During the past year, COVID-19 has emerged as a worldwide health crisis. This pandemic has influenced the world’s health policies, impacted economics, and severely disturbed communications in this global network. However, the real tragedy of COVID-19 is that people are dying everyday due to an unavailability of medical oxygen. The health situation has deteriorated exponentially in various countries, specifically India. This has led to a crash of the country’s healthcare system due to a lack of resources, unavailability of patient transportation, and a huge gap in communication within various coronavirus treatment centres.
A recent evaluation of the health crisis has shown just how unprepared India was for a global pandemic. The pandemic has also revealed a major weakness in the healthcare system: the production and delivery of medical oxygen. Despite authorities putting forth their best efforts to supply medical oxygen across the country, the demand overtook supply and made the availability inadequate to support the number of sick patients (Bikkina et al., 2021).
Why oxygen demand surges in COVID pandemic
COVID-19 severely affects the respiratory system making it difficult, if not impossible, for the patient to breathe. Of COVID infected patients, 15% will have severe respiratory illness and need oxygen therapy. Another 5% of sick patients will become critically ill and need mechanical ventilation provided by a ventilator. This then leads to an increased demand for medical oxygen among COVID patients. Therefore, the WHO (World Health Organization) recommends that COVID-19 treatment facilities be fully equipped with pulse oximeters, to measure patients' oxygen levels, and functioning oxygen systems, which includes ventilators, oxygen tanks, oxygen regulators, and oxygen flowmeters (Alex Scott, 2020).
How the situation became so bad
At the start of the pandemic, the WHO stated that there would be an increase in the demand for oxygen throughout highly affected countries. Given the obvious effect of coronavirus on the respiratory system and the need for oxygen therapy to treat infected patients, the oxygen crisis was not unforeseen (Down et al., 2020). Since the start of this pandemic, officials have faced one challenge after another. COVID-19 has severely affected the economics, social lives, education, and healthcare system of the country. Policymakers were so busy trying to contain the spread and avoid an economic collapse that the supply of oxygen never became a priority until it became a national emergency.
Even before the pandemic began, the country had an insufficient supply of ventilators and medical oxygen. Some of the more remote areas didn't even have adequate oxygen supplies for asthmatic or ARDS patients to be treated properly. The COVID surge just deteriorated the already crippled healthcare system in India. As the coronavirus positivity rate increased, the demand for medical oxygen skyrocketed. Poor planning and improper management have turned this demand for oxygen into a dire medical emergency. Patients are dying due to the huge gap between the demand for oxygen and available supply. Officials have failed to provide the country with the proper infrastructure needed to support them throughout the pandemic (Bikkina et al., 2021).
Unmet oxygen demand
India is facing a growing oxygen crisis and is on the brink of chaos. The oxygen demand and needed supply are not able to be met due to various reasons which include inadequate production, low storage capacity, an inadequate transportation system, and an unavailability of oxygen therapy devices for storage and distribution (Dondorp et al., 2020).
Oxygen demand rapidly increased due to a surge in coronavirus cases. This exponential increase in the number of patients swamped the hospitals and healthcare facilities. It also drained the stores of medical oxygen in hospitals and the oxygen shortage became a challenge (Daher et al., 2021). India had been producing enough oxygen per day - over 70,000 tons a day. The real challenge was with diverting this oxygen supply for medical use when over 85% of the oxygen produced was being used for industrial purposes. India's government has solved this problem by ordering all the producers of oxygen to temporarily direct their oxygen supplies for medical use (Alex Scott, 2020).
Storage and transport capacity
Even when the country can produce enough oxygen, it still lacks the proper storage, equipment, and transportation methods to meet the demand. Concentrated oxygen cannot be transported at a speed of more than 25mph. This regulation makes it difficult to quickly transfer and deliver oxygen from one place to another. Medical oxygen is stored inside of oxygen tanks or cylinders which are then transported in an extremely regulated environment. However, there are a limited number of cylinders and tanks available which puts further strain on supplying oxygen across the country. The only option is to refill the tanks and cylinders at the main oxygen production site and then bring them back to the healthcare centres, but this severely cuts down on the supply of oxygen at the facility when it is needed (Dondorp et al., 2020; Goyal et al., 2021).
Unavailability of oxygen therapy devices
Oxygen gas is compressed and stored in oxygen cylinders. These cylinders are filled with either liquid oxygen or a highly concentrated form of oxygen. Once filled, these cylinders do not require electricity for oxygen delivery. However, they do require some accessories and medical devices to properly deliver oxygen at the desired level. Two accessories that are currently in desperate need are oxygen regulators and oxygen flowmeters (Alex Scott, 2020).
Oxygen flowmeters are required to monitor the gas flow and control the volume of gas delivered to the patient. It is a special device designed to control the flow of oxygen from the cylinders to the patients. Any malfunction with this device can lead to an empty breathing bag which will subsequently lead to improper ventilation. With the increase in oxygen demand, the demand for oxygen regulators and flowmeters has also increased. The medical equipment industry is unable to meet the increased demand for medical accessories and thus presents another barrier in increasing the oxygen supply. While various countries are sending emergency medical aid to help India fight this crisis, the lack of infrastructure, lack of equipment, and improper government planning, are still causing a big disparity between the supply and demand of oxygen in the country. This growing oxygen crisis has caused worldwide criticism of India’s government and raised questions about their inability to handle the pandemic effectively (Dondorp et al., 2020).
Alex Scott. (2020). Medical oxygen demand soars. C&EN Global Enterprise, 98(15), 11–11. https://doi.org/10.1021/cen-09815-buscon3
Bikkina, S., Kittu Manda, V., & Adinarayana Rao, U. V. (2021). Medical Oxygen Supply During COVID-19: A Study with Specific Reference to State of Andhra Pradesh, India. Materials Today. Proceedings. https://doi.org/10.1016/j.matpr.2021.01.196
Daher, A., Balfanz, P., Aetou, M., Hartmann, B., Müller-Wieland, D., Müller, T., Marx, N., Dreher, M., & Cornelissen, C. G. (2021). Clinical course of COVID-19 patients needing supplemental oxygen outside the intensive care unit. Scientific Reports, 11(1), 2256. https://doi.org/10.1038/s41598-021-81444-9
Dondorp, A. M., Hayat, M., Aryal, D., Beane, A., & Schultz, M. J. (2020). Respiratory Support in COVID-19 Patients, with a Focus on Resource-Limited Settings. The American Journal of Tropical Medicine and Hygiene, 102(6), 1191–1197. https://doi.org/10.4269/ajtmh.20-0283
Down, B., Kulkarni, S., Khan, A. H. A., Barker, B., & Tang, I. (2020). Novel coronavirus (COVID-19) infection: What a doctor on the frontline needs to know. In Annals of Medicine and Surgery (Vol. 55, pp. 24–29). Elsevier Ltd. https://doi.org/10.1016/j.amsu.2020.05.014
Goyal, D. K., Mansab, F., & Bhatti, S. (2021). Room to Breathe: The Impact of Oxygen Rationing on Health Outcomes in SARS-CoV2. Frontiers in Medicine, 7, 967. https://doi.org/10.3389/fmed.2020.573037