant, for instance, that steel companies in eastern India which produce the gas in-house are struggling to transport oxygen to other states.

Odisha has the fourth-largest production capacity for oxygen among Indian states. With relatively lower Covid-19 case numbers, its medical oxygen requirement is currently lower than 12 states. “But the problem is that there are just not enough tankers to transport oxygen even if we have supplies that we can afford to give after meeting our own demand,” said Ruab Ali, the nodal officer for oxygen supply in the state. “That is why the government is now converting nitrogen and argon tankers to oxygen tankers.”

Industry executives agree. “The thing is that oxygen has to reach the patient’s mask from the plant,” said a manufacturer of cryogenic tankers in South India who did not want to be identified. “And normally daily oxygen needs are limited to around 300 metric tonnes-400 metric tonnes, our infrastructure is tuned for that, but the demand has suddenly gone up exponentially. Infrastructure cannot happen overnight. There is a specific manufacturing time for tankers.”

The problem of storage

The challenges do not end with transportation. Once the gas reaches its intended location, it needs to be stored in either cryogenic vessels or cylinders. Both are becoming increasingly scarce, because manufacturers say they were simply not prepared.

“There are demands for 10,000 cylinders daily, but we can just manufacture 2,000 a day, that’s it,” said Puneet Khurana of the Mumbai-based Everest Kanto Cylinders, one of India’s largest manufacturers. “Last year, the government had called us, estimated requirement, but this time there is no plan because everything happened so suddenly. This is why there is such a huge shortage.”

Another manufacturer echoed Khurana. “Cylinders are manufactured foreseeing demand, but in February-March we slowed down production because it seemed Covid was over and there was no requirement,” said Pravin Nandu of Euro India Private Limited. “So now we can’t keep up with this huge surge because the production cycle is long and raw materials need time sourcing.”

Conversations with producers of cryogenic tanks, which are used by hospitals to store liquid oxygen, reveal a similar crisis. “Our capacity is based on normal demand, but if it suddenly goes up ten times we cannot help it,” said Munjal Mehta of Shell-n-Tube Private Limited, a Pune-based manufacturer of cryogenic vessels. “The solution is that over a period of time, hospitals ramp up infrastructure because manufacturers cannot have the capacity that can cater to demand that is ten times higher.”

Ignoring localised solutions

But the government failed to ramp up hospital infrastructure, as an investigation by Scroll.in revealed.

The country’s oxygen crisis could have been partly diffused had India utilised the past year to create localised solutions in the form of small-scale oxygen generation plants within hospitals on a war footing.

It takes just four to six weeks to install a Pressure Swing Adsorption oxygen generator at a hospital, said industry players and government officials. The average cost comes to just Rs 1.25 crore, based on the Central government’s outlay of Rs 201 crore for 162 oxygen plants. India has six years of experience building PSA oxygen plants, said a Tamil Nadu-based manufacturer of such units.

But as our investigation revealed, the Central government took eight months to float a tender, and six months later, PSA oxygen plants were operational in only five of the 60 hospitals we called. Hours after our report was published, the health ministry admitted only 33 of the 162 PSA oxygen plants it had commissioned had been installed.

To be sure, these 162 plants would have added miniscule capacity – just 154 metric tonnes of daily oxygen production. But it is unclear what stopped India from ramping this up to 10 times the number, given that oxygen is essential to saving lives not just from Covid-19 but a slew of other medical emergencies.

For an outlay of Rs 2,000 crore, the country could have added 1,540 metric tonnes of additional daily medical oxygen capacity. Significantly, this capacity would exist on-site and not be subject to the challenges of logistics and transport.

This on-site capacity would have proved particularly useful in states like Delhi, Madhya Pradesh and Bihar, which have barely any oxygen production capacity of their own.

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