So the hospital chief executive Vaishali Jadhav made the decision that no medical professional wants to make. She began turning away new patients to make sure the hospital could care for existing ones.

She wasn’t the only one scrambling to deal with the unprecedented shortage in India for medical oxygen, a crucial component in treating covid-19 patients.

A doctor in Mumbai began making plans to transfer seriously ill patients to other facilities in case his oxygen ran out. The owner of another small private hospital in the city said he also stopped admitting patients who needed intensive care.

“Never in my life has this happened,” said Deepak Baid, the owner of the hospital. “There were moments in the past when beds were scarce,” he said. But “never oxygen.”

India has added more coronavirus cases in the past month than any other country during the pandemic. While much of the focus was on ventilators around the world during the earlier phase of the outbreak, the surge in India is now intensifying overall demand for oxygen and exposing the weak points in the system for getting it to hospitals.

During a meeting with state leaders Wednesday, Prime Minister Narendra Modi noted “the difficulties faced by some states recently in procuring oxygen supply” and said that “ensuring availability of medical oxygen is of utmost importance,” according to a statement from his office.

Could pass U.S. cases

With nearly 6 million cases, India is battling the second-largest coronavirus outbreak in the world. In mid-September, it set a record for the most daily cases — nearly 98,000 — since the pandemic began. The daily totals have since fallen below 90,000, although testing has also decreased. India is on track to overtake the United States as the country with the most coronavirus cases next month if current trends hold.

More than 1,000 people have died every day since Sept. 2, and the trend shows no sign of slackening. India’s total death toll is approaching 100,000. But compared with countries such as the United States and Brazil, India has a considerably lower number of deaths per million people.

While earlier the virus was concentrated in large cities, it has now spread to every corner of the country, including the vast countryside where the majority of India’s 1.3 billion people live. The health care infrastructure in such areas is notoriously weak, rendering it ill-equipped to handle rising cases. Getting large supplies of medical oxygen can also be a challenge.

In normal times, the bulk of the oxygen produced in India, as in other countries, goes to industrial uses. Oxygen is a key component in manufacturing processes for steel, chemicals, pharmaceuticals and paper.

Now the medical need far outstrips the demand from industry.

Saket Tiku, the president of the All India Industrial Gases Manufacturers Association, said the country needs 3,000 metric tons of medical oxygen a day, together with 2,000 metric tons of industrial oxygen — five times the demand in March.

Tiku said his group is working to reopen shuttered oxygen plants and to speed up approvals for new ones that are nearly ready. Transportation is another challenge, he added, because liquid oxygen requires special tankers.

Before the pandemic, medical oxygen would be shipped in a radius of about 125 miles from where it was produced, Tiku said. These days it is moving 10 or 20 times that distance, he said. “We’re transporting from oxygen-surplus places to those that need oxygen,” Tiku said. “Now it’s taking days.”

‘Not prepared for this’

For hospitals, the increase in need for medical oxygen over the past two months has been dramatic.

Vidyadhar Gaikwad, the resident medical officer for Sardar Vallabhbhai Patel Cantonment General Hospital in the city of Pune, said the 110-bed hospital once needed fewer than 10 “jumbo” oxygen cylinders a day (such cylinders contain about 1,800 gallons of oxygen).

Now a single covid-19 patient on a regimen of high-flow oxygen will use a jumbo cylinder every two hours. His hospital needs more than 100 such cylinders a day to treat covid-19 patients in its 10-bed intensive care unit, Gaikwad said.

“Frankly, we were not prepared for this,” he said.

The surge in demand “happened suddenly [and] even the dealers and vendors were not prepared.” He scrambled to find new suppliers and borrow oxygen from other hospitals and said the situation had eased compared with earlier this month.

Local governments are preparing for a long haul. In the state of Punjab, officials summoned 11 oxygen manufacturers and 20 distributors to a meeting earlier this month and asked them to restart defunct units. Before the pandemic, the demand for medical oxygen was about 40 metric tons a day, said Sibin C, a senior state official. Now it is 100 metric tons.

In the state of Assam, in India’s northeast, officials told oxygen vendors to prepare to divert the entire supply of the gas to medical uses regardless of the impact on industry. The central government is projecting that by next month the demand will surpass the state’s manufacturing capacity, forcing vendors to rely on supplies from neighboring states, said Anup Kumar Barman, a medical official in Assam.

Tiku, the head of the industrial gases association, said thinking about the future is stressful. He is simply praying that India’s cases begin to decrease. “Nobody has been able to project how many will fall sick,” he said. “We don’t know.”

Taniya Dutta in New Delhi and Sadiq Naqvi in Guwahati, India, contributed to this report.

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