The second wave of Covid-19 in India quickly went from being a healthcare crisis to a humanitarian crisis. Thousands of patients gasped for breath in the absence of enough high-flow oxygen, which is an effective treatment for the disease.
For more than a month now, the oxygen crisis in the country has been a tug-of-war between the Narendra Modi government, state governments, hospitals, and oxygen manufacturers. In several areas, individuals have been left to run from pillar to post in search of oxygen cylinders for their family and friends.
All stakeholders have their own reasons for why Indian doctors still don’t have enough supply of the essential gas to treat their patients.
Quartz spoke to Siddharth Jain, director of INOX Air Products, the largest manufacturer of liquid oxygen in India, to understand the perspective of the producers. Jain believes that it is wrong to put the onus on oxygen makers as they are doing their best. “We are trying, nobody is understanding the logistical challenges in supplying oxygen to a nation that is at war simultaneously in 30 states. It’s a Herculean task,” he said.
Below are edited excerpts from the conversation:
By when will India have enough oxygen for its Covid-19 patients?
Oxygen consumption is directly proportional to the number of cases. The pre-pandemic requirement for medical oxygen in India was about 700 tons a day. In wave one, the demand went up about 3,000 tons a day and in wave two, it’s now 8,000 tons a day.
At present, we have enough oxygen to maintain the current number of cases. All I can hope is that enough states announce lockdowns and the number of cases starts coming down. But if we start witnessing cases around 600,000-800,000 a day, we will be in a tough spot.
Do you think India could not have anticipated this spike in Covid-19 cases and no preparation would have been enough?
Absolutely… Why cases spike in this manner is beyond me. I don’t think any country would have been prepared for this kind of acceleration (in Covid-19 cases), which is currently the world’s highest.
All I can say is from an infrastructure perspective, we are scaling up. India has increased its oxygen manufacturing capacity by 30% within a month. This is unfathomable. I don’t think it has happened globally. It’s a world record in itself. The effort has been so enormous, however, increasing the capacity of manufacturing is not the same as getting it to the patient.
What logistical challenges are you facing?
When you manufacture oxygen in a liquid form, it looks like water. But it’s at minus 183 degrees centigrade and it’s stored in specialised containers. There are only 1,170 cryogenic transportation tankers available in India to move liquid oxygen. Out of those INOX has 320.
India has only 70 oxygen plants and these 1,170 containers were moving the entire production of oxygen. Earlier, out of 100 tankers that we would manufacture only 15 were going to medical, and 85 were going to industry. So all our plants are located in areas very close to industry, and not in the most densely populated areas where there are hospitals.
But now, there is a requirement for oxygen everywhere. So we needed to transport these tankers to the entire country.
Tell us more about the recent production ramp-up at your plants.
We have set up a new plant and also made investments in technological innovation inside our existing plants to increase their capacities. We have also reduced the capacity of some other gases that we make, such as nitrogen and argon, and are using those capacities to increase oxygen production.
Which states are you now supplying oxygen to? What are the key challenges in the process?
The three largest consumers of oxygen right now are Maharashtra, Gujarat, and Uttar Pradesh. We are not facing many challenges in Maharashtra and Gujarat because not only are they the largest consumers but they’re the largest manufacturers as well.
However, we are facing problems in the northern states of Uttar Pradesh, Delhi, and Himachal Pradesh. Since there’s no industrial activity in north India, the region manufactures only 10% of India’s oxygen. So the production is very small but the demand right now is huge given the number of Covid-19 cases.
There are similar issues with the eastern and southern parts of the country, too, because most of the oxygen production capacity is in central India.
You have earlier said that the Delhi government is the only one complaining about supply issues. What happened with them?
There are only 70 plants that manufacture oxygen in India. Now, what is the job of the union government? It is to tell manufacturers to produce a certain amount of oxygen and then they formed a committee to approve the oxygen demand by the states. There was a chart that was made for each state with a name and an allocation volume.
However, it is not the union government’s job to pick up the oxygen and deliver it to end locations. It is not their job to go to Odisha, pick up the oxygen and come to Mumbai and pour it in a tank. What do the states exist for? What is their job? It is the job of the state to go and organise the logistics and go and get the allocated product.
Are you suggesting that Delhi wasn’t organising the logistics and was just complaining?
Yes, absolutely. It was only later, after a lot of pressure was put on them, they started moving it.
What could have been done to avoid the current situation?
Maybe the question is, why did we need that oxygen? Could we have done something to not require that oxygen at all?
I think it’s a bit unfair to the oxygen manufacturers…Are you aware in Delhi, they’re refusing patients into hospitals? Why are hospitals not taking patients? Does the hospital have no duty to organise the oxygen themselves? Are they allowed to shut gates for their patients?
But what can a hospital do if it has a shortage of essential medical supplies?
So where does the oxygen guy get it instantly? How do you create a supply chain with 10 times more than the normal demand in a two-week period?
Let us assume petrol is available in only 70 places in India. But cars are all over India. Now, tell me if the number of cars has increased 10 times overnight and they all want petrol, how would you get the petrol there?
Tell me, does a hospital today have the ability to bring more doctors overnight if the patients double? Take any hospital, and overnight, a 200-bed hospital cannot become an 800-bed hospital. But if the need arises, will it say no, we don’t have the doctors. We don’t have nurses and doctors. No. You will have to do it. It’s your duty.
We are trying, nobody is understanding the logistical challenges in supplying oxygen to a nation that is at war simultaneously in 30 states (India has 28 states and eight union territories). It’s a herculean task.
You are suggesting that it is wrong to blame the oxygen manufacturers?
Some experts have said that India should implement a nationwide lockdown. Do you think that will help the oxygen manufacturers?
I certainly think it will help…I think most states are already under lockdown… At this point what we really need is to break the transmission chain. Come what may.