While India fights oxygen shortage, another challenge lurks in the shadows

Amid the coronavirus pandemic, India is dealing with shortages on all fronts, be it oxygen, medicines, vaccines, or even doctors and nurses. The capacity is limited and the demand is overwhelming. As a result, there is chaos and what is being called a system collapse.

So far, India has two vaccines available for use — Covishield, which is the Oxford vaccine, and Covaxin, which is made in India. Put together, India gets about 70 to 85 million doses per month.

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Earlier, 15 per cent of the total supplies were being exported butfor the moment, India has stopped exports. So we have 70 to 85 million per month and now about 170 million doses per month if India has to cover 80 per cent of the population by the end of this year.

If India aims at universal coverage, i.e. vaccinating the entire adult population, we need about 220 million doses per month. One also has to remember that even though these are estimates, the numbers fall short.

The supply is limited because the producers are limited. At the moment, more than 10 million doses are reportedly available with states and union territories. In the next three days, another eight million doses will be supplied.

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This is what we have to start vaccinating people between 18 and 45 —almost 600 million people. So, if you get an appointment, do not miss your turn and take what you are getting, be it Covishield or Covaxin.

The other big shortage, and a very important one, is oxygen. It is essential for the treatment of coronavirus. Patients with severe symptoms run out of breath because the virus spreads to the lungs. So, patients need supplemental oxygen as that is what keeps them alive, as doctors treat the infection.

In case one cannot find supplemental oxygen, patients keep gasping for breath, which worsens the infection and can lead to death.

Indian hospitals do not have enough oxygen and the crisis exploded last week as hospitals gave countdowns about how oxygen was about to run out in two hours, four hours, or even 40 minutes. Medical experts turned to social media with appeals and went to court asking for supplies.

Is India out of oxygen?

Surprisingly, the answer to this is ‘no’.

India is a significant producer of oxygen as it produces more than 7,000 metric tonnes of oxygen per day. However, in recent weeks the demand has shot up tremendously.

According to one estimate, India's coronavirus patients need more than 13 million cubic metres of oxygen. This is among the highest in the world.

The requirement for medical oxygen has increased by 76 per cent — from almost 4,000 metric tonnes per day to approximately 7,000 metric tonnes per day.

So, on paper, India can technically meet this demand and can even have a few metric tonnes to spare. However, in reality, this oxygen is not reaching patients and hospitals because India doesn't have enough tankers to supply it.

Therefore, several countries are stepping in to help and are sending oxygen tankers to India. This week, 14 tankers arrived from three countries.

India already possesses more than 1,200 oxygen tankers. According to reports, they have a capacity of more than 16,000 metric tonnes of liquid oxygen but it takes upto a week of turnaround time. It takes one week for officials to pick up oxygen from one source and deliver it to another.

The biggest bottleneck are cryogenic containers which are used to transport oxygen in liquid form.

India might face another challenge

India is reporting over 300,000 daily cases and if this trajectory continues, we might not have enough doctors to treat the patients.

Recently, some scientists from India's IITs came up with a model. They believe the second wave will peak by May but India will still be dealing with millions of cases. Their estimate says India could have 3.3 to 3.5 million active cases between May 11 and 15.

While the country can arrange more beds and oxygen tankers till then, India suffers a serious crunch for skilled medical personnel.

Before the pandemic, we had one doctor for more than 1,400 patients in India. There is a 76 per cent shortage of medical specialists in government hospitals. The second wave has pushed India's doctors to their limits.

The frontline workersare working through the week and overtime to save lives. Student doctors and nurses could be roped in to help the struggling medical experts.

According to one claim, more than 200,000 nursing students and 25,000 student doctors are waiting in the wings as they have completed their training and are waiting to appear for their final exams.

India could tap into this talent pool. The authorities can postpone the exams for now, and let them work with existing healthcare workers.

However, all of these are proposals based on trajectories and projections which may or may not come true. Experience, though, has taught usthat we must hope for the best, and prepare for the worst.