“Doobne wale ko tinke ka sahara bhi bahut.”
-Indian poet Elizabeth Kurian ‘Mona’
Roughly translated, this line says, “For those drowning, even the support provided by a straw is enough.” As India battles the second wave of Covid-19, Kurian’s words have become prophetic.
With the ever-increasing number of cases, oxygen therapy has emerged as the primary treatment for severe Covid-19. However, the unprecedented number of cases has led to a severe depletion in liquid oxygen stocks in the country, thereby creating the need to look for alternatives.
With the lives of loved ones at stake, many people are going to extraordinary limits to procure oxygen in the form of cans, cylinders, and concentrators. This indiscriminate buying has led to a surge in the price of medical oxygen devices, with black-market oxygen concentrators selling for as much as Rs. 2-2.5 lakhs per device.
However, using an oxygen concentrator is no mean task. It requires proper medical guidance, the technical knowledge of running the device, and the wisdom to know when it is needed. Before you are tempted to join the crowds in procuring any oxygen device, let’s look at what oxygen therapy is and the types of devices that could be used to help treat Covid-19 complications.
What is oxygen therapy?
Your lungs are responsible for filtering the air you breathe in and creating a steady flow of oxygen to send to the other parts of the body. Covid-19 causes respiratory complications making it difficult for your lungs to their job. When a patient’s blood oxygen level dips too much, oxygen therapy is necessary to improve the levels and bring it to safe thresholds artificially.
What is oxygen saturation?
SpO2 or oxygen level in a person’s body is a measurement of the oxygen saturation in the blood haemoglobin. Typically, a healthy person with normal lungs enjoys an oxygen saturation level of 95-100%. According to the WHO (World Health Organisation), if oxygen saturation levels fall below 94%, immediate treatment is required. Levels below 90% are classified as emergencies.
According to the Union Health Ministry in India, SpO2 of 93% and lower requires hospitalisation, while SpO2 below 90% necessitates ICU admission. Owing to the scarcity of oxygen in India, it is suggested that even those with SpO2 as low as 85% could try to improve their levels at home. Those with levels between 80-85% are likely to need a higher flow of oxygen.
What is LMO?
LMO stands for Liquid Medical Oxygen which is high purity oxygen. Distilled at low temperatures in a plant, this medical oxygen is supplied to medical facilities for treatments, to run life support systems, and to help ease the respiratory difficulties of severe Covid-19 patients. The ever-increasing cases in the second wave have burdened the LMO supply, leading to the need to look for alternatives.
What are oxygen cans and tanks?
An oxygen can is a portable medical device containing pressurized oxygen delivered through an actuator upon inhalation. Designed to be mobile devices that one can use while travelling to high altitude areas, an oxygen can is typically a small aluminium canister that delivers 150-200 breaths of pure oxygen. All cylinders and tanks provide oxygen in a continuous flow triggered by inhalation.
Oxygen tanks or cylinders are larger metal tanks that contain pressurised oxygen. Since tanks are larger than cans, they are generally mounted on a wheeled device to help you move around while using them.
With both cans and tanks, the amount of pressurised oxygen available for inhalation is finite. These devices can be refilled, but they require access to technicians and equipment capable of refilling oxygen cylinders.
A tank typically costs Rs. 6,000-8,000. Owing to the atmosphere of panic surrounding Covid-19, even empty cylinders are selling for as high as Rs. 40,000 today.
What is an oxygen concentrator?
While an oxygen concentrator also serves to deliver oxygen straight to the patient’s nose and mouth, it differs from oxygen cylinders in how that oxygen is sourced.
As mentioned, a cylinder contains a fixed amount of oxygen compressed to fit into the tank. Oxygen concentrators are medical devices that filter air and provide medical oxygen. Since a concentrator siphons oxygen from the air around you, it can provide an unlimited supply of medical oxygen as long as the battery in the device is working and there is oxygen in the air.
With an oxygen concentrator, there is no need to refill the device. It collects air from around you, discards nitrogen and other gases, concentrates the oxygen, and delivers it to the patient. An oxygen concentrator can work 24x7 for as long as five years as long as it is operated and maintained well. The oxygen concentration in these devices is between 90-95% pure.
The dosage methods depend on the type of oxygen concentrator. Primarily, concentrators can be distinguished based on whether it provides oxygen in a continuous flow or a pulse dose.
Continuous flow oxygen concentrators provide a steady oxygen flow unless the device is turned off, irrespective of whether someone is inhaling the oxygen at the other end. Pulse dose concentrators identify breathing patterns and only deliver oxygen when inhalation is detected.
What does an oxygen concentrator cost?
In the pre-Covid-19 world, the cost of a typical oxygen concentrator was approximately Rs. 35,000. These devices could be rented for as low as Rs. 4,000 per month. Owing to panic buying and renting during the pandemic, these prices have shot through the roof. Concentrators are selling at more than Rs. 80,000 per device, while rental charges have gone as high as Rs. 20,000 per month, that is, of course, if you can find one to buy or rent. Some online portals are retailing the device for as much as Rs. 2,00,000.
Should you buy an oxygen concentrator?
The global pandemic has shone a light on one of the most significant failings in humans—the fear of scarcity. From toilet paper in the West to oxygen concentrators in India, people tend to hoard supplies out of fear that they may need it later.
An oxygen concentrator is a medical device that should not be used unless recommended. It is essential to get your physician’s opinion about the type of concentrator, delivery capacity, and your litres-per-minute (LPM) need.
An oxygen concentrator would not help in severe cases and clinically-provided liquid medical oxygen (LMO) would be needed. A concentrator might be recommended under supervision for those with mild to moderate need.
It is also essential to note that it is not recommended to use an oxygen concentrator independently. Doctors recommend using a concentrator only when prescribed based on your required LPM, and then too, with guidance from a chest physician or internal medicine specialist.
In most cases, an oxygen concentrator is an essential stop-gap device to improve your oxygen saturation levels as much as possible before you find a bed at a hospital. While it can help India’s fight against Covid-19, an oxygen concentrator is not the end of the road by a long mile.
Country-wide initiatives
Oxygen therapy is a vital lifesaver when it comes to Covid-19. As people worry about themselves and their family members, Google searches for ‘how to make oxygen at home’ have grown exponentially. Trying to DIY oxygen production at home is highly unsafe.
The best course of action is to seek medical help if you are infected, keep an eye on your SpO2 levels using a pulse oximeter, and speak to a physician before getting hooked up to a tank or concentrator.
Meanwhile, there are many country-wide procurement initiatives in motion right now. The central government has announced the procurement of oxygen concentrators that will be diverted to states buckling under the medical pressure created by Covid-19. India has also deployed seven warships to convey large oxygen containers from across the globe.
Aligning with their social responsibility matrices, corporate entities like Amazon, Delhivery, and Zomato have stepped up to procure or provide logistical support for the procurement of oxygen concentrators and other medical essentials.
Panic-buying, renting and hoarding are not solutions to the pandemic woes we are facing today. Both the acquisition and the usage of oxygen concentrators should only be done when prescribed by a medical physician.
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