By Mohit Sharma
It’s now more than a year since the second wave of COVID-19 stretched the Indian health apparatus to its limits. Record cases across the country and an unprecedented surge in the demand for medical oxygen forced the government and medical establishments to rethink innovative ways to make the lifesaving gas available. This led to efforts to increase production capacity in plants across the country, with Prime Minister Narendra Modi revealing in October 2021 that medical oxygen production capacity increased to more than 9,000 metric tonnes from 900 metric tonnes before the intervention.
At the heart of these efforts was the installation of thousands of pressure swing adsorption (PSA) oxygen plants across all the districts of India. The plants, put in place by the government, private hospitals, and international donors, peaked at 3,756 commissioned throughout the country by April 2022. With a combined daily capacity of about 18,000 metric tonnes of oxygen, it is safe to say that the response to oxygen shortages in India was swift and effective. However, the pandemic has since eased and demand for medical oxygen has dropped to around 200 MT per day.
This present reality has thrown up a new challenge for hospitals and health facilities across the country. Hospital administrators have to find a way to keep their plants running, keep their technicians engaged, and maintain their relationship with liquid medical oxygen (LMO) suppliers. Beyond the PSA plants, oxygen cylinders which became a constant sight during the peak of COVID last year also have to be kept running and active.
The dilemma of PSA-equipped hospitals post-COVID
PSA plants produce oxygen by removing the nitrogen and carbon dioxide content from ambient air. In fact, some sub-standard PSA plants may have to be run for at least 40 minutes to get a good level of purity ranging from 40% to 60%, which is still not suitable for medical use. This means a facility has to run such a plant for a few hours to get the quality of oxygen that oxygen-reliant patients can use. However, certified top-quality plants will give the right results in about an hour.
This situation amounts to excess oxygen, as an average plant produces between 250 to 1,500 litres per minute, depending on capacity. Meanwhile, most hospitals only need about 50-300 litres. But storing the excess oxygen in cylinders will also cost some money for a pressurising machine. Some hospital administrators peg the cost at almost Rs 25 lakh for a standard model. This is necessary because oxygen (and most other gases) have to be pressurised when stored in a cylinder. This is now a burden too heavy for hospitals to bear.
Finding solutions for unused oxygen cylinders
Medical oxygen demand in India rose to a record 9,000 metric tonnes during the second wave of the deadly coronavirus. The streets and hospitals were filled with patients holding on to oxygen cylinders in queues and by their beds. But with demand falling drastically, there is a need to put PSA plants and cylinders to use to prevent deterioration. The government, through the Union Ministry of Health and Family Welfare, is already overwhelmed with complaints from large hospitals that can’t keep up with the cost of running their PSA plants and is now proposing a solution that bridges the gap between these two problems.
There are indications that PSA-equipped hospitals may have to fill up cylinders and supply them to those smaller hospitals in a bid to control excess demand and commercialise the PSA plant operations at the same time. Nursing homes around such hospitals can also be supplied using cylinders, as against the pipelines used in supplying oxygen onsite. This measure can help provide these medical centres with an extra source of income to help run the PSA plants and mitigate the risk of shutting them down for long periods. However, the cost and machinery required for filling up cylinders is another mountain that may be too steep to climb.
Another possible solution might be the provision of power subsidies for hospitals with PSA plants so that they can keep them running. This can help to cut down electricity bills significantly while ensuring that production is sustained in a manner that ensures a win-win situation for everyone. The major problem for hospitals’ PSA-equipped plants is the high energy-cost burden of keeping them running, so a subsidy will help to assuage the situation.Some may also suggest a commercial offload of excess oxygen for the non-medical market, including its use in submarines, aircraft systems, life support, rocket propellant, steel cutting, etc. However, industry standards are different for hospitals as they are for other applications and industries. Finding a way around this would require some form of technological interjections or hybrid innovations which may not be practical.