 Hello and welcome to Newsclick in today's episode of Talking Science and Tech. We will again look at the COVID catastrophe in India and how the oxygen shortages, the massive oxygen shortages are worsening this crisis. We have with us Prabir Prakash. So Prabir, can you first tell us why this is happening because we see that the government is saying that it is not really a matter of production. The production is there but it's because of transportation issues, because of boarding, because of black marketing. So what is really behind the current shortages that we're seeing? There are two aspects to this issue. One is that why has the demand gone up so rapidly? And that I think is the key question that this has caught the government completely unaware. They should have prepared for it. They should have had the ability to project what kind of requirements of oxygen they might get. They had done some projections that they knew that they could manage 100,000 patients at a given point of time, numbers of new cases coming up, that kind of surge that we saw last year. They could manage but beyond that they would have a problem. But the question is that did we prepare for this eventuality, that the numbers could go up from 100,000, 200, 300,000. Right now we are really looking like we are going to reach 400,000 and the speed at which we are going and probably even 500,000 and if that is so what would happen to both the ability of the system, the hospitals to handle the patients and the ability for us to be able to supply them oxygen, which is the crucial input that you do require. And that's not something you can ramp up very quickly. You can get medicines if you want, you know, plain loads of them can be flown from here and there. That's possible. The possibility exists but not when it comes to oxygen. That's the key mistake that we seem to have made. The second part of it, if we look at the other part, the issue that is there, that there is a complete lackadaisical attitude towards even doing the minimum that was talked about earlier. It took them 10 months to order what are called PSA oxygen plants, which are smaller oxygen plants. They can be put very close to hospitals within the hospitals for that matter. And therefore they provide like you have for the electrical system a backup supply. You get a backup supply. It's not a solution for hospitals but you do get a backup supply that could be there. But number of plants ordered were not very large. The amount that was being spent on this was again not very large. We're talking of something like 30 crores or so. And if we take the 162 plants that the government ordered, it took them 10 months to order. And even after that, if it's taken five more months for them to install only 30 odd plants. And the tragedy is that at the current moment that we are seeing, it only meets about max 2.5% of the requirement, even if all the plants have been functional. So let's face it, this is not a solution. But even that, a palliative arrangement, particularly for far flung areas where oxygen supply, reaching liquid oxygen is difficult. This would have been some kind of a stopgap arrangement. It wasn't the solution for cities like Delhi, Mahmoud, Mumbai or Pune or any of the big cities because there the oxygen requirement is in hundreds of tons. So therefore to think that a small PSA plant or a set of PSA plants could do the job was certainly not going to happen. So one was the gross miscalculation with the numbers itself. And that we have discussed earlier that this is something that happened because the government of India, the Prime Minister included and declared victory and thought that this was not going to come back. And here, the modellers who have been sort of believing the government's propaganda or the government believing its own propaganda are also to blame that they declared that maybe India has reached herd immunity or any really solid data basis to say so. And as we can see, we are really facing the biggest test we have had in COVID-19. Now, India is at the moment almost 50 people going towards 50% of the global new cases that are arising. And what happens is of course that the people who fall ill today are going to turn serious in another section of them are going to become seriously in another say two weeks, one to two weeks. And therefore, even if the numbers are dropping or even the numbers flatten, the pressure on the hospital system is going to stay or even grow. So we are going to see even worse crisis ahead. For instance, in cities like Delhi for oxygen, if we are not able to solve the logistical problem. And here the problem is there is ability to produce liquid oxygen. We have cryogenic facilities. We produce other gases also. At the moment, all non-medical use of oxygen has been stopped. And you have started producing only medical oxygen. But having done that, the number of tankers you need to handle this capacity of liquid oxygen, which at the moment, according to the empowered group of what is it called the empowered group 2, which is the one looking for at the logistical issue, you are going to require by 30th April according to their predictions, about six and a half thousand metric tons. You don't have the capacity of actually able a capacity to move even a fraction of that number because you have 200 tankers approximately, which can make the daily trips. You have a total of larger number of tankers. I think you have about 12,024 oxygen tankers, but they take six to seven days because the facilities are somewhere in eastern India, somewhere in other parts of the country. So if you want to take an average trip from the production facility to the city that you are targeting to deliver oxygen to and then send it back, you are talking of maybe five to seven days per trip. So the 1200 tankers, oxygen tankers you have, it actually reduces to about 200 tankers, which means you are able to, at that rate, you'll be able to only handle one third of the total liquid oxygen that you need to deliver. So you have a logistical crisis. You can repurpose your other cryogenic tankers for carrying oxygen, but even that will be a partial solution. So we are going to see a shortfall of actually liquid oxygen still. Yes, you can boost it by trains. It's not good to be so easy. We're already facing problems of different kinds when you try to transfer it through trains and so on because the essential issue of the logistics of this was not taken into account. And even if you have the production capacity, the logistics is actually proving to be your Achilles heel. And that's really the key issue that we have to, that we are failing. That A, we didn't plan for this. We never calculated that you were going to get the 300,000 plus numbers. You thought you had one victory and even when you saw the crisis coming, you reacted very late. It's only by 15th April, the so-called EG2, which you're supposed to look after logistics met. You haven't done that for almost a year when you had the time to prepare for it. When you had at least five, six months when you saw your earlier wave go down, you had that five, six months to prepare for it. And preparing logistics, buying cryogenic tankers, keeping them in reserve, was that a big issue? Did you not calculate that how much of oxygen you require? I think those are the key issues that we seem to have pointed. Right. And like your talk mentioned just now that industrial use oxygen is basically it's not being used for any industrial purposes. Now all oxygen has been redirected for medical purposes, but even this, how sustainable is this in the long term? Well, there's a cascading effect. If you do not use oxygen for industrial purposes, there's a whole set of other industrial activities that will grind you out. And if it does happen, then there are cascading effects across the board. And those effects will also exhibit itself in finally to your other production facilities being affected and even your medical and vaccine facilities will be affected. So it is possible to reduce it temporarily. Yes, you can stop other economic activity for the time being, but can you stop it for one month, two months? That's a question we need to really seriously address. And if that situation has to be faced, how do you face it? So that is the other part of it, but I'm really at the moment focusing or we should be really focusing on how to overcome the next two to four weeks, which is where the key crisis is going to be. How do you augment oxygen supplies at this stage? And then when you plan for the future, what are the long-term plans that we can put in place? Looking at the short-term plans that we can have, one is repurposing the cryogenic tankers, stopping all other in use industrial use of oxygen. These are two measures we have taken. Even then we are going to have a shortfall that's clear. So what do we do then? What of course is large import of right now, what is called the oxygen concentrators and they can be procured in large numbers. For example, China has offered and they do produce a very large number of oxygen concentrators. India unfortunately does not. It's not a major oxygen concentrator production hub. So we need to import from somewhere and since China is now talking with India, India is talking with China in spite of whatever the border tensions might be there, I think this is a welcome development because there's only ones who can lift oxygen concentrators in large numbers. That can relieve the pressure of at least oxygen cylinders and therefore that can also go to the smaller clinics. Also the kind of COVID facilities should be opened across cities where people not very serious people are being admitted and therefore if they can be provided with oxygen support or even home oxygen support that will take some pressure off your hospital. So I think that's a short-term measure that can be done while we are looking at how to augment cryogenic or liquid oxygen import. The government is not talking about importing 50,000 tons but even 50,000 tons of oxygen is really finding a supply at the current rate that we are going. So I think we need to really think that at the moment it's emergency. These are the emergency measures we need to take. There isn't much else that we can do but there is one thing that we really need to do right now which is really expand the secondary facilities, not the primary hospital facilities, the secondary facilities opening really larger centers which we are doing, which we just we had closed down in February and providing oxygen support there so that only serious and very serious cases go to the hospital at the moment because if we require oxygen there isn't any other way to get it people have to get admitted to the hospital because it's very difficult to get oxygen cylinders at home. So even patients who could do with oxygen cylinders some oxygen supplies they need to be centralized in terms of where they need to be. So those are some of the measures you can take to relieve some of the pressures in the hospital. Let's face it if the we have been talk hearing about big hospitals facing problems but the smaller hospitals their flight has been equally bad and we haven't heard about them. Most of them really depend on bottled oxygen, oxygen cylinders and they are in fact also being starved because they're not getting even the oxygen cylinders because the pressure of the oxygen cylinders has been so much that from hospitals to homes people are taking oxygen cylinders and there is also possibly some amount of holding that's going on because of that because if you fall ill that doesn't seem to be a hospital bed for you and even if you're well connected so people have started also holding holding oxygen cylinders. So that kind of pressure will be relieved if you also have the secondary centers it was a it was a real tragedy we closed them in February the month before the peak again hit us. So I think that's the other miscalculation we did thinking COVID was over we have won a victory as Modi declared in Davis as the BJP executive committee met and took a resolution how India has shown the way how to defeat COVID-19 instead of that we should have been really preparing okay we are lucky once maybe we'll be lucky the whole time but we should have prepared for the worst and that is a huge huge mistake that the country made and its leadership made. But we see that we also had all sorts of you know committees subcommittees which were set up to respond to the pandemic but despite this you know we see all of these massive miscalculations and this complete failure of planning why how is that? While the number of committees existed did the meet the national task force should appears not to have met for a very long time then this empowered group two which was supposed to be looking after logistics they were active when the PPEs were in short supply they did some work at that point of time after that as you can see they took 10 months to place order now it's interesting 10 months to place an order for the PSA oxygen plants it's interesting how many plants did they calculate what were the basis is not clear they just they have a document which is a specifications now you know the specifications for this were released by WHO in April so it is not that they had to create something from nothing the specification existed they needed to take a call on how many of them where they should be and you have the logistics to really reach liquid oxygen everywhere if not then how much do you plan for? Let's face it the amount you are spending today if you had spent 2000 crores for instance on the PSA plants then you would have had a cushion of about 25 percent and you know the point is it doesn't need the logistics they are right there where you need them in next to the hospitals in the hospitals so that is again as you point out a planning mistake that you didn't really plan for a peak you didn't calculate what the peak could be and the second part of the not calculating the peak was that actually you threw up your hands when the second wave struck and said now it's a responsibility of the state governments because let's face it you this peak appeared very rapidly in the speed at which it appeared actually caught the government completely by surprise they were still busy in electioneering particularly electioneering in Bengal so their eyes were off what was happening in the country and unfortunately from the record it's not clear that the empowered group how many times they met this empowered group 2 which is what we are discussing about how many times they met or did any of their calculations there is a report in February which has come from the papers that they had said not empowered group 2 but a group had met and said experts had said that we will not be able to handle a peak beyond 200,000 and if it goes to 300, 400,000 we are going to be in deep crisis did we then plan what we will do when this warning was given and what happened happened within a month month and a half of that so those are the kind of gaps we had but you know the point that people have to understand today is that the only real medicine that we have for COVID-19 at the moment is oxygen because if there is a medical crisis the only other medicine which seems to work is your corticosteroids that reduces the inflammation of the lung which takes place because of what's called cytokine storm or your body attacking antibodies attacking the healthy tissues of the lung that's really what is what causes the maximum amount of lung damage so apart from corticosteroids which lot of the most of them patients so they're very cheap and widely available the only other real medicine is oxygen so this remdesivir etc are really peripheral to the current crisis they work marginally in the initial phase in the serious cases well they have again marginal effect if any so what was really required was oxygen capacity and that's something that we did not really prepare for and if you don't provide oxygen at this time then obviously the results are catastrophic and this is what we have seen right in the beginning in Italy that the hospital systems get overwhelmed that's when really the death rate mounts death rate is not a function of how many infections you have it's only a function of two things what is your age profile if you have an older demographic profile people are likely to be more sick and if they are more seriously ill then the chances are that they will be have to be hospitalized and they will need oxygen support if you don't or are not able to provide the hospital facilities or the oxygen and the system collapses that is when the death rate really spikes up and that's what we saw in Italy the high death rate was not because the Italians were just older it was also because hospitals collapsed and that's the scenario under which we see the death rate has gone up in India too and one last warning that I have to give in this discussion that this is going to continue for some time because if you have say the people who will turn serious a fraction of them will turn serious after a week to 10 days or even two weeks so that is the time when you will see the numbers of serious cases go up and if that happens also proportionately the number of deaths will go up so it is it was completely immature on Indian spokesperson's part to talk about how the Indian death rate is lower and therefore we're doing a good job the real issue is if the hospital system gets overwhelmed that is when the death rate spikes up and that's the scenario we are seeing for last two to three weeks in Mumbai, Pune, Delhi and various other cities and again the unfortunate part is looking at the curve of rising infections even where some states are starting to plateau you will see the crisis even there is going to continue for two to three weeks and rest of the country the figures are still rising so I think we are still going to have a bad six to eight weeks and the only solution at the moment is non-pharmaceutical intervention which is lockdown selective city-wise area-wise that's something for the state governments and the local authorities to decide yes they are the right authority to decide that but that's the only way you can break the chain of transmission and this time entire families are getting infected because the transmissibility seems to be higher so we are going to have a tough four to six weeks or four to eight weeks before things start to look better right so thank you for joining us today and that's all the time we have keep watching this