Medical oxygen has become an important life-saving commodity in the fight against

COVID-19, and lowering the level of oxygen in the blood of patients could be effect lead to the
development of Pneumonia and Hypoxia. Therefore, Oxygen is often used in general medicine,
medical assistance and emergency medicine. The availability of medical oxygen can make the
difference between life and death. We know that the Covid-19 virus often infects the lungs,
targeting the respiratory system. In severe cases, this can be lead to hypoxemia which leading
cause of death among COVID-19 patients.
Blood oxygen saturation (SpO2) above 95 percent is a healthy range for children and
adults. Oxygen saturation levels below 90 percent are considered dangerous per the World
Health Organization (WHO), about 20 percent of COVID patients’ needs to have oxygen therapy
to prevent respiratory problems. For such type of reasons, it is essential to ensure supply of
oxygen continuously to save peoples life from COVID 19 virus all the time.
A recent example of medical oxygen deprivation in India
The tragic stories of patients dying from lack of oxygen in Delhi hospitals have drawn
international attention to where this life-saving gas comes from. Oxygen is all around us in the
air we breathe, but when our lungs become inflamed and damaged, as in severe lung infections,
they find it difficult to absorb enough oxygen to meet the body's needs. All our cells need
oxygen to survive and when the oxygen level in the blood starts to drop our organs and tissues
are starving. To combat this, patients hospitalized with severe COVID-19 are often given extra
oxygen.
As the number of corona virus patients in India has increased, medical oxygen
consumption has increased eightfold and dozens of hospitals in Delhi and elsewhere have
reportedly run out of supplies needed to keep patients alive. Various countries have provided
oxygen cylinders, concentrators, and cryogenic tanks to transport oxygen in extremely cold
liquids, and organizations such as UNICEF are working with their partners to purchase and
install oxygen-generating power plants in hospitals. But how to extract oxygen from the air?
How to prevent future shortages as the plague continues to wreak havoc around the world?
Sri Lanka's current need for oxygen to cope with the third wave
We know that the peoples of Sri Lankans here today are facing a very critical
period in Sri Lanka due to the Covid-19 epidemic. Previously, we suffered from the first
wave of Covid-19, which starts on January 27, 2020. At that time was found a 44-year-old
Chinese woman living in Hubei, China, she was identified and confirmed as the first person
who contracted the virus first in Sri Lanka. Now we are following the second and third
waves of the epidemic & in this month of May 11, 2021, there were 131,042 active patients,
107,642 people cured of the disease, and 850 people who died from the epidemic in the
country. These numbers are growing even faster by the minute.

Since the beginning of May, Sri Lanka has seen an increase in the number of COVID-19
patients, with a daily average of over 2300, and with this increase, the need and demand for
medical oxygen is the only thing that keeps us all alive & it’s demand is increasing day by
day because of increasing number of COVID patients.
When going to be discuss about the medical Oxygen current requirement in Sri Lanka as
per the Health Minister Miss Pavithra Wanniarachchi said that Sri Lanka has ordered more
oxygen cylinders as the number of Coronavirus patients admitted to hospitals began to rise in
a third wave. Sri Lanka’s hospital system currently has 24,000 medical oxygen cylinders and
4,000 jumbo cylinders. As per the health Minister, the problem is not oxygen but cylinders to
store oxygen to distribute throughout the country.
Curranty government have ordered 7000 more jumbo cylinders to store Oxygen and
another 400 cylinders will expect by the end of the week. Several hospitals in Sri Lanka have
piped oxygen from a liquefied gas tank.
Ceylon Oxygen one of the two oxygen producers in Sri Lanka has suggested installing
tanks in major hospitals currently. As per the health Minister, the country has the capacity to
produce four times the required amount of oxygen in-country at the moment.
“The required amount of oxygen in hospitals is 25 tons, “However, Sri Lankan
government has the capacity to increase it up to 80 tons.”
Ceylon Oxygen, a unit of Linde AG is the top supplier of medical oxygen. Another
firm Industrial Gases also produces the gas.
There are also oxygen concentrators in the market that can produce gas from air, which
can be plugged into a wall socket and connected to ventilators for individual patients.
Several hospitals in Sri Lanka have piped oxygen facilities supplied from a large
liquefied gas tank.
 Ceylon Oxygen one of two oxygen producers in Sri Lanka has suggested the
installation of more such tanks in major hospitals.
Sri Lanka’s The Morning newspaper said Ceylon Oxygen had written to the Director General
of Health Services suggesting that 10 large liquefied gas tanks imported for hospitals that
already have such facilities be fitted to ones that are using cylinders.
These are Colombo South Teaching Hospital in Kalubowila, the Teldeniya Base
Hospital, the General Hospital Kalutara, the Puttalam Base Hospital, the Chilaw Base
Hospital, the Teaching Hospital Kurunegala, the Minuwangoda Base Hospital, the
Mulleriyawa Base Hospital, the Karawanella Base Hospital, and the Nawalapitiya Base
Hospital, the newspaper said.
The firm had also suggested that Covid-19 patients be kept in hospitals within 200
kilometers of Colombo so that there are no undue delays in distributing the gas.

What kind of factors that can be caused to arise oxygen deficiency in Sri Lanka?
Sri Lanka is in dire need of medical oxygen as the country is gripped by a deadly third
wave of the epidemic. But bureaucratic barriers delay the delivery of critical resources to those in
need. Based on the experience gained in the last few weeks, if the oxygen requirement will be
exceeded 50% for any of the following reasons, solutions should be sought to overcome those
barriers very quickly.
1. Very few number of oxygen cylinders are available in Sri Lanka
Governments all over the world attended medical emergencies triggered by the COVID-19
pandemic situation. Like several other countries, Sri Lanka, a populous country in the South
Asian region, battling for optimal usage of medical infrastructures, such as hospital beds,
medical oxygen, and others. This pandemic required different kinds of facility to handle patients
from distance while prediction of lockdown period also have importance as discussed.
Apart from its industrial usage, oxygen is used for various medical purposes - from
general medicine administration to medical assistance and emergency procedures. Oxygen is a
critical element for human life existence, and because of its natural availability through the air, it
is sometimes forgotten to be a life-saving essential medicine. The timely availability of medical
oxygen is a decider of life and death for the patient. Hospitals are always giving priority over the
rest regarding the continuous availability of medical oxygen.
 Currently Sri Lankan has made arrangements to order 21,000 oxygen cylinders for
emergency use for Covid patients (Sri Lanka: Government to order 21,000 oxygen cylinders for
emergency use for Covid patients, 2021). The requirement for additional oxygen cylinders as
predicted by the Ministry of Health is 2,000 small cylinders of 4 liters, 10,000 large cylinders of
12 liters and 9,000 cylinders of 47 liters. It would be very beneficial if it could be possible to
facilitate the small-scale Oxygen producers in the country to supply along with the two largest
oxygen producers in the country, Ceylon Oxygen Limited and Gas World Lanka Limited.
2. Collecting of oxygen cylinders distributed in all over the country.
With the current increase in the number of COVID patients, it is imperative to add available
oxygen stocks and cylinders to treat hospitalized patients and other health facilities. It is also
important to test whether the cylinders are suitable for medical purposes.
The collection and storage of oxygen cylinders must be properly managed. the Collection centers
have to have safe and proper storage facilities that can be set up by municipal councils or locally
to meet that need. These centers distribute or supply the collected cylinders to the required
locations as per the requirements. Responsible persons can be appointed to collect oxygen
cylinders from industries and available locations. Officers can be assigned to collection centers
to manage the storage and distribution process.
In the midst of rising COVID patients in India, the Kerala authorities have decided to collect
oxygen cylinders used for industrial purposes and store them in the warehouse of the Kerala
Medical Corporation on the instructions of district collectors with the help of village collectors.
Village officials, with the assistance of industry department officials, will collect the oxygen
cylinders. A special team has been set up under the Additional District Magistrate.
3. Medical oxygen is considered a hazardous material to transport
Given the pandemic scenario and need for medical oxygen, even if there are sufficient
medical oxygen accessible from the state and the Medical Authorities, it might be difficult to
deliver medical oxygen to hospitals and also seen as a dangerous item. It is particularly sensitive
to security safeguards to be transferred to hospitals and other healthcare institutions. The oxygen
tanks such as oxyacetylene welding tanks or medical tanks must be handled by someone who can
store and safeguard oxygen tanks.
The safe shipment of oxygen cylinders authorized by the US DOT is regulated and its main
requirements are complied with (levins,2020);
  A hazardous substance declaration form must be available for transportation vehicles.
 In order to prevent accidental rupture, oxygen cylinders must be provided with work
pressure relief mechanisms and leaks inspected before the filling plants leave.
 Sustainable Class 5 UN hazardous labels for both cylinders themselves and shipping
packaging for overpacks must be labeled with Oxygen Cylinders in an easy to see area.
 During shipping, oxygen cylinders must have secure valve protective caps in place.
 Oxygen cylinder must comply with the structural integrity DOT cylinder requirements.
 Hazmat certification should be used by employees (such as drivers and warehouse
personnel) that handle or transport oxygen.
For safer transportations of medicinal oxygen in the country, rules above can be used.
4. Analysis and system for supplying oxygen demand
The best approach for meeting the increased demand for oxygen during a pandemic is found
in many nations, governments and hospital management. In this way, one of the objectives of
tackling these problems is to help decision-making.
As the coronavirus spreads (SARS-CoV-2), it threatens poor nations with vulnerable
healthcare systems and increasing medical oxygen requirements. The WHO Director General
reports that around 620,000 m3 of oxygen daily, which is around 88,000 cylinders huge, will be
needed if the newly infected population stays at present level of one million a week (Balys et
al,2021). The demand for medical oxygen in numerous countries outstrips the supply. In
addition, few companies, like Air Liquide, the Linde Group and Nippon Gases, dominate almost
80% of the market (WHO Director-General, 2020).
A mechanism for assessing and estimating the oxygen gas demands should be in place at
every district hospital. The evaluation should include monthly or seasonal changes in oxygen
use. The performance of the health gas provider should be included in a review, and this
information should be used in the local hospital to get medical gas.
5. Enough health care infrastructure to meet the increase in demand for oxygen.
As there are an increased number of instances of Covid-19, health union said that a hospital
network of the nation does not have the medical infrastructure needed to deal with an increase in
demand equivalent to that in neighboring India, such as the proper supply of oxygen. At now,
only large hospitals with just approximately 30 oxygen cylinder per facility have enough supply,
they say. There are presently less than five oxygen cylinders available at other hospitals, such as
the district and base hospitals (Mudugamuwa, 2021).
In view of the increased number of patients admitted to the covid-19 hospitals, the Union
encouraged the Government to take prompt measures to boost the supply of oxygen and other
infrastructure necessary for the treatment of patients with serious consequences, such as
breathing difficulties.
The most significant thing is the provision of this oxygen in the bedside of the patient. The
ideal way of doing this is to distribute piping oxygen from a central liquid oxygen tank instead of
cylinders. Sadly, just 28 such liquid oxygen tanks in hospitals are deployed across the country. In
hospitals and other health care institutions additional liquid oxygen tanks should thus be
provided. Distillation of Cryogenes Plants using fluid oxygen may obtain pure oxygen in excess
of 99.5% whereas the oxygen production plant utilizes the air, it compresses and filters it for
93% oxygen extraction (Bikkina, Manda and Rao, 2021).
Cryogenic liquid tankers may be installed in hospitals, which may utilize liquid oxygen,
which is less bulky, thereby shortening the time for providers to fill oxygen gas gas cylinders
(Bikkina, Manda and Rao, 2021).
6. Safe oxygen storage in health centers and hospitals.
Although oxygen is not flammable, it is a good speed, which makes fire hotter and faster.
Oxygen is one of the three features required to ignite a fire in the Fire Triangle. If oxygen is
freed up unregulated around open flames, enormous fires can grow quickly and explosions can
occur in rare cases. Oxygen tanks must thus be handled quite carefully.
In one of the following conditions, oxygen-related problems frequently happen:
 Inaccurately, the valve of an oxygen cylinder is left open.
 Damages caused by the leaking of hoses, valves or other cylinder devices.
 An oxygen cylinder spoils the impact.
 Leak detection equipment does not identify the presence of leaks.
If one of these dangerous scenarios is combined with an open fire, a catastrophe may take
place and oxygen tanks should therefore be kept and shipped carefully.
The OSHA (Occupational Safety and Health Administration) of the USA has a
comprehensive set of standards for the manipulation and storage of oxygen. This can also be
taken as a guidance for the storage of oxygen compressed cylinders in hospitals and health
centres. It is necessary to be fully aware of the regulations (Levins,2020).

7. Monitoring of Oxygen supply

Most district hospitals are not equipped with the continued delivery of oxygen to monitor the
loss of essential care. An effective alarm system-based monitoring system to monitor the
delivery of oxygen in different hospital locations, particularly in critical care sections, is
necessary to resolve oxygen supply restrictions.
The Uttara Pradesh Oxygen Monitoring System in India is a 24x7 live oxygen monitoring
system throughout the state to satisfy the requirements for medical oxygen in private and public
hospitals.
The system must provide live information on oxygen demand by hospitals in various
districts, the allocation and loading of oxygen in vehicles, the live positioning of road transport
vehicles and the provision of and use of oxygen (Srivastava, 2021).
In Sri Lanka, this type of technologically improved computer applications can also be used to
meet the intended requirement. This could also be very beneficial if oxygen producers and health
authorities work together well and trust they are able to cope to a large extent with any increase
in demand.
8. Supply chain management of medical Oxygen
In order to ensure that life may be preserved through a safe supply of medical oxygen, it has
been stressed the problems of logistics and the supply chain management. In LMICs (Low- and
Medium-Income Countries) the availability is reduced owing to costs, infrastructures, and
logistical barriers despite the fact oxygen is critical for effective treatment of COVID-19 patients
in hospitals. Institutions of health care often have no access to the oxygen they require, hence
preventing loss of life.
Since the second wave of COVID-19 threatens the country's system of healthcare to
overload, India is facing a scarcity of medical oxygen. We need to guarantee that medical
oxygen is supplied reliably and long-term in Sri Lanka.
Seven COVID- There have been 19 patients who died in an Indian hospital as the oxygen
tanker driver planned for delivery has failed and challenges that go beyond extending oxygen
capacity. Not just because of supply limits, but also because of the problems of logistics and
supply chain management. (Ryhove, 2021).
Specialized cars and well-trained drivers are needed to transport therapeutic oxygen. Most
hospitals in Sri Lanka employ oxygen cylinders instead of storage cells on site. Logistical
problems include the supply of cylinders. Cylinder vacuums should be collected and filled as
quickly as feasible. Hospital and clinical staff must understand this strategy. This may be seen as
a sophisticated supply network on which life depends.
For strong, trustworthy supply chains that are critical for good health outcomes, like medical
oxygen supply networks, an experienced and connected supply chain staff is necessary. The
skills of current supply chain resources must be strengthened, and awareness must be increased,
and an atmosphere created which recruits properly qualified professionals from the supply chain.