Accelerating oxygen access during India’s second wave

When the devastating second wave of COVID-19 swept through India in May of this year, oxygen needs skyrocketed. With PATH India’s deep expertise, PATH was well positioned to respond quickly. And thanks to the influx of support from individual, corporate, and foundation donors, we were able to accelerate this work, to reach more people, faster.

We checked in with Mohammad Ameel, head of primary health care, technology, and innovations, PATH India to discuss the long-term vision for the work.

When the pandemic began, we were already working on respiratory care and medical oxygen systems in Karnataka, Maharashtra, and Punjab. We continued this work during the pandemic, but when the second wave hit, our work expanded quickly. It needed to. At the peak of the crisis in early May, the government reported more than 390,000 new cases in one day—more than three times the amount reported just a month earlier.

We’re thankful for the donors who contributed to support this urgent work. With their help, we scaled our efforts from 3 to 15 states, each of which had a dedicated team working on strengthening oxygen production and delivery.

Our work was two pronged. First, we were supporting states through the often lengthy, complex procurement processes, helping them acquire pressure swing adsorption (PSA) plants—which allow hospitals to produce and supply oxygen in house—and oxygen concentrators—which produce oxygen for patients directly at their bedside—and other necessary equipment and accessories. Once procured, we then helped fast-track their operationalization.

Second, we were helping states strengthen every step of their oxygen delivery process—from planning to delivery. This included assessing demand against facility requirements to identify gaps and develop road maps for strengthening oxygen systems, training health care workers, and building capacity for long-term sustainability.

It has become clear that oxygen production is not the only challenge. During the first wave, demand for medical oxygen rose from pre-COVID-19 levels of 800 metric tons to around 4,000 metric tons. During this second wave, demand reached around 8,000 metric tons.

Production scaled up to meet this demand, but the key challenge was around supply chain and logistics—from storing the oxygen and converting it into usable forms, to transporting it and procuring the accessories needed to deliver oxygen to patients. Oxygen isn’t always in a usable form; hospitals weren’t prepared to store huge amounts of oxygen; and it wasn’t easy to transport oxygen over long distances.

PATH provided more than 1,000 oxygen concentrators and is providing technical assistance to establish more than 1,200 PSA plants. We also made huge investments into every other aspect of the medical oxygen delivery process. For example, we supported more than 125,000 health facilities with planning, supplier sourcing, and equipment installation, and trained more than 2,000 health care workers.

The long-term vision is critical. As we know all too well, it’s very difficult to scale up medical oxygen access overnight. When a crisis strikes, we must have the systems and infrastructure already in place, from supply chains and production capacity to storage and transport.

This also includes human resources. When patients need oxygen, we must have health care workers who are trained in medical oxygen delivery, and trained technicians who know how to maintain and repair equipment. This forward planning often falls down the list of public health priorities during “normal” times, but when demand spikes, it can mean the difference between life and death.

We conduct our respiratory care work with this in mind—addressing short-term, urgent needs, with long-term sustainability as a goal. This means putting a plan in place for ongoing funding to support maintenance and operations, which can include peripheral requirements like power supply. We are advocating to ensure there are budget lines for these things and partnering with implementing organizations to enhance capacity for maintenance.

We’re currently exploring the use of solar energy to power PSA plants—which are great solutions for on-site oxygen production, but require reliable energy to run well. We’re also looking at developing new oxygen production and supply models. The hub and spoke model, for example, will enable one facility’s PSA plant to refill cylinders with excess supply that can then be shared with nearby facilities.

Thanks to increased vaccination rates and other, non-pharmaceutical interventions, COVID-19 cases have dropped since May. Medical oxygen supply and demand is under control as well—India has resumed exporting oxygen to neighboring countries, including Sri Lanka and Vietnam.

However, we cannot and must not relax now. Many experts are anticipating a third wave, so we’re still enhancing systems and ramping up oxygen supplies. But we don’t know how the third wave will look, not only in terms of scale, but also in terms of impact. Our first wave largely affected people with comorbidities, and the second wave affected more middle-aged people.

Some are predicting the third wave could have a greater impact on children, so even with a significant oxygen supply, this would pose great challenges. Pediatric cases require different equipment and trained specialists. I hope this prediction is wrong, but it’s just one example of what could happen. We don’t know what is going to happen, but we’re much better prepared than we were before.