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1/ If you are buying, importing, ordering, shipping, transporting, deploying, operationalizing, and maintaining oxygen support for the Indian Covid second wave, this could be a useful thread for you.
Some insights on Cryogenic containers, tankers, PSA plants, OCs, and cylinders.
Some insights on Cryogenic containers, tankers, PSA plants, OCs, and cylinders.
2/ The last 3 weeks have been a whirlwind time to look at the fragility of our supply chains. There are a handful of firms involved in industrial oxygen generation and distribution, fewer still in medical grade oxygen or hospital business. Firm capacity and scaling remain low.
3/ The first imminent problem at scale is the distribution of oxygen across the country through cryogenic tankers and containers. The second problem is internal management within districts of a state based on caseload. The third is hospital-level planning and O2 implementation.
4/ The demand-supply O2 mismatch for states and their natural capacity to fulfill it is different. TN or Maha can naturally fulfill their needs, Delhi can't. The industrialization of the state and health capacity is the primary dependent variable of the O2 requirement/crisis.
5/ The nature of the problem (national), issue (coordination), and solution (regional) has complicated the issue with daily hearings in various High Courts and Supreme Court. The most accurate picture of Oxygen data is thus in court submissions and judgments. @GiveIndia @ketto
6/ The last few weeks have virtually exhausted any existent stock of containers, plants, concentrators, cylinders, and oximeters. The dynamic need for fulfilling pay orders at differential prices in the short run is why Delhi Govt is collaborating with NGOs for funds/supplies.
7/ Containers and tankers suffered from 2 issues. One, long-term use/utilization not clearly understood and their surge pricing was too high for a risk-averse unsupported bureaucracy. The second was around the issue of PESO approval, ASME 'U' Stamp, and Helium inner shell test.
8/ The "ball is not in my court" syndrome and "Not sure what's the really the problem" problem created unpardonable delays on India's front. Several international brokers on Chinese supply chain complicated things. On May 5th, a useful decision was taken
https://pib.gov.in/PressReleaseIframePage.aspx?PRID=1716302
https://pib.gov.in/PressReleaseIframePage.aspx?PRID=1716302
9/ There are still enough vendors and suppliers on the tanker/container front from international locations (Egypt, London, China) who are vetted and can get 10-20 tankers of 10 Metric Tonnes to India. If you need one as a government/company, let me know and I am happy to connect.
10/ Many hospitals are trying to install Oxygen plants to reduce their dependence on cylinder supply chains for individual patients or oxygen concentrators for wards. They can be imported from outside India or installed from Indian vendors. Former costs more, latter takes time.
11/ In Delhi, French Government's rapidly installed plants at BLK or Sanjay Gandhi or Dharmshila and upcoming plants at Burari and Deen Dayal Upadhyay hospital are examples of donor money being put to public use. Plants make a hospital self-sufficient and free up LMO cylinders.
12/ The PM CARES fund is allocated to these plants. The lack of installation or fulfillment is a marker of bad government contracting as well as firm capacity. The plants are also much smaller than the O2 need for the second Covid wave with each patient needing a lot more O2.
13/ Each government (national, state, or local), and large private donors, should invest deeply in PSA plant projects at any hospital over 100 beds in cities and 50 beds in states. It is financially viable in the medium/long run. Help charitable, govt and cash-poor hospitals.
14/ Oxygen concentrators are utilized at hospitals, makeshift hospital sites, or care centers. 10 LPM at 80% purity is way better than 5 LPM for scalable public use. Plan for volume, customs being unpredictable with easing in 3 weeks. Other states should order their bulk orders.
15/ D-type cylinders and oxygen plants that fill cylinders are the largest bottleneck in transporting and fulfilling O2 requests especially when there is panic and risk-averse decision-making at the individual level. With OCs and cylinders, get as many as fast as possible.
16/ The future of this wave and the ones that come after will need post-Covid recovery/follow-up, mental health counselling, better tele-triaging, IT/Tech systems, genomic surveillance, regular knowledge creation, BiPAP machines, ventilators and oximeters for the population.
17/ In terms of impact, the smart pots of money compared to the problem's size and scope should go towards:
1. Regular sampling and survey of the population (a la CMIE)
2. Integrating private resources/connections, university/research knowledge into government operations.
1. Regular sampling and survey of the population (a la CMIE)
2. Integrating private resources/connections, university/research knowledge into government operations.
18/ Some Is and Ts to dot and cross:
1. Use war-room/call-center and real-time demand-supply match at regional and hospital levels for tanker distribution.
2. Install PSA plants at hospitals where possible. Land, feasible piping, and electricity load with discom is budgeted.
1. Use war-room/call-center and real-time demand-supply match at regional and hospital levels for tanker distribution.
2. Install PSA plants at hospitals where possible. Land, feasible piping, and electricity load with discom is budgeted.
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3. Get oxygen concentrators and cylinders to one large hospital or center instead of distributing a shipment by geography or hospital.
4. Always have an on-ground point of contact identified for donation/loan transactions.
5. Vet vendors technically and on past delivery.
3. Get oxygen concentrators and cylinders to one large hospital or center instead of distributing a shipment by geography or hospital.
4. Always have an on-ground point of contact identified for donation/loan transactions.
5. Vet vendors technically and on past delivery.
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6. Put circuit breakers for 5-10 concentrators being used wherever.
7. Do an oxygen audit for PSA plants through third-party engineering firms. Hospitals can't do it and vendors have no incentive. Costs Rs. 25k per plant and worth it to prevent potential catastrophes.
6. Put circuit breakers for 5-10 concentrators being used wherever.
7. Do an oxygen audit for PSA plants through third-party engineering firms. Hospitals can't do it and vendors have no incentive. Costs Rs. 25k per plant and worth it to prevent potential catastrophes.
21/ Containers and plants will have better monitoring and usage due to ticket size and institutions involved. Get concentrators/cylinders only in hands of publicly verified decision-makers for supply chain optimization and optimal utilization whether you're a donor or non-profit.
22/ Potentially useful intellectual outputs:
1. Daily roundup on directions/data of High Court/SC cases on O2/Covid.
2. Calculator/predictor for O2 requirements (in imperial, SI, and B/D type cylinders),(cases/hospitalization, bed capacity/type) + (hospital, district, state)
1. Daily roundup on directions/data of High Court/SC cases on O2/Covid.
2. Calculator/predictor for O2 requirements (in imperial, SI, and B/D type cylinders),(cases/hospitalization, bed capacity/type) + (hospital, district, state)
