It was only on Thursday after the hospitals in Kathmandu Valley started worrying about a possible shortage of oxygen that the Ministry of Health and Population invited the Nepal Oxygen Industry Association to discuss the situation.

Amid death toll skyrocketing in India due to the lack of oxygen for Covid-19 patients, Nepali authorities have finally woken up to the need to ensure the supply of oxygen.

“It was the first time the government invited us for consultations since the pandemic began last year,” said Narayan Timilsina, general secretary of the association, who attended the meeting. “The government was concerned about the availability of oxygen.”

Since oxygen levels go down in seriously ill Covid-19 patients, giving them supplemental oxygen till they recover can save lives, according to doctors.

And as caseloads continue to surge, increasing production of oxygen is the first line of defence against the illness.

But, oxygen manufacturers say it would be difficult for them to increase production immediately.

“Had the government asked a few months ago to increase our capacity, we could have taken steps towards it,” said Gaurav Sharda, president of the association. “But the government never consulted us during the entire pandemic period.”

Oxygen manufacturers, however, say that they are, for the moment, in a position to supply more oxygen to Kathmandu’s hospitals.

According to the association, which represents eight oxygen plants in the Kathmandu Valley, currently the demand for oxygen per day is around 4,500 to 5,000 cylinders and their existing production capacity is 8,000 cylinders per day.

Although capacity of cylinders differ, those used in hospitals hold seven cubic metres of oxygen and requirements differ from patient to patient.

About 30 percent of the total demand comes from various businesses and the rest from hospitals, according to the association.

“We can also divert oxygen going to businesses to hospitals which will also help bridge the supply gap,” said Sharda.

He, however, said soon it could be difficult for them to meet the demand as hospitals and business have already started hoarding oxygen.

“Fearing oxygen shortage, the hospitals have started placing higher demands than usual. That’s why, when we supply to one hospital, we struggle to meet the demand of another,” said Timilsina, who is chairperson of Sagarmatha Oxygen Nepal Pvt. Ltd.

Most hospitals in the country rely on external supply of oxygen. According to the Health Ministry, out of the 185 hospitals across the country, only 26 have oxygen plants and not all of them are in operation.

According to the manufacturers, major hospitals in the Kathmandu Valley like Patan Hospital, Grande International Hospital, Human Organ Transplant Centre in Bhaktapur, Bhaktapur Hospital, Hams Hospital, Himal Hospital, Madhyapur Hospital and Everest Hospital among others have been buying oxygen from private sector suppliers.

According to the association, their members have an estimated 70,000-80,000 oxygen cylinders.

“With a proper management of the cylinders in coordination with the government, hospitals and businesses, we can address the potential shortage of oxygen particularly in the Kathmandu Valley,” said Sharda, who is also the director of Kantipur Oxygen Pvt. Ltd.

During the meeting at the Health Ministry, the association has also submitted its plans to increase the number of cylinders by 20,000-40,000.

“We have told the government that we can add cylinders in the next 45 days provided the government supports us with tax exemptions and facilitates the import,” said Sharda. “We have already started talking with the Chinese suppliers.”

The government, on its part, has also taken steps towards facilitating the import of cylinders.

“On Friday, we wrote to the Finance Ministry for exemption of customs duty on the import of oxygen cylinders,” said Jageshwar Gautam, spokesperson at the Health Ministry.

Some hospitals outside the Kathmandu Valley have already started facing oxygen shortage, according to media reports.

Some hospitals in the Kathmandu Valley have their own oxygen plants but currently many of them are not in operation.

For example, the Tribhuvan University Teaching Hospital has three separate oxygen plants — one with a capacity of producing 1,000 litres per minute while the capacity of two others is 500 litres each per minute.

But, the big plant has not been in operation for the last one year in lack of a kit, which needs to be imported from France.

There has been a rapid rise in the number of hospitalizations with 55 beds occupied by Covid-19 patients at present, up from 24 last week, according to the hospital administration.

The hospital estimates that it may have to serve around 400 Covid-19 patients in the worst case scenario.

“At present, our oxygen requirement is being met from our own plants,” said Santa Kumar Das, chief of the Covid-19 Management Committee at the Tribhuvan University Teaching Hospital. “But, if cases continue to jump then our internal supply will not be enough.”

After the peak of the first wave of the pandemic, global supply chain disruptions had eased. But, the hospital was still unable to import the kit.

“The supplier failed to bring the kit from France citing frequent lockdowns in Europe and other supply chain disruptions,” said Das. “But now the supplier is saying it could be brought in two weeks.”

Sukraraj Tropical and Infectious Disease Hospital, which has once again been designated as a dedicated Covid-19 hospital since last week, has its own refilling plant with capacity of 20,000 litres, through which it supplies piped oxygen to the hospital.

Sagar Kumar Rajbhandari, director of the hospital, claimed that his hospital has no shortage of oxygen.

“We refilled our plant with oxygen on Friday fully which will be enough for 15 days to one month,” said Rajbhandari. “It is enough to supply oxygen to 50 patients requiring a high amount of oxygen for 15 days round the clock.”

The hospital imports oxygen in a tanker from Madhya Pradesh, India but Rajbhandari is not worried about supply despite the ongoing oxygen crisis in India.

According to him, the shortage in India is of the oxygen supplied in cylinders, but not the liquified oxygen supplied in tankers.

“We are confident that supply from India won’t stop,” Rajbhandari said.

But authorities say that they are concerned about possible shortage in the event of a sharp spike in cases.

“If the situation worsens compared to the peak of the first wave of Covid-19, managing adequate oxygen could be challenging,” said Gautam, spokesperson at the ministry.

On Saturday, 2,486 new cases were confirmed through the polymerase chain reaction tests and 133 from antigen tests. Active cases in the country stand at 16,828, according to the Health Ministry.

The ministry has projected that an additional 300,000 people could be infected with the virus by July 15 and the daily cases could reach up to 11,000.