Here is a brief explainer on the crisis surrounding supply and distribution of liquid medical oxygen in Karnataka.

An health staff covered in PPE lifted an oxygen cylinderFile photo/PTI
Delve Coronavirus Saturday, May 08, 2021 - 11:40

An increased demand and inadequate supply of oxygen has led to multiple hospitals in Bengaluru sending out distress signals since May 3 as they started running out of oxygen. It started with Medax Hospital in RT Nagar, which had around 25 patients needing high-flow oxygen. Soon after, Rajarajeswari Medical College and Hospital, which had more than 100 such patients, sounded a distress call. And then it was Mediscope, Chaitanya, and it continued till the afternoon of May 6, with KC General, ESI Indiranagar and Ramakrishna Hospital in Jayanagar among the latest to sound an SOS alert.

While help arrived just before the situation turned critical for all these hospitals so far, two patients in Arka Hospital in Yelahanka succumbed.

With the risk of immediate danger, attendees of patients admitted in these hospitals are told to shift the patients out in case adequate oxygen is not refilled. But in the current situation, there is next to zero free HDU, ICU and ventilator beds anywhere.

So why are so many hospitals sending Oxygen SOS? 

Storage issues

Given that the state and the country is seeing a massive rise in COVID-19 cases in this second wave, the number of patients needing oxygen support too have increased creating a demand supply gap. The spike in cases in Bengaluru is not an isolated incident – major cities like Delhi and Mumbai too are facing a similar devastating second wave.

Hospitals like Medax and Mediscope in Bengaluru, don’t have their own oxygen storage tanks on the premises and run on dura cylinders, which need to be replaced with new ones by their suppliers. 

Dr Srihari Shapur, MD of Medax Hospital, explained that earlier they used to need 15-20 oxygen cylinders daily but with the increase in number of patients they now need 180-200 cylinders daily. “Earlier if I needed 10 cylinders, I could’ve kept 10 as backup so that even if there was a delay from my supplier, I could manage. But now I don’t have backup as there is already a huge demand and I’m hardly getting what I need, leave alone for backup,” he said.

On May 3, Dr Srihari’s usual supplier, who was late by more than 24 hours, reached the hospital at 11 pm even though the alert was sounded in the afternoon. Dr Srihari’s SOS resulted in Shifa Hospital in Shivajinagar giving him 15 cylinders, which helped him run things for four hours.

He added, “Now, as the demand has increased everywhere, my supplier is not able to meet requirements. He also can’t increase his capacity in terms of vehicles and drivers overnight. I’m willing to buy storage units but there is a shortage of that too. Until this week, we small hospitals were helping each other out by lending cylinders but it has gone out of control now.”

Bigger hospitals like Rajarajeshwari as well as all major government and private hospitals have their own storage units which gives them more breathing space.

“So here, bigger setups that have their own oxygen storage units have more time to plan and get help in case of their regular supplies. We were telling our patients to shift to those hospitals only to realise there are no beds there,” Dr Srihari added.

Like Dr Srihari, Dr Asif of Mediscope Hospital said that he is dependent on vendors for his daily supply and a delay affects them more as they don’t have any buffer stock in the light of the current situation. He said, “Even though now IAS officers have taken over the system, there has been no immediate relief. One of my vendors is based in Hosur, he often complains that his tanker is stopped at the borders.”

Senior IAS officer Munish Moudgil, who has recently been appointed as the nodal officer for oxygen logistics in the state, acknowledged the shortage. He said, “There is a shortage compared to uncontrolled demand. Private hospitals should not add oxygen beds without proper tie-up for oxygen supplies. In this crisis, there is a need for an oxygen audit.”

“Some hospitals are using too much oxygen even for a small number of patients. Optimal and efficient use of oxygen is necessary by all,” he added.

The logistical nightmare

While there is a demand and supply gap, this unprecedented growth in demand has also led to a new set of logistical challenges.

Liquid medical oxygen is manufactured only in Ballari and Bengaluru in the state. Further, another 100 MT is sent to the state in tankers airlifted from Andhra and Odisha. This liquid oxygen is distributed to refilling units which in turn supply it to hospitals in cylinders. Hospitals that have storage capacity can directly fill from tankers and use it through their manifold system.

Manjunath IAS, Bangalore Urban Deputy Commissioner, said, “It’s not easy as people think it is. When there are multiple patients on ventilators needing high-flow oxygen, it requires more oxygen to create adequate pressure for patients once the hospital’s storage units are used up to more than 60-70%. This is the point at which we should ideally refill.”

“But this need for oxygen is dynamic depending on the improvement and deterioration in patients’ condition too. So today the tank might reach the 60-70% level at 11 am but tomorrow it may reach that level only at 3 pm. So there has to be a constant oversight of the process, and it must be ensured that the oxygen is delivered. Today due to the crisis, we’re not in a position to keep oxygen as backup. Even at this point, we’re still adding capacity in terms of oxygen beds,” Manjunath told TNM.

Districts worse off than Bengaluru?

A day before the tragedy at Bengaluru’s Arka Hospital, 24 persons on ventilators had succumbed in Chamarajanagar district (less than 200 km from Bengaluru) due to the same problem. Another 12 COVID-19 patients in Kalaburagi also died due to oxygen shortage this week.

The tragedy at Chamarajanagar saw the District-in-charge Minister and the Deputy Commissioner there put the blame on the Mysuru district administration, alleging highhandedness by the latter. Following this, the Mysuru Deputy Commissioner dismissed the charges citing official records and said her version will stand up post an inquiry, which is to be conducted by a retired High Court judge.

However, this is not the only incident where a Deputy Commissioner has been accused of interfering. On May 2, two patients died at the Khaja Bandanawaz Hospital in Kalaburagi district. Then it was said that the supplier for that hospital was allegedly stopped by the Raichur district DC as the district itself was facing a shortage.

Lack of intrastate quota

While the Union government has allocated a quota for states, however inadequate, it still gives room for planning. But districts or hospitals do not have a quota, which has left the system fluid. The Mysuru Deputy Commissioner in fact said after the death in Chamrajnagar that it is the responsibility of districts to manage their own oxygen supplies. “If any supplier does not supply or the needs of the district are not met then supervision and correction is by the State level officers. The DC Chamarajanagar should have coordinated with these State Level officers and got his supplies. He failed to do that and now is blaming DC Mysuru.

This was confirmed in the High Court order dated May 6. The HC said that the Advocate General admitted that there was no exhaustive written protocol or guidelines for the benefit of the hospitals in the districts and taluks.

“Even the centralized data of the requirement of oxygen of various districts and taluks is not available. The War Room created by the State Government for dealing with the requirements of oxygen can work efficiently provided centralized data as aforesaid is made available and real time updates thereof is made. The State Government shall take immediate steps on this behalf,” the order read.

A senior IAS officer in Karnataka told TNM that every taluk in the state has increased the number of oxygen beds in the wake of the crisis because the number of patients have increased too.

“A relatively small district that was taking 50 cylinders before now needs 350 cylinders while the state’s whole quota is the same,” the officer explained.

“But we don’t have a district-wise quota. So there is an ad hoc system of DCs/ district health officials filling oxygen from refillers wherever available in the vicinity. This has led to districts fighting over oxygen with each other,” the officer added.

Lack of prudent leadership

The officer also alleged a complete lack of foresight and understanding at the state level leadership compared to the leadership during the first wave. “We’ve told the state leadership to fix a district-wise quota as ministers and MLAs are throwing their weight around and demanding oxygen beds in their constituencies. Everybody needs oxygen and there is a shortage, but there is no one giving clear information about how much the shortage is,” the  officer further explained.

The officer pointed out that a CMO note issued last week had said that the CM has instructed the Mysuru district administration to ensure that all five oxygen generation plants were functioning. But in truth they are all refillers and one of them has stopped functioning as their supplier – Inox – has been asked to provide oxygen only to Maharashtra.

How much liquid oxygen does Karnataka have?

According to official records submitted to the Karnataka High Court, Karnataka is projected to need 1,792 MT of liquid oxygen daily but has been given only 965 MT. The Union government on May 6 had approached the Supreme Court to bypass a May 5 Karnataka HC direction to give the state 1,200 MT on an ad-hoc basis.


Karnataka in total has 8 liquid oxygen manufacturing private plants which have a production capacity of 718.78 MT. And as of May 4, the allocation for Karnataka was 675 MT. Another 378 MT which is produced within the state have been allocated for other states. However, Karnataka received liquid oxygen from other states and their total quota is 956 MT.

It is to be noted that use of liquid oxygen is controlled by the Union government and the state cannot exceed the cap even if the oxygen is produced within the state. And Bengaluru having two-thirds of Karnataka’s cases is facing an acute crunch. In terms of numbers, Bengaluru recorded 14,402 new COVID-19 cases in March, 87,249 cases in April, and has seen 44,497 cases in May already. By contrast, the number of cases in February were 6,361.



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