Andhra is managing its medical oxygen supply but grappling with distribution

Officials have said that while there is an adequate supply of medical oxygen for now, few districts are facing problems due to operational issues.
Liquid Medical Oxygen tanker for treatment of Covid-19 patients onboard a wagon at Kalamboli Goods Yard in Navi Mumbai
Liquid Medical Oxygen tanker for treatment of Covid-19 patients onboard a wagon at Kalamboli Goods Yard in Navi Mumbai
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On April 22 morning, a train carrying empty tankers arrived in Visakhapatnam from Maharashtra, to take back liquid oxygen filled at the Vizag steel plant. While the steel plant doesn’t usually supply medical oxygen to hospitals, it has been tapped into since the first wave of COVID-19 in March 2020. Amid rising coronavirus infections, as a grave shortage of oxygen is being reported in many states in India, some of the Vizag steel plant’s reserves have been diverted to Maharashtra, while the rest are being distributed within the state. State government officials have said that so far, they have been able to meet the daily requirement of medical oxygen with the allocations made by the Union government. But with consumption expected to increase in the coming days, the state is looking to address challenges like transporting oxygen from distant sites, and ensuring distribution is streamlined to prioritise hospitals facing a shortage. 

Within Andhra Pradesh, there are three producers of medical oxygen — Rashtriya Ispat Nigam Limited (RINL) (or Vizag steel plant) and Ellen Berries in Visakhapatnam and Liquinox of Srikakulam. As per the allocations made by the Union government, Andhra gets a daily allocation of 100 metric tonne of medical oxygen from RINL, 60 metric tonne from Liquinox, and 40 metric tonne from Ellen Berries. From within the state, this amounts to a daily supply of 200 metric tonne. While it is currently possible to draw 197 metric tonne per day from RINL, 97 metric tonne has been allocated to Maharashtra. 

Speaking to TNM, IAS officer Shan Mohan Sagili, who has been deputed to manage the oxygen supply control room in the state, says that the RINL’s present capacity is based on reserves that were stocked up. “The supply is likely to come down once the reserves are depleted, as they can actually produce around 100 metric tonne per day. So that’s a challenge we need to prepare for, but we are hoping to get more allocation by then. So far, we have been able to meet daily medical oxygen requirements,” Shan Mohan said.  

The state has also been allocated around 68 metric tonne of liquid oxygen from suppliers in Karnataka’s Bellary, and around 10 metric tonne from Sriperumbudur near Chennai. On Wednesday, the state was additionally allocated around 150 metric tonne from Angul in Odisha. Medical oxygen from these suppliers is distributed to 146 COVID-19 hospitals across the 13 districts. These include government hospitals as well as private hospitals dependent on the government for oxygen supply.  

Challenges in distribution  

The Union government’s decision to allocate oxygen from distant locations in Odisha has been criticised by Telangana Health Minister Eatala Rajender. Andhra Pradesh is also now faced with the difficulty of bringing in the allocated oxygen all the way from Odisha. It would take four days for a tanker leaving from Andhra to reach Angul, fill oxygen and return, Shan Mohan said. “The turnaround time for vehicles is at least four days. To transport 150 metric tonne per day seamlessly, we would need 30 to 40 tankers of around 20 metric tonne capacity. It’s difficult to arrange so many cryogenic tankers at this point. We are considering other options, to see if it’s possible to cut down on turnaround time.”

The three suppliers within the state are concentrated in the north Andhra region.  While the Bellary area is catering to the Rayalaseema districts — Anantapur, Kadapa, Kurnool and Chittoor — the rest of the state is receiving its supply from the Vizag region, Shan Mohan said. 

According to the state health department, in a recent meeting with Covid command and control centre Chairman KS Jawahar Reddy, many District Collectors stressed on the issue of availability of oxygen, with Jawahar Reddy assuring measures towards centralised supply and distribution of oxygen. On Thursday, state Industries Minister Mekapati Goutham Reddy said that Krishna, Guntur, Prakasam, Kurnool and Nellore districts have been facing issues related to oxygen shortage. By Thursday evening, the Industries Department would submit a report with information on district wise current oxygen consumption and projected requirements for the coming days, as well as oxygen manufacturing capacity of each industry, he said. 

According to Shan Mohan, issues have been arising with districts as the distances even within the state are too long from Visakhapatnam and Srikakulam. A tanker takes about 6 hours to be filled, and the long queues at filling sites are coupled with distances of 400 to 500 km to cover. “We need to know where each vehicle is at any given time. We are trying to use GPS systems to track the vehicle,” he said. 

While the supply of medical oxygen is adequate for now,  the major challenge is to manage the ensure it reaches hospitals on time, he said. “On average, we need to transport around 15 to 20 tankers daily. Some districts end up in a difficult situation when the tanker assigned to them is delayed and their storage is depleted.” Officials are trying to streamline communication so that the control room can reprioritise and divert vehicles to other districts, or share with neighbouring districts, he said, adding that finding enough cryogenic tankers has also been a concern.  

Rising oxygen requirement

The state government is currently distributing oxygen to 146 hospitals which have a total of 26,446 beds with an oxygen pipeline. The government has projected a maximum consumption of around 416 metric tonne per day based on the total number of beds, according to Shan Mohan. The average requirement has been lower and within the supply available so far, with around 280 metric tonne consumed on Wednesday while supply was around 309 metric tonne. However, the requirement has been going up day by day, Shan Mohan said. 

Other private hospitals that are not dependent on the government also get their supply from the same three suppliers in north Andhra, and the government allocations are done without disrupting their existing tie-ups with private hospitals. The two private suppliers other than RINL have ramped up production in order to meet government requirements as well as existing commitments, he said.  Across districts, the storage capacity of various forms of medical oxygen is up to 515 metric tonne. 

On Thursday, state Health Minister Alla Kali Krishna Srinivas (Nani) assured that the oxygen supply is in line with the requirement level. He said that the state currently needs around 360 metric tonne of oxygen, adding that the Union government will provide assistance to set up a new oxygen plant in the state. 

Of the 150 PSA (Pressure Swing Adsorption) oxygen plants that were sanctioned by the Union government at government hospitals across India, five were to come up in Andhra Pradesh, in Vizag, Kakinada, Kurnool, Guntur and Tirupati. Three of these hospitals (in Kakinada, Kurnool and Vizag) have received the machinery and are awaiting installation of the plant, and hospital authorities said that they are expected to be up by the end of May. The Guntur GGH (Government General Hospital), and the Ruia GGH in Tirupati, hospitals are yet to receive the machinery. Each of these PSA plants is expected to generate 900 to 2000 litres per minute of liquid oxygen. These PSA plants or concentrators, however, would function at a smaller scale to meet emergency demand of 1 to 2 metric tonne a day, said Shan Mohan. 

Industries Minister Goutham Reddy said that the Andhra Pradesh Medtech Zone, a medical equipment manufacturing facility in Vizag, must also be used to produce oxygen, adding that the government will work towards producing 300 metric tonne at any cost. Amid complaints from Telangana Health Minister over unfair resource allocation by the Union government, and the Tamil Nadu Health Secretary’s objection to compulsory diversion of oxygen from Sriperumbudur to the Telugu states, Goutham Reddy said that oxygen will be sent to other states from Andhra Pradesh only after meeting the state’s own requirement. 

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