Anticipating the need for more oxygen than ventilators to treat patients of the coronavirus disease (Covid-19), the Delhi government has set out to procure 2,000 oxygen concentrators.

An oxygen concentrator is a device that removes nitrogen from the ambient air to enrich it with about 93% concentrated oxygen for patients in need of respiratory support, with a mask, whereas a ventilator is a machine that pumps air in and out of the lungs through a tube.

In India, only 0.45% of Covid-19 patients are still on ventilators, while 2.94% of them are on oxygen support, according to data from the union health ministry. The data also goes to show that 0.4% of Delhi's patients are on ventilators but does not elaborate upon how many are on oxygen support.

A senior official from Delhi's health department said on condition of anonymity, "After treating so many Covid-19 patients, we've realised that most of them do not need ventilators. Oxygen support is good enough to improve their respiratory rate and oxygen concentration. Therefore, the Delhi government has decided to purchase oxygen concentrators."

The Delhi government is preparing for a worst-case scenario of 30,000 active cases simultaneously. There are 5,720 active cases in Delhi as on May 20, according to Delhi government data.

The official quoted above said that oxygen concentrators would not only be used within hospitals where there aren't any gas pipelines but also in hotels or dharamshalas where Covid-19 patients could be treated if the number of cases increases.

"There are gas pipelines in most designated Covid-19 hospitals that deliver oxygen to patients. However, some hospitals make use of oxygen cylinders. Oxygen concentrators can be used in these hospitals instead, eliminating the need for oxygen cylinders. Also, if the number of cases goes up, and people start receiving treatment in hotels and dharamshalas, these machines can be transported there," the senior official said.

According to the official, the Delhi government was looking at purchasing 500 ventilators earlier. There are around 306 ventilators in government hospitals and 800 in private hospitals in Delhi as of now.

An internal committee of the Delhi government has also started examining the standards for procuring personal protective equipment.

According to Delhi government officials, the tender for two lakh PPE kits floated by the Delhi government has failed at least twice within a month as none of the 32 manufacturers could match the quality of the components—coveralls, respirators (N-95), gloves and goggles—that has been prescribed by the health ministry.

"The health ministry guidelines have referred to international standards for goggles, masks, coveralls and gloves and several good quality products cannot be purchased if they are not certified according to these standards. Hence, the tenders failed. Now, an internal committee is looking at the products whose quality we can examine and if we find it satisfactory, procure them even if they do not have the requisite certification according to international standards," another official from the health department said on condition of anonymity.

According to the second official, there is no immediate shortage of the kits as "the government-run company HLL Lifecare Limited sent 40 trucks full of PPE kits to the Delhi government earlier this week".

HLL Lifecare Limited had been designated to procure PPE kits through global tenders; however, the company has now stopped procurement, the kits will now be available on Government E-Marketplace for state governments and hospitals to procure.

In an earlier shipment last month, from HLL Lifecare Limited, the Delhi government had received only 1,700 goggles and masks (components of the PPE kits) for a total of 15,000 kits, because they were in short supply.

"The N-95 respirators were in a short supply in the open market as there were just two of the ten existing Indian manufacturers of the masks in operation during the lockdown. They supplied mostly to HLL. The import from other countries had also gone down. However, the BIS has now allowed companies to get their products certified from approved laboratories outside. Earlier, one of the requirements for a manufacturer was to have a complete in-house testing facility, which usually cost ₹50 lakh to set up and around ₹2 lakh each year to maintain. Now, mostly MSMEs (Micro, Small & Medium Enterprises) make these respirators and cannot afford the testing facility. Several companies have now come forward to make the masks and the shortage should reduce within the week," Sanjeev Relhan, chairman, Preventive Wear Manufacturers' Association of India (PWMAI), said.

"There is a shortage of goggles, though, as per the standards mentioned by the ministry of health, but there are enough face shields and visors available, which are actually more comfortable to work in, especially for those who wear spectacles. State governments could, perhaps, modify the health ministry's guidelines. The guidelines for rational use of the kits have helped," he said.

The health ministry guidelines have clearly specified what kind of protective gear has to be worn in what parts of the hospital.

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