The dilemma of oxygen shortage and where Sikkim fares.

The dilemma of oxygen shortage and where Sikkim fares.
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Gangtok, April 26:

With the second wave of COVID-19 hitting the country battered, many states continue to face a severe shortage of medical oxygen, with many hospitals around the country running with a severe shortage of medical oxygen. Many COVID-19 infected patients have died due to this unavailability of medical oxygen, like in Delhi, Maharashtra, Gujarat and Madhya Pradesh. Due to which netizens and the general public have severely criticized the Centre and State government for this dire situation. 

With many blaming the government for this shortage, the reports from India’s FY21 oxygen exports shows that the country produces over 7,000 metric tonnes of liquid oxygen per day, which is enough to support the country’s current requirement of medical oxygen, but uneven supply and logistical issues have caused for an oxygen crisis in some states.

While the demand for oxygen in India was relatively low as the county had exported only  4,502 metric tonnes of oxygen in FY20, whereas during the first wave of COVID-19 in 2020 the demand for liquid medical oxygen (LMO) saw an increase from 700 metric tonnes per day (MTPD) to 2,800 MTPD and with the second wave of COVID-19 this has catapulted to 5,000 MTPD. 

According to oxygen export data by the Department of Commerce, which states that India exported twice as much oxygen to the rest of the world during FY21’s first ten months as compared to the previous financial year. This could be because the demand for oxygen in India was not as much during the previous financial year. During the second week of April, the demand for medical oxygen skyrocketed and saw a five-fold jump.

After Maharashtra started showing a surge of COVID-19 cases in March 2021 and many patients suffering from shortness of breath during the second wave led to the need for medical oxygen to double. Inox Air Products, which produces over 50% of the medical oxygen requirement in India has stated that while the production meets the current demand, the cause of some states facing these problems is due to distribution issues. 

The Health Ministry of the Government of India has announced the government’s decision to import 50,000 metric tonnes of oxygen which will help in mitigating the oxygen demand crisis with an operation already underway. Added to that is the Centre government sanctioning the installation of 162 Pressure Swing Adsorption (PSA) oxygen plants in public health facilities across states, to supplement the medical oxygen capacity by 154.19 metric tonnes. Out of the 162 PSA plants sanctioned by the Centre 33 have already been installed- five in Madhya Pradesh, four in Himachal Pradesh, three each in Chandigarh, Gujarat, and Uttarakhand, two each in Bihar, Karnataka, and Telangana; and one each in Andhra Pradesh, Chhattisgarh, Delhi, Haryana, Kerala, Maharashtra, Puducherry, Punjab, and Uttar Pradesh.

Now looking at how Sikkim fares compared to the rest of the country, due to the mountainous terrain of the state it is difficult for the state to bring in oxygen. However, both STNM Hospital, Sochaykhang and the Central Referral Hospital (CRH), 5th Mile have their respective Volume Swing Absorption Oxygen Plant with STNM Hospital’s operating since 2019. With the Volume Swing Absorption Oxygen Plant taking oxygen from the atmosphere which in turn extracts and collects the oxygen to the oxygen plant as Sikkim's air is relatively cleaner making extraction much easier.

 Sikkim Chronicle spoke to Dr K.B. Gurung, Medical Superintendent of STNM Hospital Gurung on this matter and we came to know that STNM Hospital has an adequate supply of medical oxygen due to the oxygen unit, with plans for more installation of oxygen units with Rs. 50 lakhs provided by the State government being provided for this. 

Gurung also assured that all medicines, testing kits etc. which might come in handy for the treatment of COVID-19 infected patients have already been ordered. As all civil and electrical work has been completed for a new oxygen generation plant, Gurung remarked that by April 30 it will come to the State as it has already acquired approval for the same from the Centre Government. While the installation may take a week but by May-mid it will be done.

Added to that, Gurung has said, “The Chief Minister P.S. Tamang calls me every day on this matter and has assured that help will be given if required so that the general public of Sikkim and the patients face no shortage of medical oxygen. The situation in Sikkim is not as dire as the rest of the nation, so I appeal to the Sikkimese public to not worry.”

Ravi Chauhan, Biomedical Engineer of the Volume Swing Absorption Oxygen Plant with STNM Hospital also in a press conference in an effort to clear any confusions and worries of the general public explained that most other metropolitan hospitals use the Cryogenic oxygen plant which is the process in which nitrogen and oxygen are separated from the air and where high-quality liquid oxygen is used, which takes oxygen from the atmospheric oxygen which is then cooled until it gets liquefied. After this stage, oxygen is distilled at its boiling point of -183 degree Celsius, and this technique is used for generating industrial gases such as oxygen, nitrogen and argon.

Whereas, in Sikkim Pressure Swing Absorption system Oxygen Plant is used and has been in use since October 9, 2020. In this process, no consumables are used and only needs maintenance, as it uses the air from the atmosphere to extract oxygen, and has a purity of 93% as compared to liquid oxygen’s 99% purity. The 93% purity doesn't make a difference, Chauhan said. The Volume Swing Absorption Oxygen Plant will be able to give 500 litres per minute at maximum, whereas the Pressure Swing Absorption System can give 200 litres per minute.

The process has been in use for since long along with the oxygen manifold system which is able to fill 48 jumbo cylinders at a time, as well as 12 emergency cylinders. Chauhan also informed that this system is used both in STNM Hospital’s COVID-19 ward as well as the main hospital. After looking at Sikkim’s patient load, the maximum consumption is 20-metre cube per hour whereas STNM Hospital has a plant that gives a 30-metre cube, along with the manifold which gives 67 cubic-metre per hour oxygen supply. Added to that is the Centre approved oxygen plant, which will operate after April 30, which will give a 12-metre cube per hour oxygen supply. Bringing the total to 109-110-metre cube per hour oxygen in comparison to the maximum 25-metre cube per hour of oxygen supply consumption of the state.

Chauhan also enlightened on the fact that at the moment STNM Hospital has 260 jumbo cylinders in stock, while some might have been sent to Siliguri to refill. Along with 101 B type cylinders, with 10 litres supply which is used directly on patients in case of an emergency, while another 100 has been approved by the government has been sent for, out of which 25 have been delivered. 

Gurung concluded by asking the Sikkimese general public to panic as he assures that there won't be an oxygen shortage in the state.