In an internal audit, the Maharashtra government has found that it has thrice the number of Covid-19 patients on oxygen support than the national average, indicating a tendency to put patients, including those who are moderately or mildly ill, on oxygen at times for more duration than necessary.
On September 18, state Health Secretary Dr Pradeep Vyas wrote to all districts raising “serious concerns over the quantum of oxygen being used in Maharashtra per day”.
“There may be tendency on the part of private hospitals to put patients on oxygen for duration more than necessary, may be for commercial reasons. We need to monitor such activities scrupulously,” the letter by Vyas said.The health department has now directed hospitals to not use more than 7 litres per minute of oxygen per patient in normal wards and 12 litres per minute in intensive care units (ICU) per patient apart from foxing pipeline leaks.
Data from the Union health ministry suggest that 5 to 6 per cent of active Covid-19 patients across the country are on oxygen support and require treatment in ICU. In Maharashtra, 15 per cent of active patients – three times the national average – are on oxygen support.
“It is possible that some patients no longer require oxygen support but they are still kept on it by private doctors. Maharashtra is consuming more oxygen than necessary,” an official said. The excessive use of oxygen for Covid-19 patients may exhaust state’s supply soon, the official added.
The state is already witnessing problems with oxygen transport and supply to hospitals in north Maharashtra and Marathwada that have no major manufacturers to quickly supply medical oxygen. The biggest manufacturers, Inox Air Products and Linde India, produce over 800 metric tonne and are located in Mumbai, Pune, Raigad belt and Nagpur. But regions like Latur, Beed, Osmanabad, Jalna and Satara are suffering from oxygen shortage.
Maharashtra has the capacity to produce 1,210 metric tonne of oxygen per day. Currently, there is demand for 868 metric tonne for medical and industrial purposes. Of this, 600 metric tonne is utilised for medical purposes.
With the state recording 20,000 to 25,000 new cases every day, senior officials anticipate Maharashtra will surpass its oxygen production limit within a few days. Over 27,000 Covid-19 patients are currently on oxygen support across the state.
While according to official data, the state currently has 2.91 lakh active Covid-19 patients, the health secretary said that of these, at least 1.08 lakh have been discharged but their information has not been updated on the government portal.
Each district has now been asked to list its oxygen demand based on the number of Covid-19 patients and take a review of those who do not require oxygen support.
The districts will have to maintain proper records of patients on oxygen support. In several hospitals that are not designated Covid facilities, patients are admitted based on rapid antigen test results and put on oxygen support. The health secretary’s letter made note of this and directed the collectors and commissioners to put an end to this.
The decision has, however, not gone down well with private doctors.
Dr Jignesh Thakkar, a radiologist from Mumbai, said that patients may require more than 12 litres of oxygen per minute if they are critical. “Are we supposed to call local authorities if a patient needs more oxygen? If there is a pilferage, patients should not be made to suffer,” he added.
Private doctors said critical patients can require 30 litres to 60 litres of oxygen per minute if high flow nasal cannula is used.
According to pulmonologist Dr Jalil Parkar, oxygen requirement varies from patient to patient and rationing is not possible.
“This is absurd to fix oxygen capacity. A physician should be allowed to decide on the treatment process. We do not indulge in any malpractice or sell oxygen that such a direction had to be issued.”
On noticing that beds were unnecessarily occupied by patients, the Brihanmumbai Municipal Corporation in Mumbai had on September 19 issued a notification directing that asymptomatic patients be discharged from hospitals. Parkar said he has several patients who even after clearing Covid viral load, still require oxygen support.
Meanwhile, in the letter, Vyas also came heavily down on Thane, Nagpur and Pune for not updating their patient discharge data. This “is unnecessarily bringing the state under criticism”, the letter stated.
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