India has amassed millions of new covid-19 cases in a matter of weeks. The number of people needing life-saving oxygen support has gone out of control causing the country to slip into an oxygen supply crisis. Here in Pakistan, the ordeal may just be starting. So far, the supply to the healthcare system was manageable but that might be changing soon. In fact, it may be a matter of time before hospitalized oxygen supply chokes.

Stay home, stay safe. This slogan cannot be overemphasized given the precarious capacity of the healthcare system in Pakistan. The Indian situation has made people worried at home. The oxygen shortages have not hit home yet because the supplies which were meant for various industries have been diverted towards the healthcare network.

Pakistan’s daily oxygen production is close to 750 metric tons (MT). In routine days, 30 percent is allocated for healthcare while remaining goes to other industries such as steel furnaces, cutting and ship breaking industries, glass making etc. Since March-15, supplies to healthcare started increasing and by now, 80-90 percent of oxygen supply directly or indirectly is diverted to the sector.

There are two big oxygen producers and three small ones. The biggest unit—Ghani Gases Limited—was operating at 80 percent of capacity a couple of months back and now with a booster, it is operating at 115 percent capacity. The story of other players is similar.

The supply to big hospitals in Punjab - Mayo in Lahore, Allied in Faisalabad, Nishtar in Multan used to be one tanker (10-20 MT capacity) for two days. Now two tankers are being supplied on a daily basis. Tertiary care hospitals have oxygen supply pipelines and some secondary health care units also have this facility. Remaining hospitals and clinics rely on cylinder supplies. The oxygen tankers do rounds of supply. Oxygen is highly inflammable and needs specialized tankers and cylinders for transformation.

Tankers and cylinders supplies are harder to enhance in the short term. In India, there is enough oxygen produced for the industry which if diverted can solve the problem. There are however, bottlenecks, mainly the conversion of oxygen from gas to liquid, the logistical challenge of transporting from the production place to where the need is, and most critically, the lack of tankers and cylinder to supply and store.

Pakistan can face similar problems. Oxygen producers are eying imports – but the import supply would not last for more than 2-3 full days of need. The supply chain bottlenecks would constrain higher imports. The other option is to import oxygen concentrators. These are like electricity generators to produce oxygen. But these have their own limitations. One, it is expensive and other it is of single person use. It supplies around 10 liters of oxygen per minute, which is not enough for critical covid-19 patients.

There is no other option but to ration oxygen supply and to limit social exposure. Hospitals are postponing elective surgeries. Supplies are maxing out. Critical cases in Pakistan are growing. Pakistan is currently seventh in the world for critical coronavirus cases while on overall covid-19 cases, Pakistan is at the 31st spot, implying that cases are grossly underreported.