Medical Oxygen Crisis

In News

Recently, the Centre has invoked the Disaster Management (DM) Act, 2005 and has ordered the States to make available all Liquid Medical Oxygen (LMO), including the existing stock with private plants, to the Government.

About the Latest Order

• The order was issued by the Union Home Secretary, who is the Chairman of the National Executive Committee under the DM Act.
• All the manufacturing units may be allowed to maximise their production of LMO and make it available to the Government, for use for medical purposes only.
• Under Section 10(2)(I) and Section 65 of the DM Act, States have to ensure that LMO is not allowed for any non-medical purpose and all stocks have to be made available to the Government without any exception to any industry.

Reasons for Shortage In Supply

• The requirement for medical liquid oxygen has increased by 76 per cent in the previous few days.
  • As per latest data, after allowing the use of industrial oxygen for medical purposes, India’s daily production capacity was to the tune of 7,100 metric tonnes per day (MTPD).
  • Out of which, the government allocated 6,822 MTPD to 20 worst-affected states and now its running short of that too.
• There is a shortage of empty containers and cylinders to cater for the demands and also the cost of refilling a cylinder or renting an oxygen concentrator has increased manifold.
• Location of oxygen producing plants is also a factor as most of them are situated near industrial zones, far from the cities.
• Also, road transportation of the element has inherently unique challenges, including the high investment on specialised containers and availability of good and unhindered roads.

Steps Taken and Suggestions for Improved Supply

• Setting up PSA Plant: Government approved setting up of Pressure Swing Adsorption (PSA) plants in public health facilities in all States.
  • This will turn hospitals self-sufficient in meeting their need for LMO, while also reducing the burden on the national grid.
• Encourage Industrial Production: Encourage industrial giants to produce more LMO to cater for the demand and develop infrastructure for its quick delivery to the hospitals from the manufacturing units.
• Better and Faster Transportation: Oxygen Express trains are being run by the Railway to transport LMO and oxygen cylinders across the country.
• Increasing Imports: Importing oxygen is one other alternative. India also expects to receive supplies from about 15 countries including Australia, China, Germany, Russia, UAE, UK and the US in the following days.
  • The priority at present is to fly in as much oxygen-related equipment, including containers, concentrators and generators, as well as Covid-treatment drugs remdesivir and tocilizumab, which are running in short supply.
• Other Steps: Stopping supply of oxygen for non-essential industries, measures to speed up road movement as well as exploring rail and air movement.

Medical Oxygen

• It is a high purity nutrient.
• Human lungs consume 5-6 milliliters (ml) of oxygen per minute and the whole body consumes around 250ml/min.
  • This consumption increases upto four times in case of a diseased lung.
• It was known to be the only element that supports respiration as early as 1800 and was first used in the medical field in 1810.
• In the early to mid 20^th century, oxygen therapy became rational and scientific and currently, modern medicine could not be practiced without the support of oxygen supplies and Covid-19 pandemic has highlighted its significance even more.
• To transport it, oxygen needs to be compressed into a liquid to fit in a smaller, lighter tank and for that, it is cooled to a temperature of ?297 degrees Fahrenheit (?183 degrees Celsius).
• Medical oxygen is used to
  • Provide a basis for virtually all modern anaesthetic techniques.
  • Restore tissue oxygen tension by improving oxygen availability in a wide range of conditions like shock, severe hemorrhage, carbon monoxide poisoning, major trauma, cardiac/respiratory arrest, etc.
  • Aid resuscitation.
  • Provide life support for artificially ventilated patients.
  • Aid cardiovascular stability.

• Also, industrial oxygen is used in factories for combustion, oxidation, cutting and chemical reactions. Its purity levels are inappropriate for human use.
  • However, post Covid-19 outbreak, industrial oxygen has been diverted for medical purposes in India after clearing the impurities.

Need for Covid-19 Patients

• Covid-19 virus causes inflammation in the lung that blocks the diffusion of oxygen and carbon dioxide.
• Alveoli (tiny air sacs in lungs) are filled with inflammatory material and the vessels that carry blood to the lungs are also blocked in certain individuals due to coagulation (a process by which blood changes from a liquid to a gel, forming a blood clot).
• This can lead to respiratory failure and pneumonia, necessitating oxygen support.
• In case of high-risk patients with a history of lung diseases, oxygen therapy is required.
• Respiratory Support
  • Mild to Moderate Cases: Moderate oxygen flow with a simple face mask.
  • Severe Cases: Nasal high flow oxygen.
  • Very Severe Cases: Non-invasive and invasive ventilator support.

(Image Courtesy: TOI)

Oxygen Sources in India

• Air Separation Units (ASU)
  • These are used to commercially produce oxygen on a large scale.
  • There are various types of ASUs which are big and can go up to Rs. 60-200 crore for construction, depending on the size of the plant and other equipment required.
• Pressure Swing Adsorption (PSA)
  • These are small units used to produce oxygen on a medium scale.
  • These have tiny capacity, like 20 to 200 cylinders a day and can be used in 50-100 bedded hospitals.
• Oxygen Concentrator
  • It is a medical device that takes in this air, filters it through a sieve, releases the nitrogen back into the air, and works on the remaining oxygen.
  • Thus the device concentrates oxygen from surrounding air at homes and small rooms.
    • Normal airspace has 78 per cent nitrogen, 21 per cent oxygen and 1 per cent other gases.

Source: TH