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The devastating nationwide second wave of the Covid-19 pandemic saw the central and state governments installing pressure swing adsorption (PSA) oxygen generation plants in hospitals across the country, to ensure adequate supply for Covid-19 patients. However, with the demand for oxygen in hospitals across the country going back to nearly pre-pandemic times, many of the hospitals are now working overtime to make sure these plants don’t fall into disrepair.

Even a senior functionary in the central government, which sanctioned at least 1,500 PSA plants for states, acknowledged that maintenance is becoming an issue, especially in states with weaker infrastructure.

The Delhi government’s Lok Nayak Hospital, which is the largest Covid-19 facility in the city, has over five PSA plants, with a capacity of generating around 5MT oxygen daily, of which two were installed after the Covid crisis. The hospital has also increased the storage capacity of its LMO from 30MT to over 60MT.

When HT visited the plant in Lok Nayak, the hospital administration showed there was a dedicated team looking after the maintenance of the infrastructure, giving routine updates to the private partners for the upkeep of the plants. However, in the absence of a high volume of Covid patients currently, the team explained, the oxygen levels were adjusted and also diverted to non-Covid departments. This was being done to ensure that the equipment did not become obsolete and non-functional at a time of need.

According to medical experts, under ideal conditions, 55 tonnes of oxygen per day is enough to cater to 2,500 beds, but the actual distribution cannot be confirmed as it depends on the requirement of each patient. Depending on the severity of the illness of patients they are put on high flow or low flow oxygen.

“We have nearly doubled our storage and transportation capacity now. We are definitely much better prepared now,” said Dr Suresh Kumar, medical director, Lok Nayak Hospital. Oxygen was sourced to Delhi from plants in several states that including Uttar Pradesh, Haryana and Odisha.

The distribution task across India was taken over by the central government.

A senior doctor at another Delhi government run hospital— Guru Teg Bahadur Hospital— said that currently with the oxygen preparations made by the hospital, it has a three-layer arrangement—oxygen cylinders, LMOs and PSA plants. He said that oxygen from these in-house facilities is distributed to various departments of the hospital on a need-basis.

“Hospitals primarily depend on LMO, and PSA plants mostly act as backup. During the Delta wave, since the viral infection mostly impacted people’s lungs, many patients needed high flow oxygen and that overwhelmed our facilities. We have never seen such a situation before,” the doctor said.

Apart from government hospitals, all major private centres have also invested in its oxygen infrastructure over the last year.

On the orders of the Delhi High Court, all private hospitals in the city with a bed capacity of over 100 have also started installing their own PSA plants, with a capacity of at least twice their normal requirement. The hospitals that were the worst hit by the oxygen crisis during the Delta wave--Jaipur Golden Hospital, Batra Hospital, Sir Gangaram Hospital, Saroj Superspeciality Hospital--have over the course of the last year identified private vendors and set up their own PSA plants.

The administrations of most of these hospitals, however, said that their first option continued to be LMO and PSA plants were a plan-B.

Dr Bishnu Panigrahi, group head (medical strategy and operations) at Fortis Healthcare, said that if a situation similar to what Delhi experienced in April-May were to reoccur the city would be better prepared to handle it.

He also said that even though the current Covid variants are not impacting the respiratory systems of patients, the oxygen facilities added in hospitals will have to be diverted for non-Covid patients, which will only help health care infrastructure.

“With the arrangements that we have made now, we will definitely be in a better position to handle a crisis of a similar scale. There are a few downsides to installing these oxygen plants, the electricity consumption increases and there is a slight noise levels so some nearby residential areas could have complaints but its benefits far outweigh these minor inconveniences,” added Dr Panigrahi.

Despite the downside, the arrangements had to be made in a short span of time to ensure there was not a repeat of what was seen during the delta wave.

As Omicron-driven third wave hit the country in January, this year, the centre directed hospitals to keep at least 48-hour buffer stock of oxygen ready, to meet any rise in demand for oxygen while treating Covid-19 affected patients.

On January 11, Union health secretary, Rajesh Bhushan, said in a letter to states, “…all health facilities providing in-patient care and oxygen therapy should have buffer stock of medical oxygen sufficient for at least 48 hours. The liquid medical oxygen tanks at the health facilities should be sufficiently filled and uninterrupted supply chain for their refilling should be ensured…”

The trigger behind writing to states as the Covid infections began going upwards was centre’s harrowing experience of the devastating delta wave from nearly eight-nine months ago, with patients desperately running around hospitals to search for a vacant oxygen bed that wasn’t to be found.

The national capital was the worst hit during the fourth wave.

The increased demand for oxygen can be gauged by the fact that Delhi’s daily oxygen requirement was anywhere between 178-220 metric tonnes before the crisis, which increased to almost 700 metric tonnes during the peak of the Covid wave, last year.

The natural reaction was to direct a major chunk of the resources towards oxygen preparedness.

Senior Delhi government officials said that since April last year, the city has learnt its lesson and has worked towards building a robust infrastructure for medical oxygen across government and private hospitals to avoid a re-run in 2021.

“We have done our homework over the last few months. The capacity of liquid medical oxygen (LMO) has been increased, we have set up PSA medical oxygen generation plants in hospitals and we also have oxygen tanks that are equipped with modernistic telemetry devices to monitor the oxygen levels in real-time. It was a positive sign that Covid waves since Delta, have been relatively milder and patients have not required this infrastructure but we are prepared for a worst-case scenario,” said a senior official of the Delhi government’s health department who has followed the procurement of oxygen infrastructure.

Government data show that since the shortage, at least 40 hospitals in the city have installed PSAs on their premises. A PSA oxygen plant uses specialised technology that absorbs nitrogen from ambient air to concentrate oxygen for supply to hospitals. Till May last year, Delhi had the capacity of around 730MT of LMO, which has now been increased to 991.51MT (as of April 19, 2022).

Apart from this, the city also has a buffer stock of 442MT. The Capital has also installed 97 PSA plants with a capacity of 116.06MT and has commissioned another 97, which is likely to come up in the coming months. According to the latest data by the Delhi government, the Capital’s present oxygen consumption is around 220-250MT per day.

“Delhi continues to rely heavily on liquid medical oxygen (LMO) facilities from neighbouring states such as Haryana and UP, but over the last year the government has improved the LMO capacity as well. Work has been awarded for 15 LMO tankers, we expect to receive all by mid-June,” said a senior health official.

The officials also said that Delhi was given a target to set up eight PSA plants from the central government’s PM-CARES fund, but these were primarily targetted for the centre-funded hospitals including the All India Institute of Medical Sciences (AIIMS), Ram Manohar Lohia Hospital, Lady Hardinge Medical College and affiliated hospitals.

A spokesperson at the AIIMS said that for centre-funded hospitals in the national capital, the patient load is comparatively in general is also much higher and additional infrastructure is helpful in better management of daily hospital functioning.

“During the Covid many non-Covid patient admissions and surgeries were temporarily halted, and the resources were all diverted for Covid care. additional oxygen infrastructure in a premier institute like AIIMS is always helpful and we have got all the assistance we need from the centre,” said the spokesperson.

As per a government statement issued last year in December, the central government sanctioned 1563 PSA oxygen generation plants of which 1463 were commissioned. “These include 1225 PSA plants which have been installed and commissioned under PMCARES Fund in every district of the country. Additionally, 338 PSA Plants are set up by PSUs of Ministry of Petroleum & Natural Gas, Ministry of Power, Ministry of Coal, Ministry of Railways etc. till date. The States have also been asked to install PSA plants in public health facilities and facilitate installation of PSA plants in private health facilities.”

The empowered group constituted by the government on emergency management plan and strategy recommended that for calculation of oxygen demand, the required rates of oxygen flow in non-icu and icu setting are 10 and 24 liters per minute per day per case, respectively.

Based on the above, according to government calculation, these plants could support at least 1,00,000 beds per day.

The PSA Plants under PMCARES have been supplied and commissioned by the Central Government. States provided for space, 3-phase power supply, DG set for uninterrupted power supply and availability of medical gas pipeline system for interconnection with PSA plant.

The department for promotion of industry and internal trade and its subordinate office the Petroleum & Explosives Safety Organization (PESO) in collaboration with the All India Industrial Gas Manufacturers’ Association(AIIGMA), monitors overseeing the availability of medical oxygen to end users by ensuring that there is no disruption in the production, transportation and supply of medical oxygen and to maintain production in close coordination with the manufacturers of medical oxygen and cylinders.

For this purpose, PESO also nominated nodal officers state wise.

“Some states have been pointing out that the PSA plants have become more like white elephants for them as with the demand down, it was taking a lot to keep them running. They said it requires three persons to maintain a plant; we advised them to share the responsibility of each PSA plant among three-four hospitals. It does not seem feasible to them. The state governments will have to step up and keep these going now that the infrastructure has been created. We have to remain future ready,” said a senior functionary at the Union ministry of health and family welfare aware of the matter, requesting anonymity.

Soumya Pillai covers environment and traffic in Delhi. A journalist for three years, she has grown up in and with Delhi, which is often reflected in the stories she does about life in the city. She also enjoys writing on social innovations. ...view detail

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