Page 12 - GHES-2-3

Global Health Economics and
Sustainability
Medical oxygen during COVID-19 pandemic

3.2. Oxygen supply 3.3.4. Non-invasive ventilation (NIV):

Saving lives during the COVID-19 pandemic is not just • Delivery: A mask or helmet delivers pressurized air or
about ventilators; it is about ensuring a steady flow of a mixture of air and oxygen to improve breathing.
medical oxygen. The successful treatment of moderate and • Benefits: Supports breathing without intubation and
severe COVID-19 patients hinges on having a sufficient avoids potential complications of invasive ventilation.
and dependable supply of medical oxygen. This vital
gas supply is the backbone of treating not only severe 3.3.5. Invasive ventilation:
COVID-19 cases but also other respiratory complications, • Delivery: A tube inserted through the mouth or throat
surgeries, and intensive care unit (ICU) care and operations delivers oxygen directly into the lungs.
in all health-care facilities. It was observed that the major • Application: Patients with severe respiratory failure
sources of oxygen are oxygen cylinders, LMO tanks, and who do not respond to other oxygen therapy methods.
PSA plants. However, reliance solely on oxygen cylinders
and LMO tanks has proven insufficient to meet the rising Important considerations for choosing an oxygen
demands during the COVID-19 pandemic. To address delivery method include:
this surge in demand, the National Medical Commission 1. Choice of therapy: Depends on the patient’s severity,
has mandated that all medical colleges install PSA plants oxygen needs, and availability of equipment.
within 6 months (Ministry of Health and Family Welfare, 2. Aerosol generation: HFNC and NIV carry a risk of
2021e). spreading the virus, requiring airborne precautions
for healthcare workers.
3.3 Oxygen therapy 3. Monitoring: Oxygen levels and vital signs need close
monitoring during all forms of oxygen therapy
Oxygen therapy plays a crucial role in managing severe
and critical COVID-19 patients. However, navigating the While oxygen therapy is vital for COVID-19 patients,
different delivery methods can be complex. Further details consulting a health-care professional is crucial to determine
concerning the delivery methods are discussed as follows. the most appropriate method and ensure safe and effective
treatment (WHO & UNICEF, 2019).
3.3.1. Low-flow oxygen therapy (nasal cannula,
Venturi mask) 3.4. Constitution of empowered group
• Delivery: Oxygen flows through thin tubes placed in An empowered group consisting of secretaries of various
the nostrils (nasal cannula) or a Venturi mask covering union ministries and senior-level officials from different
the nose and mouth. central ministries of the GoI was formed to plan strategies
• Flow rates: for improving and augmenting health infrastructure. This
• Children: 1 – 2 L/min group aimed to enhance oxygen capacity storage, analyze
• Adults: 5 L/min (nasal cannula), 6 – 10 L/min the region-wise oxygen demand-supply position, discuss
(Venturi mask) caseload projections, and plan medical oxygen supply
• Benefits: Low-cost, simple to use, comfortable for dynamically in response to the shifting pandemic (HT
patients. Correspondent, 2021; Ministry of Health and Family
Welfare, 2021d).
3.3.2. Moderate-flow oxygen therapy (reservoir mask)

• Delivery: Oxygen flows through a mask with a 3.5. Oxygen production, allocation, and storage
reservoir bag, providing higher concentrations. As India’s medical oxygen demand during the COVID-19
• Flow rates: 10 – 15 L/min pandemic soared, the health-care system was pushed to its
• Benefits: Delivers higher oxygen concentrations than limits. During the first wave, the peak of oxygen demand
a Venturi mask or nasal cannula. reached 3,095 metric tons (MT) per day on September 29,
2020 (Ministry of Commerce & Industry, 2021). However,
3.3.3. High-flow nasal cannula (HFNC): the real crisis unfolded in April 2021, with demand
• Delivery: Oxygen flows through heated and skyrocketing to an average of 5,500 MT per day in the
rd
humidified tubes placed in the nostrils at higher flow 3 week, then further increasing to 7,100 MT and 8,943
rates and concentrations. MT in the following weeks (Ministry of Health and Family
• Flow rates: Up to 60 L/min Welfare, 2021a). The Indian government, in collaboration
• Benefits: Improves oxygenation without needing with state governments, scrambled to avert disaster. They
invasive ventilation, reduces the risk of intubation, quickly ramped up LMO production, boosting daily output
and is comfortable for patients. from 5,700 MT in August 2020 to a record high of 9,690 MT

Volume 2 Issue 3 (2024) 4 https://doi.org/10.36922/ghes.2023