Kist Hospital in Lalitpur had 50 Covid-19 patients on oxygen support including 13 on ventilator on Saturday.

But at 3:20pm the hospital was about to run out of oxygen.

“We were about to crash,” Dr Suraj Bajracharya, medical director at the Kist Teaching Hospital, told the Post.

Relatives of the patients were panicking and some had started to cry.

The hospital pleaded with the Ministry of Health and Population, senior police officials in the district, Covid-19 Crisis Management Center, and district administration office about the critical shortage of oxygen.

The National Trauma Center finally came to the hospital’s rescue.

“We sent 15 cylinders to the Kist Teaching Hospital today,” Dr Santosh Poudel, director at the National Trauma Center, told the Post. “We too do not have many cylinders in stock. But to save the lives of those critically ill we sent those cylinders.”

The patients who needed oxygen were saved.

“Had we not got the oxygen all the patients in the intensive care unit, on ventilators and general beds would have died within half an hour,” Bajracharya said.

As the country grapples with the deadly second wave of the Covid-19 pandemic, hospitals throughout the country have been facing acute shortage of oxygen.

Nepalgunj Medical College Teaching Hospital of Banke, one of the worst hit districts in the country has been turning back patients every day since it does not have enough oxygen.

There have also been reports from various districts as well as from the Kathmandu Valley about deaths of Covid-19 patients due to lack of oxygen supply.

Kist Hospital, like many across the country, has said that it has stopped admitting new patients due to shortage of oxygen.

“We have also written to the Health Ministry informing it that we cannot provide treatment to Covid-19 patients due to shortage of oxygen,” said Bajracharya.

The hospital, which can provide care for over 300 infected patients, has not only stopped admitting new patients but also warned that it would be compelled to stop providing care to its patients if oxygen supply is not ensured.

The 15 cylinders that it has received from the National Trauma Centre is only a stop gap measure.

“We don’t know what will happen at night,” Bajracharya said at 6pm Saturday. “We have sent empty cylinders for refilling but have not got them yet.”

The hospital needs over 400 cylinders a day but is getting only around 150.

Oxygen bottlers said they are not in position to meet the growing demand for oxygen cylinders, as demand now is more than four-fold than the total capacity of the industry.

“We are also shocked by the soaring demand for oxygen in the last four days,” said Narayan Timalsina, chairman of Sagarmatha Oxygen Nepal Pvt Ltd. “Demand is more than four fold than the actual capacity of the industry.”

According to the Oxygen Industries Association, a grouping of Kathmandu Valley-based suppliers, oxygen manufacturing companies in the Valley have capacity to produce oxygen for 8,000 cylinders per day.

“My own company can produce 800 cylinders a day but demand is for over 2,500 cylinders,” said Timilsina who is also the general secretary of the association. “Relatives of patients have been coming to the industry directly and pleading for oxygen.”

It is also not possible to ramp up the capacity of the industry overnight, he added.

Doctors say fatality from Covid-19 will increase several fold if the patients who have been suffering breathing difficulty are not provided oxygen support.

“There are 23 patients on oxygen therapy on the grounds of our hospital,” Dr Sagar Rajbhandari of Sukraraj Tropical and Infectious Disease Hospital told the Post. “All the patients who have been admitted or staying on our hospital premises need high flow oxygen supply.”

The hospital, which has its own liquid oxygen storage, has been using bottled oxygen after it ran out of liquid oxygen, it normally uses, a week ago. The supply of liquid oxygen has stopped due to the restriction in export by India.

It used to use two cylinders of oxygen per day in normal times but now it needs 400 cylinders a day.

The National Trauma Center, which also has its own liquid oxygen tank, said that due to a halt in supply from India, it has been using bottled oxygen.

“We are told that India has lifted restrictions on oxygen export and a tanker carrying liquid oxygen has left Birgunj for Kathmandu,” Poudel, director at the Center, told the Post.

But for most of the hospitals in Kathmandu, it is oxygen cylinders that they have to depend on.

Shankar Oxygen Gas Pvt Ltd said over 30 hospitals have sent their cylinders for refilling.

There are eight oxygen factories in Kathmandu Valley which have around 70,000-80,000 cylinders, according to the association.

There are plans to import 20,000 cylinders from China but again, they will not arrive overnight.

The government is taking delivery of 400 oxygen cylinders it is receiving as grant assistance from China and a Nepal Airlines aircraft is flying to Beijing on Monday to get them.

“The cylinders will have a combined weight of 27 tonnes which is enough for a plane to carry,” Dim Prasad Poudel, managing director at the Nepal Airlines, told the Post.

China is providing 3,500 cylinders along with 10 ventilators on grant, according to D.B. Chhetri, under secretary at Nepal's Finance Ministry

“After the 400 oxygen cylinders arrive, China will have 1,600 cylinders ready for delivery in the next two weeks,” Chhetri, who oversees economic cooperation with China at the ministry, told the Post. “The government will send planes again to get the remaining cylinders as per the decision of bringing 2,000 cylinders by air.”

According to him, the remaining 1,500 cylinders will be brought by land route as per the agreement with China.

“The Chinese side will deliver these oxygen cylinders at the Rasuwagadhi border point and Nepal will receive them there in the next three weeks,” he added.

Cylinders could not be delivered immediately due to a mismatch of cylinders’ valves in Nepal and those available in the Chinese market and new valves needed to be designed and manufactured, according to Chettri.

Even though Nepal had sought 20,000 cylinders from China in grant assistance, officials said it is not clear whether China would provide all of them in grant or Nepal will have to pay for them.

Meanwhile, hospitals in Nepal are scrambling.

Alka Hospital in Lalitpur Friday evening issued a notice saying that it would not admit new patients due to lack of oxygen.

“The problem is not only of our hospital but all private hospitals in the Kathmandu Valley,” Kumar Thapa, chairman of the Hospital told the Post. “But other hospitals have not said so publicly.”

Thapa, who is also the senior vice-president of the Association of Private Health Institution Nepal, said that his hospital too needs over 200 oxygen cylinders a day, of which it produces 30, but the bottlers have not been able to supply as per the demand.

And more people continue to get infected and die of Covid-19 complications.

Nepal on Saturday recorded 8,287 new cases from the 17,315 polymerase chain reaction tests and 131 from 989 antigen tests. The country recorded 53 deaths. The death toll has reached 3,632. Active cases stand at 83, 493.

“Of the total tests performed in our hospital, the positivity rate is over 60 percent today,” Rajbhandari, director at the Sukraraj Hospital, told the Post.

Nationally, the positivity rate on Saturday was 48 percent, a record.

Authorities feel helpless.

“I feel completely hopeless,'' Dr Samir Adhikari, joint spokesperson at the Health Ministry told the Post. “Luckily we could arrange some cylinders and prevent a disaster at Kist Hospital. Situation is more or less similar in all hospitals of the Valley.”

Adhikari, who had been aware of the situation at Kist Hospital for the last three days, had been depressed due to his failure to arrange oxygen and the looming disaster.

“Situation has already gone out of control and the Health Ministry alone cannot do everything,” Adhikari said.

(Prithvi Man Shrestha contributed reporting.)