Mumbai’s Oxygen Model to fight Covid-19 surge receives praise

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<strong>Recently the Supreme Court while hearing a case on oxygen allocation case arising due to the increasing cases of Covid-19 cases, Justice Chandrachud made an interesting observation. “Bombay Municipal Corporation has done some remarkable work and not disrespecting Delhi but we can maybe see what was done by BMC. Maharashtra is also an oxygen supply state.”</strong></p>
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The Apex Court also recommended that the Centre should look to Mumbai and take note from the Bombay Municipal Corporation as the civic body had done a good job in managing oxygen supplies. In fact, Prime Minister, Narendra Modi too had patted Maharashtra in a telephonic conversation with the State Chief Minister, Uddhav Thackeray for its efficient handling of the Covid-19 second wave.</p>
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<strong>Mumbai 02 Model</strong></p>
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With the second Covid-19 wave hitting the financial capital Mumbai, it immediately went back to its 15 big and 11 smaller Liquid Medical Oxygen (LMO) tanks. These were installed in the State Capital’s six hospitals and as many Jumbo Covid-19 Centres between May and June 2020. That time it helped the State tide over the increase in oxygen demand during the first wave.</p>
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<strong>Also read: <a href="https://www.indianarrative.com/health-news/modi-praises-mumbai-s-resilience-to-counter-second-covid-wave-86683.html">Modi praises Mumbai's resilience to counter second Covid wave</a></strong></p>
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Referring to these tanks, in an article in India Today, P. Velrasu, the Additional Municipal Commissioner, remarked: “Building the additional LMO tanks helped us cope during the second wave.” He went to add that the total cost of putting up these tanks was over Rs.14 crore. “At that point, we did not know if they would be utilised, but we still went ahead and created that infrastructure.”</p>
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The LMO tanks constructed are highly pressurised tanks, installed on reinforced concrete structures. These require certification by the Petroleum and Explosives Safety Organisation under the Ministry of Commerce and Industry.</p>
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Keeping in mind the utility of these tanks, the Brihanmumbai Municipal Corporation (BMC), has plans for 10 more of these as part of preparation for a possible third wave expected anytime between July and September.</p>
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<img alt="" src="https://www.indianarrative.com/upload/news/Oxygen_Generation_Plant_Twitter_@mybmc.jpg" style="width: 1024px; height: 1024px;" /></p>
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<em>An Oxygen Generation Plant (Pic: Courtesy Twitter/@mybmc)</em></p>
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<strong>Oxygen crisis</strong></p>
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This year in April with the rise in the average cases several patients were shifted from one hospital to another due to a shortfall of oxygen. For example 168 patients were alone moved out of six government hospitals to jumbo centres on April 17 after oxygen supply was affected.</p>
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Realising the gravity of the situation, BMC announced the appointment of six officials for coordination between oxygen suppliers, assistant municipal commissioners of the 24 civic wards, and the Food and Drug Administration. These officials were made responsible for maintaining the existing oxygen supplies and ensuring they are used sparingly.</p>
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Besides, the civil authorities also took steps to ensure safe transportation of oxygen cylinders.</p>
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Among the hospitals only two BMC-run hospitals, Kasturba Hospital and HBT Trauma Care, have oxygen generation plants while the other big ones have LMO tanks, which are refilled at least once daily. Many others rely on oxygen cylinders. It is mandatory for all hospitals to keep cylinders as a backup.</p>
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When the crisis hit, the civic body deployed six quick response vehicles to ferry cylinders and concentrators to hospitals in need. Speaking to India Today, Krishna H Perekar, BMC’s Chief Engineer, said: “Ward-level teams were formed to coordinate and move surplus oxygen from one site to another…”</p>
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<strong>Keeping proper inventory</strong></p>
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Up-to-date and detailed inventory and use of oxygen at hospital proved to be great boon. Elucidating about it, Velrasu said: “Our inventory has micro-details like the number of jumbo oxygen cylinders, dura cylinders, and capacity of the LMO tanks at all hospitals. We also have exact details of the oxygen usage at each hospital. We formed crack teams to ensure that the LMO tanks reach Mumbai smoothly. These teams were also deployed at the cylinder refilling plant at Navi Mumbai to ensure that Mumbai gets its quota of cylinders.”</p>
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During the peak demand of oxygen, Mumbai fell short of 15 to 20MT oxygen. This shortage was tidied over by moving surplus stock from one place to another and seeking oxygen from Gujarat.</p>
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<strong>Switching to Bilevel Positive Airway Pressure machines</strong></p>
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The State’s Covid-19 task force recommended that doctors should stop the use of High Flow Nasal Cannula (HNFC) to deliver oxygen (up to 80 litres/min) when the demand increased last month. They encouraged hospitals to use Bilevel Positive Airway Pressure (BiPAP) machines. These deliver oxygen either through a flowmeter (up to 15 litres/min) or a non-invasive ventilator (up to 30 litres/min), and with lower pressure.</p>
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BMC has plans to install 16 oxygen generation plants at 12 hospitals to reduce the dependence on LMO and cylinders. “We may still require LMOs as they provide better pressure, mainly for patients in the Intensive Care Units. But having oxygen plants at all facilities will reduce the dependency to a large extent,” explained Velrasu.</p>