Why is there still an oxygen shortage?

Nepal’s Supreme Court ordered the government to ensure that no citizen dies because of the lack of oxygen, the government banned all non-medical use of oxygen, in the past week alone, at least 10,000 oxygen cylinders have been flown in, while the Tibet government trucked 30,000 litres of liquid oxygen.

Yet, patients are still being turned away from city hospitals due to the lack of beds with oxygen. Patients who could have been saved with timely and adequate medical oxygen have died. 

When his mother Usha Shakya was admitted to Patan Hospital with Covid-19, Ujjwal Shakya had to get an oxygen cylinder because the government facility had just enough for patients already there.

He tried the nearby oxygen plant at the Patan Industrial Estate and several other factories, and brought the cylinders so his mother could breathe easier. 

“The families of other patients in the ward told me it was better to get our own oxygen because the hospital might run out,” he said.

In Bhaktapur, Sanjay KC has been looking for oxygen cylinders for his sister who had to go to hospital after her condition worsened in home isolation. He finally found a cylinder and got his sister admitted. 

There are reports of hospitals which have told families of patients they can only be admitted if they bring their own oxygen since they simply do not even have enough supply for patients already in ICU and ventilators.

“It is inhumane for hospitals to ask patients to bring their own oxygen, besides, if our hospitals cannot source oxygen, how can the patients?” asks Dinesh Kafle, a doctor at the Tribhuvan University Teaching Hospital.

Some doctors have admitted that they have had to ration the oxygen and to make the difficult decision about which patients had the better chance of survival.

“We never ask patients to bring heir own oxygen, it is just that there are shortages everywhere,” explains Ashish Shrestha, a physician at Patan Hospital. “Some families just get their own cylinders just to be sure.”

On Sunday, there were 193 more fatalities from Covid-19 all over Nepal, taking the total deaths so far to 6,346. Of the nearly 20,000 people tested, 7,914 were positive for the coronavirus. There were 7,664 recoveries, and the active cases count has started levelling off at about 115,000.

In the past few days, hospitals report a drop in the number of very serious cases, and a slight easing of the demand for oxygen. Some of the oxygen concentrators and cylinders sent by organisations overseas are also reaching hospitals.

For example, Patan Hospital last week took delivery of 100 oxygen cylinders supplying 10 litres/hour donated by the US-based Nick Simons Foundation, and provincial hospitals have been sent the concentrators that arrived from Singapore, Spain and Switzerland this week.

“There was an imbalance in the demand and supply some weeks ago, but the situation is steadily getting better,” says the Ministry of Health spokesperson Jageshwar Gautam, who says reports of shortages are exaggerated by oxygen black marketeers. . 

However, there are still more than 1,700 seriously-ill patients in ICU and above 510 people on ventilator support in hospitals all over the country. 

Doctors say more patients in the second wave need oxygen, and most them are on high-flow, increasing demand on the already scarce supply of medical oxygen.

The daily demand for oxygen nationwide is now 35,000 cylinders, but the total oxygen generation capacity in the 22 factories across the country is 20,000, of which only 6,000 are produced in Kathmandu Valley where bigger hospitals produce abbot 2,500 of their own. Oxygen demand is greatest in hospitals in Kathmandu, Nepalganj, Butwal and Birganj.

With the second wave moving up-country to remote areas, where there are few health posts, no oxygen, and almost no testing, it is hard to gauge just how serious the oxygen need is.

The government has taken an ad hoc trial-and-error approach. Two weeks ago it entrusted the inter-ministerial Covid-19 Control and Management Committee (CCMC) to manage oxygen supply and it imposed a quota system on hospitals. But that only created an artificial shortage, and made the problem worse with some hospitals having too much oxygen and others not having enough. The quota system was scrapped.

With the political turmoil of the past week, elections announced and Prime Minister Oli preparing to reshuffle the cabinet, there is more policy-level confusion. On Friday, Oli took over as head of the CCMC from his deputy Ishwar Pokhrel.

At the government’s Civil Service Hospital, Covid-19 focal person  Suman Marhatta says there is still a critical shortage of oxygen at his facility. “We could not even get the oxygen we were allotted under the quota, but things are slightly better this past week,” he says.

Bhaktapur Hospital is operating at double its maximum capacity, with nearly all patients with Covid-19. It is getting only 70% of the oxygen it requires for its patients.

“The government send us oxygen by counting the number of beds,” says Sumitra Gautam at Bhaktapur Hospital. But, she adds, many of patients are on the floor and in the corridors.