Covid-19 crisis: Hospitals scrape bottom of barrel as oxygen runs out

Not just patients, social media is seeing cries of help from big hospitals which have often been left with just a few hours of supply

As his oxygen level dropped below 40 and family struggled to arrange an oxygen cylinder or hospital bed in Lucknow, retired government official S P Srivastava died.
 
“No private person was allowed to refill cylinders after a state government order. We couldn’t find a cylinder for two days,” a family member said.
 
Not just patients, social media is seeing cries of help from big hospitals which have often been left with just a few hours of oxygen.
 
On Friday morning Sir Gangaram Hospital in Delhi said it had lost 25 of its critical patients in the past 24 hours and that it was left with just two hours of oxygen.
 
“Resorting to manual ventilation in ICUs and ED. Major crisis likely. Lives of another 60 sickest patients in peril. Stop catastrophe. Need Oxygen to be airlifted urgently,” the hospital said.
 
While Gangaram was provided with 2 tonnes of oxygen, enough for another five hours in the morning, its spokesperson said the patients had not died of oxygen shortage.
 
Elsewhere in Delhi another hospital said it had lost at least one patient to oxygen shortage but it could not say so on record. “They will shut us down and say why we did not manage the resources properly. Oxygen is in short supply and we have ambulances lined up outside since we can take a limited number of patients in,” a senior doctor said.
 
Oxygen was also supplied to Max Healthcare after it tweeted that it had less than an hour’s oxygen left in two of its hospitals.
 
With hospitals surviving hand to mouth in terms of oxygen, some have stopped admitting patients. Manipal Hospitals, India’s second-largest hospital chain, for instance, said it would stop admission at its Jaipur facility from Friday, with very little oxygen left.
 
“We have decided to prioritise and save the lives of those who are already admitted and thus we are helpless and have to stop fresh admissions in Jaipur,” said Dilip Jose, managing director and chief executive officer, Manipal Hospitals.
 
Hospitals are witnessing a surge of seven to eight times in oxygen consumption. Two to three days of oxygen was left in other Manipal hospitals in Karnataka, Tamil Nadu, Andhra Pradesh, and Goa.
 
“In Jaipur, the need is much more. It is about 10-12 fold of what we need in normal times. We did not face such a situation in the pandemic last year,” Jose said.
 
From increased consumption and delays in tankers reaching hospitals to suppliers unable to meet demand, inter-border movement -- there are manifold challenges to oxygen supply. “Food, shelter and clothing are not the only essentials. We should add air to the list now ...The way people died of Covid recently is cold-blooded murder,” a Delhi-based hospital’s owner said.
 
Fortis Hospital in Haryana, for instance, had raised an alarm it had 45 minutes of oxygen left on Thursday night and that its oxygen tanker was stuck in Bhiwadi, Rajasthan. The issue was resolved after multiple calls to various people in authority.
 
“We have failed collectively in upping our infrastructure and using the time after the first wave to prepare for the impending second one … epidemiologists and virologists should monitor this and not clinicians like us,” said Bishnu Panigrahi, group head, medical strategy and operations, Fortis Healthcare.
 
In the wake of the oxygen crisis, the Maharashtra Covid19 task force has advised hospitals to discontinue the use of HFNC (high-flow nasal cannula) because it guzzles oxygen.
 
“For patients with respiratory distress, non-invasive ventilation may be used. The high flow oxygen or HFNO machines use almost 80 litres per minute at times,” said Sanjay Oak, who is heading the task force. The state produces roughly 1,250 tonnes of oxygen daily. Almost all of it is now getting used.
 
In Uttar Pradesh, which is among the worst affected in the second wave of Covid-19, the ‘Oxygen Express’ has started its onward journey from the industrial town of Bokaro, Jharkhand.
 
Additional Chief Secretary Awanish Kumar Awasthi said the train carrying oxygen container vehicles would supply oxygen to Varanasi and Lucknow -- the two cities that account for the maximum coronavirus caseload in the state.
 
UK variant could be behind surge in Delhi: NCDC
 
The current wave of the coronavirus pandemic in Delhi could have been fuelled by the UK variant as its prevalence in genomes sequenced nearly doubled from the second to the last week of March, Sujeet Singh, director of the National Centre for Disease Control, said on Friday. Speaking at a webinar, Singh said the UK variant of coronavirus is also dominant in Punjab. In Delhi, there are primarily two types of variants — B.1.617 and the UK strain — found in the genome sequenced samples, the NCDC director said.
 
The B.1.617 variant of coronavirus is also known as the double mutant strain.
 
The UK variant was found in 28 per cent of samples in the second week of March. In the last week of the month, 50 per cent of samples had this variant, Singh said.
 
"If we try to co-relate, the surge we are observing in Delhi, it directly co-relates to the type of variant which we are observing," he said.
 
So far, Singh said, 15,133 samples have been sequenced by INSACOG, a consortium formed in December last year to increase viral genomic surveillance in order to understand the spread of the coronavirus in a rapid and robust manner.

Dr Venkat Raman Kola, clinical director – Department of Critical Care Medicine, Yashoda Hospitals, Hyderabad, which runs over 2400 beds across its network hospitals pointed out they curtailing the high oxygen utilising devices like high-flow nasal cannula (HFNC) which roughly uses 5-10 times more oxygen than ventilators. Kola said that they were trying to procure oxygen concentrators which can provide 5 litres to 8 litres oxygen per minute that can be used in non-ICU patients. 

"We are planning to divert all available oxygen for ICU & Emergency department use. We have to restrict our admission to a point to avoid the shortage of ventilators for existing in-patients," Kola added.