The Issue of Medical Oxygen in India-Explained, Pointwise

Introduction

A number of states are reporting shortage of medical oxygen after an increase in the number of Covid-19 patients. So, India is planning to import at least 50,000 metric tonnes of medical oxygen to cater to the rising demand. With the Covid-19 cases increasing day by day, the demand for medical oxygen is going to increase in near future.

Bridging the shortage of oxygen supply is essential to avoid a situation like the Gorakhpur Hospital tragedy that occurred in 2017.  In 2017, 72 children of Uttar Pradesh’s Gorakhpur BRD Medical College died due to a lack of medical oxygen supply. So, in this article, we will explain the importance of medical oxygen and its impact on health care.

About the decision to import medical oxygen

• According to industry experts, India has the capacity to produce more than 7,000 metric tonnes of medical oxygen.
• Maharashtra has the total capacity to produce  1,250 tonnes/day. But according to the government sources, Maharashtra has already exceeded its production capacity. Further, they are also procuring 50 tonnes from Chhattisgarh and 50 tonnes from Gujarat daily to meet their regular medical oxygen demands.
• Madhya Pradesh, on the other hand, does not have its own manufacturing plant and relies on Gujarat, Chhattisgarh, and Uttar Pradesh for oxygen supply. With 59,193 active Covid-19 patients as of April 16, it requires 250 tonnes of oxygen daily.
• Similarly, Gujarat’s Oxygen requirement has increased to 500 tonnes per day.
• Further, As India touches 16 lakh active Covid-19 infections, many states reported a shortage of medical oxygen.
• So the Health Ministry decides to import 50,000 metric tonnes of medical oxygen.

What is medical oxygen?

• Medical oxygen is high purity oxygen suitable for use in the human body. So, it is used for medical treatments.
• The Medical Oxygen cylinders contain a high purity of oxygen gas(99.5% purity). No other types of gases are present in the medical oxygen cylinder. This is to prevent contamination.
• The cylinders previously used for other purposes have to be evacuated, thoroughly cleaned, and labelled appropriately before filling up oxygen.

Application of Oxygen in medical field

Due to the indispensable use of medical oxygen, the World Health Organisation include this on their List of Essential Medicines. Today modern medicine almost depend on the support of oxygen supplies. Benefits include,

• Provide a basis for virtually all modern anaesthetic techniques.
• Restore tissue oxygen tension by improving oxygen availability. This is used for a wide range of conditions such as shock, severe haemorrhage, carbon monoxide poisoning, major trauma, cardiac/respiratory arrest.
• Provide life support for artificially ventilated patients.
• Aid cardiovascular stability of patients.
• To aid heartbeat stability in an acutely ill patient

Side effects of medical oxygen

If it is used above the prescribed amount, the medical oxygen creates certain side effects. This is why the doctor prescription of oxygen is essential. The side effects include,

• Convulsions or seizure will appear in patients after a few hours of exposure to oxygen at pressures above 3bar(g).
• It can cause Retrolenticular fibroplasia in premature infants if they exposed to oxygen concentrations greater than 40%. In short, it is a condition of abnormal growth of blood vessels in the eye. Retrolenticular fibroplasia is the leading cause of child blindness today in the world.
• Some patients will also develop coughing and breathing difficulties after they put under medical oxygen.
• The issue of Oxygen toxicity: Excessive or inappropriate supplemental oxygen can cause severe damage to the lungs and other organ systems.

Why there is a shortage of medical oxygen in India?

1. Lack of cylinder and cryogenic tankers: India does not have enough cryogenic tankers to ensure 24×7 road transport of oxygen. Similarly, smaller suppliers do not have enough jumbo and dura cylinders to supply medical oxygen to remote locations. This results in higher prices for an oxygen cylinder. Thus raising the cost of oxygen.
2. Setting up a medical oxygen plant is a time-consuming process: It is not feasible to set up new oxygen manufacturing plants or expanding existing plants within a month. For example, A private company that starts to install a new oxygen-producing facility in the past took almost 24 months to properly installing one manufacturing plant.
3. Oxygen wastage and unnecessary use in hospitals: In the past, the Health Ministry repeatedly demanded hospitals to reduce wastage and unnecessary oxygen use in Hospitals. But the hospitals not yet take any decision on this. Industrial experts also raised concerns over possible leakages in hospital pipelines that supply oxygen.
4. Heavy reliance on private players: Of the total medical oxygen supply nearly 60% is manufactured by only one private firm.

Regulatory provisions of medical oxygen in India

• According to the  Drug Prices Control Order, 2013, Medical oxygen is placed under the National List of Essential Medicines (NLEM).
• The National Pharmaceutical Pricing Authority will monitor and control the prices of the National List of Essential Medicines (NLEM). 
• So, the NPPA controls and monitors the medical oxygen prices in India.

Government initiatives to increase the availability of medical oxygen

During the Covid-19 pandemic, the government initiated various steps to increase the production of oxygen and also maintaining the prices. This includes,

1. Under the Disaster Management Act, 2005, the Ministry of Health & Family Welfare(MOHFW) delegated its powers to the NPPA. Especially to take all necessary steps to regulate the availability and pricing of liquid medical oxygen (LMO) and oxygen cylinders.
2. Further, to ensure the availability of oxygen at a reasonable price the NPPA capped the price of medical oxygen cylinders and LMO for six months(in September).
3. Recently, Central Mechanical Engineering Research Institute(CMERI) develops an oxygen enrichment unit(OEU) that could provide crucial support to COVID-19 patients.  An oxygen enrichment unit is a device that concentrates the oxygen from the surrounding air.
4. Mapping of oxygen sources for 12 high burden state: The Centre-appointed Empowered Group-2 mapped the medical oxygen capability in 12 States having high disease burden. Such as Maharashtra, Tamil Nadu, Kerala, Gujarat, Delhi, etc.
5. Identification of hospitals for installing PSA plants: Recently the MOHFW sanctioned the installation of 162 Pressure Swing Adsorption plants at hospitals to augment oxygen capacity by over 154 Metric Tonnes.
6. During the first wave of the Covid-19 pandemic, industrial oxygen producers were allowed to produce LMO.

Suggestions to improve medical oxygen

1. Fixing the PSA Plants in remote locations: This will make hospitals manufacture their own oxygen and make the hospitals self-reliant. Further, it will reduce transportation costs and delays in oxygen supply.
2. Exploring alternate mode of oxygen transportation: At present, oxygen transportation relies primarily on road transport. Industry experts suggest using trains to transport oxygen faster.
3. Converting surplus industrial oxygen into medical oxygen: Empowered Group-2 suggested using argon and nitrogen tankers in oxygen transport to fulfil the demand. It also suggested using industrial cylinders for refilling. The government can implement the suggestions.
4. Curbing oxygen wastage and unnecessary use in hospitals: The MOHFW repeatedly warned against this. The health ministry even appointed an expert committee to fix medical oxygen for patients. The committee suggested the following,
   • Firstly, fixing the oxygen supply to 40 liters in intensive care units and 15 litres in normal wards per patient per minute.
   • Secondly, providing oxygen only to patients having oxygen saturation levels below 94%. (Oxygen saturation in the blood below the level of 94 is considered as a matter of concern for people suffering from Covid-19).
     The hospitals have to follow this limit as it will reduce wastage.

Oxygen is essential for hospital care. India is improving its capacity drastically. But till then it is the responsibility of doctors to use the oxygen effectively.