This document deals with the subject of making arrangement of adequate availability of Oxygen for patients at BCRTH, in the event of a significant load of symptomatic patients either suspected or diagnosed with Covid 19 infection, receiving treatment or waiting for transfer to a state designated centre.

About 25% of all patients who contract coronavirus will not show any symptoms (asymptomatic, and the most dangerous group who are quietly spreading the virus in the community!). Of the remaining 75% who are symptomatic, 80% will require non-ICU hospital care in the ‘Isolation’ ward; 20% will require critical care at ICU; 5% will proceed to requiring supportive ventilation (non-invasive or invasive; Bi-PAP/Ventilator).

But in all categories of admitted patients, oxygen remains a mainstay of treatment as most deaths are due to pulmonary involvement/infection that may or may not proceed to multi-organ failure. There is no medicine that will take care of the virus.

The hospital is currently providing oxygen to its patients using Type B Oxygen cylinders on a bedside basis. The potential risks with this type of arrangement include (in the event of a significant load of patients with Covid 19 infection) –

1. Shortage of Oxygen supply from the vendor (as all vendors will be under stress; hospitals requisitioning higher volumes will get preference; availability of vehicles and drivers and staff may also be a problem);
2. Cylinders will empty, sometimes erratically, without much of a prior warning;
3. Wastage of oxygen, as with pressure dropping, cyclinder will be decommissioned even with about 20% liquid oxygen remaining;
4. Non-uniform supply pressure, resulting in inability to maintain an even FiO2, which can be dangerous for a patient with pulmonary symptoms resulting from Covid 19 infection;
5. Inability to store in large volumes;

Under such circumstances, and considering that the hospital does not have copper pipeline installed for oxygen supply through wall-mounted valves, and through multiple rounds of discussions held over last 3 days with reputed large vendors, the most appropriate solution seems to be the following –

We will approach a company called “Air Water”, with office in Kolkata. They can install a small manifold system for say, a 20-bed Ward (the potential Covid 19 ward at the hospital that we will make within the existing structure) and supply this with a battery of Type D cylinders.

This will ensure reliability, availability, uniform pressure and a longer ‘lead’ time for us. Besides, this would also not be a wastage of money as it is better for the hospital to have something like this, even without the threat of Covid 19!

The problems with alternatives are as follows –

1. Individual small portable Oxygen concentrators – unreliable; generally used only for mountaineering. Besides, these will have no use in future. After sales service from Philips is not good.
2. Large-scale Oxygen concentrators – would have been ideal but will require construction of a larger scale pipeline system which would be impossible to do quickly now, given embargo on labour movement.

I have started the process of initiating a conversation with “Air Water”; but kept it tentative and non-committal.