A medic collects samples from a woman for a COVID-19 rapid antigen test, in Srinagar, August 10, 2020. Photo: PTI/S. Irfan.
Srinagar: At first, the young men waited patiently in a queue for their turn. Some of them were in protective gear, some others were wearing masks, but most of them had neither.
They all looked tired. As they waited longer, their patience thinned out. The queue slowly turned into a noisy crowd. Soon, each man was scrambling for an oxygen cylinder.
This is a regular scene at Srinagar’s Shri Maharaja Hari Singh (SMHS) hospital, where COVID-19 patients’ relatives turn up every day to ensure their kin received enough oxygen.
As Kashmir continues to record an increasing number of COVID-19 cases, hospitals are struggling to meet the soaring demand for medical oxygen – an important part of the treatment for these patients.
“This (shortage of oxygen) is scary,” one doctor at SMHS hospital told The Wire Science.
Inside hospitals
After the pandemic hit the Kashmir Valley in March, the government designated the Chest Disease and J.V.C. hospitals, both in Srinagar, as COVID-19 centres, and also set up a dedicated facility at the Sher-e-Kashmir Institute of Medical Sciences (SKIMS).
However, following a sharp rise in the number of cases, authorities were forced to open four wards at SMHS to manage COVID-19 patients last month. The institute went from 30 beds at the beginning to at least 232 beds today reserved for COVID-19 patients. However, only 130 are fit with oxygen ports.
Dr Nazir Choudhary, the medical superintendent at SMHS, acknowledged the hospital was facing an oxygen shortage. He said that against 2,000 liters of oxygen generated per minute by two plants at the hospital, the demand has risen to 7,000 liters.
Another senior doctor described the gap between demand and supply as worrisome. “There is no let-up in admissions. If the situation continues as such, no oxygen supply will be adequate,” the doctor said.
SMHS is a trauma care institute and regularly receives critically-ill patients and those who need urgent care, including oxygen therapy, from around Kashmir, compounding the challenges for the hospital’s administrators.
SKIMS isn’t faring any better. One doctor said, thanks to the oxygen shortage, COVID-19 patients were being admitted into the emergency ward, which is meant for critically ill patients for reasons other than COVID-19, for “days together” because the ward has a dedicated supply of oxygen.
Though he acknowledged that admitting COVID-19 patients in the emergency could turn into a “health catastrophe”, the doctor said they had “no other option”.
According to the official data, 25-30 patients with COVID-19 requiring high-flow oxygen support are admitted to SKIMS every day, and at any given time the institute is treating 250-300 such patients.
Of the 260 COVID-19 beds at SKIMS, 180 have oxygen ports. The hospital’s three oxygen plants produce around 3,000 liters of oxygen per minute. The hospital also has 450 oxygen cylinders. “We are somehow managing, but it can worsen if there is further increase in admissions,” a senior doctor at the hospital said.
A pulmonologist said a COVID-19 patient requires three to four oxygen cylinders a day. In those with severe COVID-19, the virus attacks the lungs, rendering them unable to absorb oxygen. This can cause blood oxygen levels to fall below normal, a condition known as hypoxaemia, which is then managed with high-flow oxygen.
The pulmonologist said the prevailing situation exposed the government for its failure to augment oxygen production infrastructure in all these months. “Didn’t we see this situation coming?” he asked.
Since March this year, when the Kashmir Valley reported its first COVID-19 case, the total number of cases have climbed to 22,434; a little over 500 people have died of the disease.
Rural hospitals are faring worse. For example, an oxygen production plant set up at the Kulgam district hospital five years ago hasn’t been commissioned till date. The Shopian district hospital doesn’t have an oxygen plant while the facility at Pulwama has few beds, if any, with oxygen supply. The 250-bed Anantnag district hospital has only 80 beds with the supply.
As a result, authorities have been forced to refer COVID-19 patients in need of oxygen therapy to hospitals in Srinagar.
People stock up on oxygen
The oxygen shortage has triggered panic among the people, who are now stocking up on oxygen cylinders for COVID-19 patients anticipating a grave shortage in the coming weeks. Kaiser Ahmad runs an oxygen refill shop in the Chanpora locality of Srinagar. According to him, his shop has been receiving 20 orders a day for the last few weeks, apart from regular inquiries about the sale of cylinders.
“Earlier, I used to get two to three refill orders a day,” Ahmad said. “Every family with a COVID-19 patient [is now making sure] they have a cylinder reserved.”
Some NGOs have also joined in these efforts. Bashir Nadwi, the chairman of an NGO named Athrout, said they have already provided around 200 oxygen concentrators to coronavirus patients from across the Valley. Athrout has placed orders for 100 more concentrators.
(According to Wikipedia, “An oxygen concentrator is a device that concentrates the oxygen from a gas supply by selectively removing nitrogen to supply an oxygen-enriched product gas stream.”)
“We get around a hundred calls every day with people asking for concentrators, oxygen cylinders and ventilators,” Nadwi said.
In Anantnag, mohalla committees and local trusts have been raising money to purchase the devices. Sheikh Aadil, a member of Syed-o-Sadaat, a local trust, said they had arranged for 23 concentrators to be received by patients in need of them.
“We purchased seven more concentrators today only, for which we have already got requests in advance,” said Aadil. Like Kaiser Ahmad, Aadil said he receives around 15 calls every day, with callers asking about oxygen concentrators and cylinders.
Waking up to the crisis, the J&K health department has decided to set up eight new oxygen plants at tertiary care hospitals in its summer capital of Srinagar. However, officials estimate it will be four or five months before the plants can be operationalised.
Dr Saima Rashid, the principal of Government Medical College in Srinagar, said they have floated tenders to build an oxygen plant, and the parts for which will be sourced from Germany An official added that there was a separate proposal to equip major district hospitals around Kashmir with additional oxygen plants. A project report is expected to be finalised soon.
As a stopgap measure, the official said, district hospitals will be supplied with “additional quota” of oxygen cylinders and concentrators. “We hope and pray the situation doesn’t worsen further.”
Mudasir Ahmad is a freelance journalist.