India can’t breathe.
Hospitals battling a furious Covid-19 surge around the country have exhausted their supplies of oxygen cylinders, necessary to help patients deal with the oxygen depletion caused by the virus. The Delhi high court has ordered India’s government to get oxygen by any means possible, though most avenues of procurement, including imports from other countries, are too slow for the current emergency.
Organizations such as Hemkunt Foundation, a nonprofit that has directed its humanitarian efforts toward Covid-19 relief, are trying to procure oxygen for hospitals, though supplies are hard to locate, and Tata, one of India’s largest corporations, has ordered cryogenic containers to transport the gas to help improve distribution.
But what are cryogenic containers? And how can there be a shortage of oxygen, a gas so ubiquitous it fills the air we breathe? And what makes it so hard to get supplies of it in India?
How medical oxygen gets made
Medical oxygen indeed comes from the air we breathe, which gets separated into its component—the main ones nitrogen (78%), oxygen (21%)—in an air separation unit (ASU).
ASUs are plants that treat large volumes of gas, from a few hundred tons to 20,000 tons per day. The majority of gases isolated by ASUs are sold for industrial use—particularly in the iron and steel industry—and represent a global market of about $5 billion. Asia is the biggest market, hosting over 40% of the world’s ASUs.
ASUs use a process called fractional distillation, which separates the components of air after cooling it to a liquid state, then extracting liquid oxygen from it. The oxygen is then transported either directly through a pipeline connected to the production plant, if the end destination is close to it, or via special containers such as aluminum cylinders. For larger quantities, cryogenic containers, such as the ones Tata is importing, are used.
Hospitals usually either get bulk tanks that supply internal oxygen pipelines, or purchase refillable oxygen cylinders. Oxygen cylinders come in different sizes, and can be pretty heavy. The largest size is about 1.5 meters (60 inches) tall, weighs about 60 kg (150 lbs), and contains over 7,800 liters of liquid oxygen. A Covid-19 patient in a hospital can require up to 30 liters of oxygen a minute, so it would last about four hours.
Hospitals can produce oxygen on-site
Hospitals can also opt for on-site generation of oxygen, which is typically done by pressure swing adsorption (PSA), which separates the gases present in the air by concentrating them. It produces oxygen of lower purity than ASUs yet pure enough to be used by hospitals.
Producing oxygen near or in the hospital also has the advantages of providing a larger supply than hospitals can secure with cylinders, and making sure hospitals aren’t in competition with one another to secure their oxygen supplies.
Earlier in the pandemic, the Indian government solicited bids for 162 PSA plants—facilities containing machines able to condense oxygen from the air—for government hospitals, but it took eight months to award the contract, and so far only 33 of them have been installed (and not all are functional) across 15 states, leaving most facilities dependent on external provisions.
Not enough oxygen
Without sufficient on-site production, India faces two problems: There isn’t enough oxygen, and it isn’t efficiently distributed.
According to official government sources, the country produces over 7,000 metric tons of oxygen per day, while the country needs 8,000 metric tons a day, according to the latest estimate, supplied by a government official to the Delhi High Court. Prior to the Covid-19 outbreak, the need was for about 700 metric tons a day.
However, as Scroll reported, the demand might be underestimated. While most of the country’s oxygen production has now been directed toward medical use, there are still certain industries, like water purification and pharmaceutical companies, allowed to use some of the oxygen through the emergency. Altogether, they consume about 2,500 metric tons a day—leaving the overall available supply at about 4,500 metric tons.
Further, the number of cases has gone up dramatically in the past few days, so the shortage may be at least 3,500 metric tons a day—and rising. Even with an additional 50,000 tons the government has planned to import, oxygen supplies are bound to be insufficient.
Problems with transportation
Additionally, whatever oxygen is available is not getting where it’s needed. Special tankers are required to drive oxygen in larger quantities across states, but there aren’t enough to move the entire oxygen production. Similarly, there is a shortage of cylinders, which aren’t being refilled fast enough to meet demands.
The government has recently taken measures to help in this respect, by allowing tankers on any roads, regardless of limitations like state-specific permits, giving them priority status similar to ambulances. Cylinder-filling facilities, too, are now allowed to operate 24-hours a day, seven days a week, and cylinders typically used for other gases are being turned into oxygen containers after sanitizing.