Last year in May, Subhas Dhungel faced an unprecedented problem. His father, a kidney patient, was admitted to Shahid Dharmabhakta National Transplant Centre in Bhaktapur and he caught Covid-19.

He was on oxygen support. He needed to bring his father home as per the consultation with doctors, but he was told he should be given an uninterrupted supply of the life-saving gas.

The chase began, recalled Dhungel.

“I tried to get a cylinder of oxygen for my 75-year-old father. I put out a help post on social media. I ran from pillar to post,” Dhungel, who works at an engineering college, told the Post. “It took me around three weeks to arrange a cylinder of oxygen.”

It was the time when the country was grappling with the second wave of the coronavirus. Hospitals were turning away patients for lack of beds, ventilators and above all, the life-saving oxygen.

As the coronavirus has gripped the country with doctors calling it the third wave driven by the same old devastating Delta and the new variant called Omicron, Dhungel said he is praying the country does not face a similar crisis of oxygen.

On Monday, Nepal reported 6,734 new cases—5,747 in 14,014 polymerase chain reaction tests and 987 in 3,451 antigen tests, according to the Ministry of Health and Population.

There are projections that the daily cases could reach as high as 20,000. The hospitalisation rate has also been increasing.

Oxygen manufacturers and hospitals in Kathmandu Valley say that despite the rise in the number of hospitalised coronavirus patients, demand for oxygen has not gone up and they don’t expect an oxygen crisis like the one the country experienced during the second wave.

They, however, insisted that effort should be made to ensure that even a small chance of an oxygen crisis does not turn into reality.

“Unlike the Delta variant, the Omicron variant appears to have caused minimal respiratory problems among the coronavirus patients,” said Dr Ravi Shakya, director at the Patan Hospital. “So we expect that there won’t be an oxygen crisis as bad as we experienced during the second wave.”

The second wave hit the country in April. Only after August did cases start to ebb. More than 6,000 people died during the peak, largely because of a lack of oxygen and ventilators.

It was a wake-up call for the government and hospitals.

Most of the major hospitals in Kathmandu and some major cities now have increased oxygen production capacity either by establishing new oxygen plants, by upgrading existing oxygen plants or by adding liquid oxygen tanks.

For example, Patan Hospital set up a new oxygen plant with a daily production capacity of 270 cylinders while Bir Hospital increased its capacity to 150 cylinders per day along with a separate liquid oxygen tank with a capacity to store 20,000 litres, according to officials at the hospitals.

Tribhuvan University Teaching Hospital has a new oxygen plant with a capacity of 2,000 litres per minute along with a liquid oxygen tank that can hold 20,000 litres, according to Dr Santa Kumar Das, coordinator of the Covid-19 management committee at the hospital.

Even though cases and hospitalisations have been rising, the oxygen crisis has not been reported by any hospital as of now, and oxygen manufacturing companies also say they have not received any additional demand, which experts say is a good sign.

“I am not getting extra demand for oxygen from hospitals,” said Gaura Sarda, director of Kantipur Oxygen Pvt Ltd, an oxygen manufacturing company. “We are producing 400 to 450 cylinders a day compared to our capacity of 800 cyinders a day from our Kathmandu-based plant.”

Part of the oxygen manufactured by this plant goes for industrial purposes, including in hydropower and glass factories, according to Sarda.

Other manufacturing plants also said they have not received any extra demand.

The demand has remained consistent for Sagarmatha Oxygen Nepal Pvt Ltd after the second wave of the pandemic was over.

“We are supplying around 350 cylinders a day—300 for hospitals and the rest for industries,” said Narayan Timilsina, chairperson of Sagarmatha Oxygen Nepal.

His plant has the capacity to produce 800 cylinders a day.

Timilsina, who is also the general secretary of the Nepal Oxygen Industries Association, said that no oxygen plant has informed him about an increased demand for the gas yet.

Shankar Oxygen Gas Pvt Ltd is also operating only one of its two oxygen manufacturing units and producing 400 to 500 cylinders a day.

“At the moment, we are not receiving an increased demand for oxygen,” said Shakar Lal Agrawal, managing director of the company.

Shankar Oxygen, which also plans to set up a liquid oxygen plant, has helped set up liquid oxygen plants in 17 hospitals—both government and private.

“There is hardly any demand for liquid oxygen from government-run hospitals but private hospitals are placing some orders. I think government hospitals have set up their own plants now,” said Agrawal.

Bir Hospital, National Trauma Centre, Teaching Hospital and Sukraraj Tropical and Infectious Disease Hospital set up liquid oxygen tanks as alternative sources of oxygen.

Oxygen manufacturers say the fact that the demand for oxygen has not grown should be taken as a good sign and that even if people are being hospitalised for the coronavirus, their condition is not serious. However, with the coronavirus, no one can be sure, they say, and urge caution.

“I think the government should keep hospitals ready for potential crises by filling up all oxygen cylinders,” said Sarda, who is also the president of Nepal Oxygen Industries Association.

Manufacturers said that despite the government hospitals receiving a large number of oxygen cylinders in donations from various countries and organisations, they are unsure about whether they are being utilised or stored somewhere.

According to the data with the Department of Health Services, the country received 4,126 oxygen concentrators, 6,945 oxygen cylinders, 13,820 body bags and 218 ventilators, among others, from a number of foreign governments and domestic and international agencies between April 14 and July 4 last year.

“I have not seen those cylinders as they have not been brought to our plant for refilling,” said Sarda.

The manufacturers also said that the government should return oxygen cylinders which were seized during the second wave and distributed to the hospitals.

“Over 4,000 cylinders seized from several oxygen manufacturers in Kathmandu Valley and distributed to the hospitals have not been returned,” said Sarda.

According to the manufacturers, the Department of Industry held a meeting with the oxygen manufacturers last week and urged them to be prepared for the new wave of pandemic.

“The department asked us to keep our oxygen plant in the right condition to produce oxygen in full capacity,” said Timilsina.

According to the association, there are two dozen oxygen plants across the country run by the private sector and their daily production capacity stands at over 17,000 cylinders.

“These plants have over 150,000 oxygen cylinders,” said Timilsina.

Doctors and public health experts say the second coronavirus wave wreaked havoc of unprecedented proportions, exposing Nepal’s fragile health care system. Hence, there is no room to let the guard down and preparation is key, according to them.

Shakya, the director at Patan Hospital, said the oxygen demand may not be high but who knows when it could increase.

“The entire country should be ready to tackle the Covid-19 situation,” said Shakya. “The current surge is driven by the Delta that created the crisis in the second wave and Omicron. We must be prepared with regard to oxygen supplies as well.”