Relatives of COVID-19 patients wait to fill empty cylinders at an oxygen filling center at IMT Manesar near Gurugram, May 5, 2021. Photo: PTI
In a previous article for The Wire Science, I had examined data on oxygen supply at Delhi’s hospitals on the morning of May 5, 2021. The numbers revealed that most of Delhi’s hospitals that provided oxygen beds for COVID-19 patients had less than a day’s oxygen supply left. The oxygen reserves were the lowest at Delhi government hospitals and the highest at Central government hospitals, and private hospitals had an intermediate level. This broad pattern repeated itself over the next four days as well.
The question now: Has this pattern changed in the last two weeks? If so, how and why?
Since early May, the Delhi government’s COVID-19 beds portal has been sharing information about oxygen beds and duration of remaining supply in the city’s healthcare facilities. The portal displays the most recent data that the nodal officers of these establishments have reported.
As of May 23, there are around 220 hospitals and other facilities (called “COVID Care Centres” or “COVID Health Centres”) in Delhi. Together, they have allocated nearly 23,000 oxygen beds for COVID-19 patients.
And on May 23, 14.94% of these beds were at Central government hospitals/facilities, 33.41% were at Delhi government hospitals/facilities and the remaining 51.63%, at private hospitals/facilities. For the two-week duration, the median number of hours for which oxygen was left at different types of hospitals in Delhi are shown below.
Throughout the period under consideration, Central government hospitals/facilities had the most median hours of oxygen left. This figure was also relatively stable between May 6 and May 14: on any day in this span, a median of 21-24 hours of oxygen supply left was at these hospitals.
Moreover, after this period, this median followed an upward trend – and stayed above 30 hours in the last week (May 17-23). On all days between May 5 and May 10, except for May 8, there was only a median of 10 hours or fewer of oxygen supply left at Delhi government hospitals and other COVID-19 facilities that had oxygen beds.
From May 11, there has been a marked improvement: on any day since, the median number of hours for which oxygen was left at Delhi government facilities has been above 15 hours. On each of the most recent five days, this has been 24 hours or more.
However, for the two-week period we are considering, among government hospitals/facilities in Delhi that had ≤72 hours of oxygen supply, the gap between the median hours of oxygen left at Central government hospitals/facilities and that at Delhi government hospitals/facilities remained stark.
So although the oxygen supply crisis has eased at the Delhi government’s hospitals/facilities, the quantity of reserves is still consistently and significantly lower than those at Central government hospitals/facilities.
In essence, Figure 1 shows that from May 11, the broad pattern in the number of median hours of oxygen supply left, by hospital type, has changed. Since then, private hospitals (where oxygen beds have been allocated for COVID-19 patients) have consistently had the lowest number of median hours of oxygen left. This suggests that they now have the lowest oxygen reserves compared to government hospitals.
Recall: a little over 50% of the oxygen beds that have been allocated for COVID-19 patients in Delhi at present are at private hospitals. In fact, in recent days, nearly 40% of the total oxygen beds have been at large private hospitals – i.e. facilities that have allocated ≥50 oxygen beds for COVID-19 patients.
Throughout the two-week duration, the median number of hours for which oxygen was left at these large private hospitals was 12-17 hours. On 10 or more days, some of these hospitals – such as the Indian Spinal Injury Centre, Holy Family Hospital, Max East/West Block Hospital and Ayushman Hospital, each of which had >100 oxygen beds for COVID-19 patients – had only six hours or fewer of oxygen supply left.
Private hospitals that had allocated 50-100 oxygen beds – such as Navjeevan Hospital, N.K.S. Hospital and Sehgal Neo Hospital – also had six or fewer hours of oxygen supply left on 10 or more days.
Also read: Medical Oxygen Is Crucial – but It’s Not Easy To Increase Supply on Short Notice
What explains the change in pattern?
One reason is an increased supply of oxygen – partly accounted for by oxygen reserves at Delhi’s COVID Care Centres, such as those at the Yamuna Sports Complex and the Commonwealth Games Village. More generally, the increase in supply was most likely a result of the Supreme Court’s orders to the Centre to supply 700 MT of oxygen every day to hospitals that needed it.
The Union railway ministry’s press releases also suggest that a daily average of around 200 MT of oxygen reached Delhi on ‘Oxygen Express’ trains from May 6. Most recently, the Delhi high court asked all hospitals with 100 or more beds to install pressure swing absorption oxygen plants. If hospitals and officials comply with this order properly, we are likely to observe a sustained increase in oxygen reserves at these hospitals.
A second reason could be a drop in oxygen demand, indicated by a drop in the occupancy of oxygen beds. As the chart below shows, from May 5 to May 10, the average occupancy of oxygen beds was high – above 80% at all hospital types. But from May 11, the average occupancy of oxygen beds at all hospital types has been falling. By May 22, the average occupancy at Central government hospitals, Delhi government hospitals and small private hospitals had fallen below 40%.
However, despite the decline, the average occupancy of oxygen beds stayed above 50% at large private hospitals.
Given the relatively high occupancy of these beds at Delhi’s large private hospitals, this is also where the oxygen supply is more stressed.
To address this, the government can temporarily reallocate portable oxygen supplies from government hospitals/facilities, where the crisis has now largely eased.
Finally, even as Delhi has been reporting fewer and fewer COVID-19 cases every day, experts have said the rate of COVID-19 deaths remains a matter of concern. As the demand drops, the data suggests more and more critically ill people should be able to receive oxygen. To ensure they continue to receive good quality care, it’s vital that the oxygen supply continues uninterrupted – at Delhi’s government and private hospitals.
The author is very grateful for comments from Partha Mukhopadhyay and Shamindra Nath Roy at the Centre for Policy Research, New Delhi.
Shahana Sheikh is a PhD candidate, Department of Political Science, Yale University. The views expressed here are her own.