On 12 September, Dr Amit Thadhani, the medical director of Niramaya Hospitals in Panvel, spent 16 hours trying to find oxygen. Thadani runs the 55-bed hospital that is now a COVID-19 facility and needs 70 oxygen cylinders a day for his patients. Thadhani had placed orders with various oxygen dealers to meet this requirement. By that afternoon, he received only 20 cylinders against one order for 50 cylinders. By the evening, he started to look for other hospitals where he could move his patients. “By the end of the day, after making many calls and making my staff run around town, we were able to source our daily requirement of oxygen, but by then we had already shifted two of our most critical patients to another facility,” Thadani said.
Many medical facilities, especially smaller hospitals and nursing homes, repeatedly ran out of oxygen since late August, as the number of oxygen-requiring COVID-19 cases rose in Maharashtra. Oxygen manufacturers told me that demand for medical oxygen more than doubled since the epidemic started spreading. Oxygen dealers said there is a crippling lack of supply-chain infrastructure, which can result in oxygen not reaching hospitals.
Maharashtra had the highest burden of COVID-19 in India by mid-September, with close to three lakh active cases. It also had the second-highest case-fatality ratio—the number of deaths as a proportion of the number of people reported infected. The pattern observed through this pandemic has been that most deaths occur after severe respiratory distress.
In the second week of September, 40 of the 55 beds in Thadhani’s hospital were occupied. The doctor could not admit any new patients because he was unsure about whether he would be able to source enough oxygen if they needed it. “Thirty of my patients need oxygen, out of which six are on some form of non-invasive ventilation and constantly require high flow oxygen,” Thadhani explained. The doctor spent at least 12 hours every day on the phone asking for oxygen. “I have to keep making calls and seeking different vendors and dealers every day, because no single vendor has enough to supply the 70 cylinders I require,” he said. The hospital had needed not more than ten cylinders per day before the epidemic hit Panvel, when Thadhani hardly spared a thought for oxygen supply. “But now every day is a struggle,” he said. “There is a moment every day where I feel like I have run out of options, and that is terrifying.”