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By Sanjeev Nayyar
At the outset, we must know that hospitals receive medical oxygen in tankers that are unloaded and stored at hospital premises. They also receive oxygen in cylinders (re-fillers receive in large quantities and re-pack in cylinders).
The sudden shortage has caught all by surprise. Supplies are being augmented by corporate India through diversion of manufacturing capacity and imports. Some hospitals are planning to set up oxygen plants. While the crisis will blow over, we must ask certain questions and look at issues from a medium- to long-term perspective.
The questions that come to mind are:
Are stock levels for oxygen laid down by the state government or local bodies? If not, should these be laid down and at a local level? Should the storage norms be based on the total number of beds in hospital including in ICU and lead time for procuring oxygen? Given that the consequences of oxygen shortage are unlikely to be forgotten, should these norms be displayed at the entrance of every hospital?
If such norms are laid down in a fair and transparent way, it shall force hospitals to have adequate stocks for emergency needs. This shall give time to all to arrange for fresh oxygen supplies in case of an unexpected surge in demand. Surely, it will increase working capital, but that is a small price to pay for saving lives. Consumers should bear additional cost.
Next question, is receiving liquid oxygen through tankers or cylinders the only way to produce oxygen?
An oxygen unit that is the size of a double-door fridge is a portable plug-and-play (no set-up time) kind of medical oxygen supply which can take care of about 10 ICU beds. It gives a flow of 90 litres per minute that can take care of 9-11 ICU beds at a time or 18-20 normal beds. The cost is about Rs 53 lakh.
MVS Engineering makes medical oxygen generators. Another company is Airox Technologies whose site sports a Make in India logo. A third is a German company Inmatec. From their site, it appears to have an Indian arm. Companies have models with different capacities, so cost depends on that.
Have hospitals and states placed orders for these now?
Actually, it should become mandatory for every hospital to have such electricity-based oxygen generators or small oxygen manufacturing plants. Their number and capacity can be linked to number of ICU beds or as may be locally decided. Those hospitals who find upfront cost high can take it on lease.
Hospitals can also install oxygen plants as this report tells us.
An April 22 Hindu report speaks of the King George Hospital (KGH), Andhra Pradesh: “The two oxygen generators were received in the first week of this month. We expect the plant to be ready in a few weeks’ time,” Dr PV Sudhakar, Principal, Andhra Medical College.
The Centre had sanctioned two oxygen generators of 1,000 LPM (litres per minute) each to the KGH in the past. The KGH has liquid oxygen tanks of 20 KL and 13 KL capacity on its premises already. The 20 KL tank meets the requirements of the super-specialty block and the 13 KL tank meets the needs of different wards.
“The oxygen generators will be an alternative to us, when there is a shortage in the supply of liquid oxygen. The Covid-19 pandemic has resulted in a huge demand for oxygen. The oxygen generators will be of immense help during such times,” he said.
Private hospitals must take the lead in setting up plants; an example of an in-house plant is thus:
Shankar Chaudhury (chairman, Banas Dairy) tweeted that, “At Banas Medical College Covid Hospital, Palanpur, Gujarat, they installed an oxygen generating plant with a capacity of 480 cubic metres per day.”
The plant cost Rs 36 lakh (including GST) and was supplied by Atmos Power, an Ahmedabad-based PSA Oxygen Plant Manufacturer. Order, delivery and installation took less than 84 hours. The area required for the plant is only 12 by 8 feet. The hospital has 400 beds, of which ICU are 39. The plant more than takes care of the current needs.
This is quite affordable. The question is: How many hospitals in Delhi NCR and Maharashtra have such a facility?
I am neither technically qualified nor have functional expertise. Let the experts evaluate the above and other options. Clearly, the above can help reduce the extent of shortage. A third example is thus:
The Mira-Bhayandar Municipal Corporation (suburb of Mumbai) is proposing to set up its own oxygen plant at an approximate cost of Rs 80 lakh, whose construction is expected to take about 45 days. It will have a capacity to produce 200 cylinders of medical oxygen per day (Source: Free Press Journal).
Panicking and sending SOS tweets might work sometimes, but we need to look at medium- to long-term solutions. Overreacting and respected high court orders only add to the demands placed on an overburdened system. If only court orders could clear backlog of cases! Those who fed protesting farmers with pizzas, etc, are not visible at this crucial moment.
This is the time to be calm and address the cause of the problem so as to avoid repetition. Thus, we must:
—Make it mandatory for hospitals to set up oxygen plants on hospital premises or/and electricity-based generators;
—Lay down oxygen stock levels at a local level. It should be followed by a regular audit to ensure that every hospital is following the laid-down norms;
—Consumers must learn to pay more for life-saving reliable oxygen supply;
—The Centre can fund setting up of oxygen plants in major government hospitals across India, and the balance by states. States can fund smaller private hospitals or let them self-fund;
—Lastly, instead of free laptops, scooters and smartphones, voters must demand hospitals. Every government has limited resources—freebies or life-saving hospital, the choice is ours.
This is not the time for politicians to play petty games or build their image. Voters are smart, they can see through. True Leaders revel in adversity. This is the time for thoughtful action. A year from now, India might thank China for exporting the virus. Who knows: Corona-forced India to introduce reforms!
The author is a chartered accountant and founder of www.esamkriti.com