Updated: April 12, 2021 10:04:59 am
A staggering 472 metric tonnes (MT) of medical oxygen was consumed across the state on April 9, the highest since the outbreak of the pandemic in March last year and double the amount used just five days back, Food and Drugs Control Administration (FDCA) data stated. On April 4, the state had consumed 234 MT medical oxygen, it said.
Surat, Ahmedabad, Vadodara and Rajkot along with the smaller districts like Jamnagar, Sabarkantha, Junagadh, and Bhavnagar have emerged as the highest consumers of medical oxygen as critical cases pile up in government and private hospitals, the data noted. On Saturday, 5,011 fresh cases were reported across Gujarat, taking the total count to 3.41 lakh and toll to 4,759.
According to the consumption data shared by the FDCA, on March 1 the overall consumption of medical oxygen in the state stood at 50 MT, which doubled to 101 MT on March 25. The consumption level further went up to 234 MT on April 4 and in a span of the next five days, it doubled to 472 MT. Of this, the government hospitals are slated to have consumed 220 MT oxygen on April 9 and private facilities 252 MT.
“This time, even the hospitals in smaller districts and towns are consuming oxygen. Facilities are available everywhere. The four major cities –Ahmedabad, Surat, Vadodara and Rajkot, however, are seeing higher consumption owing to higher hospitalisation,” FDCA commissioner Dr HG Koshia told The Indian Express.
Surat, which is currently reporting the highest consumption of medical oxygen — 118.91 MT used on April 9 — had recorded consumption of 2.14 MT on March 1 that further dipped to 1.95 MT on March 13. On April 1, Surat reported consumption of 28.71 MT of oxygen, which shot up to 70.81 MT on April 5.
According to civic officials in Surat, 69.93 per cent of the 1,500 beds in New Civil Hospital (NCH) and 59.93 per cent of the 821 beds in SMIMER hospital are currently occupied by Covid-19 positive and suspected patients.
In Vadodara, the consumption of medical oxygen has been soaring since mid-March. Vadodara had the highest consumption of the four metropolitan cities on March 1 at 12.61 MT, which went up to 50.34 MT on April 1. The city continued to remain the highest consumer of medical oxygen in the state until April 4. On April 9, the city recorded consumption of 87.09 MT to become the third-highest consumer of oxygen after Surat and Ahmedabad.
Ahmedabad, which had a consumption of 10.38 MT to 10.64 MT until March 15, recorded 29.26 MT consumed on April 1. The consumption doubled to 59.09 MT on April 6 and over the three days on April 9, it touched 94.75 MT to emerge as the second-highest consumer after Surat.
In Ahmedabad Civil Hospital, 1,200 beds have recorded 98 per cent occupancy — of these, 333 are ICU beds (ventilator/BiPAP), while 520 are oxygen-equipped, requiring a 20,000-litre liquid oxygen tank at the hospital to be refilled once a day.
Rajkot, which recorded consumption of 3.01 MT on March 1, saw a decline in consumption to 2.80-2.93 MT until March 15. On April 1, it recorded consumption of 11.15 MT, which doubled over the next five days to 22.84 MT and further to 48.32 MT on April 9.
Doctors of Pandit Deendayal Upadhyay Hospital, popularly called Rajkot Civil Hospital, which has 808 beds for Covid 19 patients and all of which were occupied on Sunday, said the demand for oxygen is higher than the previous peak last year.
“Our daily oxygen demand has gone up to 26,000 litres of liquid oxygen, which is higher than around 23,000 litres we used to consume during the previous peak last year. There are two reasons for this: first, we have more patients this time, and second, more patients are requiring high-flow nasal oxygen (HFNO) therapy, which requires pumping around 90 litres of oxygen gas per patient per minute as compare to the 15 litres per minute in case of a patient in a normal O2 bed. One can say, prima facie, people are more unwell this time,” Dr Janmayjay Nathwani, the in-charge of medical store and oxygen in the civil hospital, said.
The hospital has installed capacity of storing 38,000 litres of liquid oxygen. “We are augmenting our storage capacity by around 3,000 litres in the next few days. The supply has remained steady so far without any disruption,” Dr Nathwani said.
JK Patel, the additional collector in charge of management of medical oxygen in Rajkot district said hospitals, both private and public are requiring 40,000 to 43,000 litres of oxygen in a day. “Linde India Limited, Shreeram Oxy Gas Private Limited of Bhavnagar, Herald Infratech of Bhavnagar, Reliance Industries as well as a few smaller local players are ensuring enough supply,” Patel said.
Mukesh Patel, chief managing director of Shree Ram Group of Bhavnagar said his company is diverting even industrial quota o oxygen to hospitals. “Our plant has installed capacity to manufacture 60 tonnes of oxygen per day and out of that, as per the direction of the government, 60 per cent is reserved for medical purposes. But in times of crises, we are diverting our industrial quota to meet the demands of medical oxygen by hospitals. We are even purchasing oxygen from other vendors and supplying it to hospitals in Bhavnagar, Rajkot, Ahmedabad, Vadodara, etc,” Patel said. The diversion of higher volumes of oxygen to hospitals, he said, was affecting ship-recycling activity at Alang.
During the first wave, which saw the peak in September last year, the highest oxygen consumption was recorded on September 21 at 240 MT. On October 1 2020, the state consumed 214 MT.
On November 28, just two weeks after the Diwali festivities, the consumption level was recorded at 196 MT. It rose again to 217 MT on December 5 that year, before going down to double-digit consumption — even under 50 MT per day in February, officials said.
With the spike in the Covid-19 hospitalisations in Surat and Vadodara, both the administrations have launched ‘control rooms’ to maintain oxygen supply chain networks, in the government and private hospitals.
In Surat, the municipal corporation has set up a special control room while in Vadodara, the district superintendent of police has set up one for streamlining oxygen support. Vadodara Officer on Special Duty (OSD) for Covid-19, Vinod Rao, on Friday also appointed SP Sudhir Desai as the nodal officer to coordinate supply, transport and distribution of oxygen in real-time.
In a notification issued for Vadodara under The Disaster Management Act, 2005, Rao has notified all oxygen filling stations and associated departments to be active round-the-clock for real-time filling of oxygen in all government and private hospitals.
Vadodara, which has set up at least three liquid oxygen tanks in the span of 10 days – 13,000 litres capacity each – on Pioneer Homeopathy campus, at a facility of Swaminarayan temple in Atladara, and a Liquid Oxygen (LOX) tanks commissioned on the Samaras Hostel campus of Polytechnic in MS University. The administration has also decided to set up a refilling station on the Navlakhi compound, located opposite SSG hospital, to reduce the turnaround time of oxygen tankers pressed into action for refilling LOX tanks at hospitals.
Gujarat Medical Education and Research Society (GMERS)-run Gotri hospital in Vadodara has a liquid tank of 13,000 litres, while the SSG hospital has two tanks of 20,000 litres each. On Saturday, the administration decided to add 50 oxygen concentrators to SSG hospital to increase bed capacity.
Dr Sheetal Mistry, former Covid-19 nodal officer of Gotri hospital, who is now the advisor to the administration and oversees the work to ramp up beds and oxygen supply, said, “There are two facilities — one is liquid to liquid filling that involves cryogenic cylinders and liquid to gas refilling involving jumbo and small cylinders that takes time. Liquid oxygen is less inflammable and needs proper vapouriser to build pressure, which is easier with a gas form of oxygen where building pressure is easier. We have plans to set up about 3,000 beds equipped with oxygen supply more in the coming days. We have asked an agency to work out the construction of the refilling tank.”
Mistry said the increase in consumption can be gauged from the fact that Gotri Covid-19 hospital was using only 6 MT oxygen per day in February which has now increased to 22 MT per day and SSG has a consumption of 20 MT per day on average while the rest of the 45 MT is used by private hospitals and other centres set up for Covid-19.
In Surat’s New Civil Hospital (NCH), currently, there are three oxygen tanks with a capacity between 13,000 litres and 17,000 litres, while SMC-run SMIMER hospital has two tanks of 10 and 20 kilolitres, respectively. On Friday, the total active cases recorded with the SMC health department is 1725 patients, of which 1,020 patients are admitted at NCH, 481 at SMIMER hospital and remaining at private hospitals.
Surat Municipal Corporation’s chief accountant Tejas Ariwala, who heads its oxygen supply control room, said: “The Inox company largely supplies oxygen to NCH and SMIMER. The 105 private hospitals, with over 20 oxygen-equipped beds, are maintaining supply chains from around 24 distributors. To overcome the oxygen supply issue, we are in contact with the distributors of the city. We are trying to sort the problem in the supply chain and holding talks with the distributors of oxygen cylinders.”
Surat’s Government Medical College dean Dr Ritambara Mehta said since mid-March the oxygen usage had gone up in the hospital and at SMIMER, for which the oxygen stock capacity has been increased. “We are also installing a plant of oxygen concentrator on NCH campus, and the machinery fitting process is underway. The machines will take oxygen from the atmosphere and it will be processed in the plant and later supplied through the pipeline network to the beds. Twenty litres of oxygen can be generated from the atmosphere by this plant,” Dr Mehta said.
Oxygen manufacturers ‘under pressure’
Meanwhile, the companies dealing with medical oxygen say they, too, are under immense pressure. An executive of an oxygen manufacturing company said the rates for the supply had increased only nominally. “We have not increased the rates after they were revised last year. Some private companies are selling liquid oxygen at Rs 35 per cubic metre, but the standard price for Covid-19 hospitals is around Rs 21 per cubic metre (Rs 18 + GST) for most cities. The situation is better this time because the government has made it mandatory to divert oxygen for medical use but there is a lot of pressure due to the increased demand from all cities, especially Surat and Vadodara. Last week, two private hospitals in Ahmedabad made panic calls that they would run out of oxygen in a few hours. The management had to acquire tankers from other cities like Bhavnagar on a war footing,” the executive said.
A private Covid-19 hospital in Vadodara said while vendors of oxygen are not refusing to refill due to the administrative notifications in place (which makes refusal a punishable offence during the disaster), the charges were skyrocketing.
A hospital located at Vadiwadi said, “We paid even Rs 45 per cubic metre of LOX and Rs 20 per cubic metre for oxygen cylinder more than four times in the last one month because we needed the refilling quickly. We have raised the issue with the administration and hopefully, with the refilling station being set up in the city itself, the cost will also be regularised. The consumption is extremely high because High Flow Nasal Cannula (HFNC), NRBM masks, ventilators and BiPAPs are working round-the-clock in bulk. The prices of pre-Covid-19 times may never return. Despite the fact, due to the increasing (Covid-19) centres pan-India, there is a shortage not just of the LOX but also of cylinders like the Dura and jumbo cylinders which are manufactured elsewhere. We also keep multiple vendors on standby to ensure that the non-availability of tankers or oxygen does not cause a tragedy. The vendors are also overworked with refilling multiple hospitals in and outside their base cities.”
— With inputs from Sohini Ghosh in Ahmedabad
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