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Explained: India's Oxygen Shortage Amid the Second Wave of COVID-19

Apr 27, 2021 6:50 AM 6 min read

India’s oxygen emergency has perilously escalated over the past week.

Social media is being flooded with distress calls begging for the life-saving gas, some states are blocking cross-border transport of cylinders to save them for local use, and thousands are dying breathless in overcrowded hospitals, ad hoc treatment centres or in their own homes.

The shortage right now is acute, deadly and not likely to be resolved soon enough. And the country finds itself in this desperate position today due to the Government - both at the centre and states - having failed to plan properly...or plan at all.

What is Medical Oxygen? What is It Used For?

Off the top, an oxygen deficiency may seem strange to comprehend. How can we be facing a shortage of a gas that is literally in the air we breathe?

When you read reports on an “oxygen shortage”, they refer to a shortage of medical oxygen.

Medical oxygen refers to high purity oxygen used widely for medical treatments including during anesthesia, first aid resuscitation, life support, oxygen therapy etc. As well as in other areas like high-altitude mountain climbing.

It is produced in plants known as Air Separation Units (ASUs). ASUs employ a process called fractional distillation wherein atmospheric air is cooled to a liquid state, its various components then separated, and liquid oxygen extracted from the same. (We don't actually breathe in oxygen. We breathe in air, which is 78% nitrogen, 21% oxygen and 1% other gases.)

From here, the "pure" liquid oxygen can be transported to an industrial plant for industrial use (many industries have in situ ASUs). Or it is filled into special cryogenic containers, from where it is transported to hospitals. The liquid oxygen is converted into compressed gaseous form, filled into oxygen cylinders, and sent to the final destinations.


India’s Problems

There are two main issues the country is facing - there isn’t enough oxygen to meet demand + whatever oxygen we have is not efficiently distributed. Let’s delve into these one by one.

Point to Note: Oxygen cylinders come in various sizes; the larger ones can contain up to 7,800 liters of liquid oxygen. A breathless COVID-19 patient may need about 130 liters of oxygen a minute, so such a large cylinder would last about an hour.


Supply and Demand

As per official figures, India’s daily oxygen production capacity is 7,127 metric tonnes or MT (medical + industrial) as at April 15th.

Pre-pandemic, medical oxygen demand was muted - barely 800 MT per day. The rest was used by industries. But since the outbreak, demand from hospitals has escalated - particularly so in the last two weeks, when requirement surged by 76% in only 10 days to 6,785 MT per day (as on April 22nd).

So… That’s a close shave, but it seems as if India still had a few hundred MT of oxygen to spare last week, right?

Dig deeper, and the shortage becomes apparent.

One, as we saw above, the bulk of the liquid oxygen that is produced in ASUs is earmarked for industrial applications. The purity levels for industrial and medical liquid oxygen are different.

Two, since April 22nd, liquid oxygen supply has been barred for non-medical industries. But some have had to be exempted - such as pharmaceuticals, steel plants, petroleum refineries, nuclear energy facilities, oxygen cylinder manufacturers, waste-water treatment plants, food and water purification. These either need liquid oxygen to remain functional or are important for the healthcare sector. Combined, these industries’ requirements add up to 2,500 MT per day.

Capacity = 7,127 MT. Availability = 7,127 - 2,500 = 4,627 MT. Ergo, the medical oxygen supply-side shortage.

Besides the supply crunch, the sheer magnitude of demand has been staggering. On April 12th, the Government said medical oxygen requirement was 3,842 MT. Five days ago, the Government submitted that the demand had surged to 8,000 MT.

Wait - what about reserves? The Ministry of Heath had said it had a reserve stock of 50,000 MT of liquid oxygen. Also, India might import as much as 50,000 MT of oxygen in the coming days, possibly.

Well, if you take demand to be 8,000 MT (it’s likely to be much higher now) and supply to be 4,627 MT, that’s a gap of 3,373 MT per day.

Even if you used the entirety of the 50,000 MT in reserves (let’s count the imports if and when they arrive), that would bridge the supply-demand gap for only two weeks. That too considering that cases, deaths, reproduction number and positivity rate remain at current numbers (they’re actually rising with each passing day).

There simply isn’t enough oxygen.



The next challenge is three-tiered and infrastructural - in production, storage and distribution.

One, only eight states control 80% of India’s oxygen production. Coronavirus hotspots like Delhi, Haryana, UP, MP or Bihar don’t have any dedicated facilities of their own. Moreover, the capacity-building underway is largely limited to existing plants; the geographical skew persists.

Two, medical oxygen needs to be transported in special cryogenic tankers, of which there aren’t many. This has led to an unsavoury situation where industries with surplus oxygen (like Jindal Steel) or states with surplus oxygen (like Odisha and Kerala) are finding it difficult to transport the liquefied gas to places that need it. (Cryogenic tankers store the liquid in extremely low temperatures (below -180°C), and their scarcity is similar to India’s underdeveloped cold storage infrastructure.)

Three, medical oxygen needs to be stored in special cylinders. There’s a shortage of cylinders - simply because manufacturers were not given estimates by the Government and even “slowed down production [earlier in 2021] because it seemed COVID was over”.


How Did We Get Here?

The Second Wave crept up on India in no small part due to our complacency - the foolish belief that the worst of the pandemic was behind us so it was okay to gather in large numbers for parties, rallies, marches and festivals.

However, the unimaginable scale of the Second Wave's toll is largely a result of Government mismanagement - or simply lack of management.

Take the inadequate number of liquid oxygen-manufacturing plants. Boosting oxygen production was indispensable to survive the pandemic - we knew this even before the first virus cases were reported in the country. But the Government inexplicably dragged its feet on this crucial matter. It waited eight long months to invite bids for new plants. And as of April 18th 2021, only 33 of the 162 plants sanctioned have been installed.

And it wasn't a matter of money. Only ₹201cr ($26.87m) was allocated for the 162 oxygen generation plants. In comparison, the PM-CARES Fund, which was created following the pandemic, had received over ₹3,000cr ($401m) in only four days after it was set up.

Nor was it a matter of time. A dairy cooperative in Gujarat recently built an oxygen unit for its hospital in only 72 hours. It’s now aiding 40 patients a day. Imagine how many deaths could have been prevented if the Government, with all its might (and a year’s time to boot) had acted on time.

An argument can be made that India’s health system was anyway too feeble and easy to overburden, so there wasn’t anything the state could do at the end of the day. But when the world’s most stringent lockdown was announced in March 2020, the Government rationalised the exercise by saying it was necessary to expand the country’s healthcare facilities - to buy it more time. It got time, and more of it - an entire year, in fact. And did the state keep up its end of the bargain? Even if one can comment from the benefit of hindsight, the experience of developed countries, each of which faced a much larger second wave, should have served as a case-in-point.


What Next?

The Indian Railways and the Air Force have been tapped to transport tankers. 50,000 MT of oxygen may be imported from abroad. Tankers and cylinders used to transport and store other gases like nitrogen and argon have been converted. Big conglomerates have diverted their liquid oxygen reserves for public use. More oxygen-generation plants have been sanctioned. Cryogenic tankers have been given priority status similar to ambulances. Cylinder-filling facilities are now allowed to operate 24x7.

But with daily new cases climbing to dystopian highs, the healthcare system on the verge of breakdown, the vaccine roll-out faltering, and projections estimating a death toll of 5,000+ per day in May, the country seems to be heading for some dark days ahead.


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