As Covid curve rises, surge in ventilators causes glut

Industry wants export channels to be opened but experts say wait and watch.

FOUR MONTHS into the pandemic, Indian medical manufacturers catering to the swelling Covid industry are facing a unique dilemma over the use of a life-saving device at the heart of every ICU: ventilators.

In March, ventilators were considered vital to treat serious Covid cases, and with the countrywide inventory at an estimated 47,000, manufacturers raced to ramp up production. But now, with health experts pointing to a shift in treatment to non-invasive oxygenation, these manufacturers are staring at excess stocks and hoping for export channels to be opened.

That’s not all. Many smaller manufacturers, who tied up with majors like Bharat Electronics Limited (BEL), Bharat Heavy Electricals Limited (BHEL) and Maruti Suzuki India in anticipation of a surge in demand, say they are facing a crunch.

Says Dr V K Paul, the NITI Aayog member who heads the Centre’s Covid task force: “The lockdown gave us time to reassess the ventilator situation and we are in a comfort zone now. While we were largely relying on imports, India has shown that large volumes of ventilators can be manufactured indigenously within a short period and excess capacities can surely be exported later.”

Other experts admit that the need for largescale manufacture of ventilators may soon be over. Dr R N Das, Medical Superintendent, Delhi Government Health Services, says the need for ventilators is “exaggerated since high-flow oxygen support is what hospitalised Covid patients mostly need”.

“This is why in the new package for private hospitals, the Delhi Government has fixed the same rate for use of HFNO (High-flow Nasal Oxygen Therapy) and ventilators, so no doctor or hospital should be tempted to use more of the latter,” he says.

Dr Deepak Tempe, former Dean of Maulana Azad Medical College and a member of Delhi’s Covid committee, acknowledges that “there was a sense of alarm on shortage of ventilators in India in March and April”.

“But recent figures from the Capital have shown only three out of every 1,000 Covid patients have been put on ventilators. Also, there is 85% mortality rate among Covid patients put on ventilators in the Capital, and doctors are reluctant to use them,” he says.

But at the same time, ventilator capacity went up from about 300 per month from eight manufacturers to over 30,000 from 16 manufacturers, according to Rajiv Nath, Forum Coordinator of the Association of Indian Medical Device Industry (AiMeD).

“Manufacturers are also perturbed over shifting goalposts, of desirable specifications being made mandatory and subjective demands made verbally by evaluators. Usually, specifications should not be changed post orders. Now there are reports of unsold inventory and stocks not being lifted by the government against orders placed causing a huge cash crunch,” says Nath.

Records show that in April, the Health Ministry placed orders with domestic manufacturers through its central procurement agency, HLL Lifecare Ltd, for 60,884 ventilators with prices ranging from Rs 1.48-Rs 4 lakh each. But the specifications were later changed to include invasive and non-invasive modes as well as synchronised intermittent ventilation, which would allow patients to breathe spontaneously.

For instance, the largest order of 30,000 machines went to Mysuru-based Skanray which announced a tech tie-up with BEL. Says Skanray Managing Director Vishwaprasad Alva: “We have given the government additional features free of cost and have now been informed that for this tender, no additional supplies were needed. If this is the case, why have exports still been blocked?”

Caught in a similar situation is Delhi-based AgVa Healthcare, which tied up with Maruti Suzuki India in March to ramp up production. The company’s co-founder Prof Diwakar Vaish says they have delivered one-third of their order of 10,000 ventilators.

“We were initially given a moving target by HLL since specifications were subsequently changed. But we have managed to push production from 50-100 ventilators a month to almost 5,000. This has brought down the cost of ventilators for use in India to one-fifth of what was being paid earlier for imported machines,” he says.

Other manufacturers say that while they received orders from HLL in April, the final technical clearances are yet to come in.

Sashi Kumar V, Managing Director, Chennai-based Phoenix Medical Systems, says their order for 1,000 ventilators, to be manufactured at their Vizag plant, was a slice of a larger order for 13,500 machines placed by HLL in the Andhra Pradesh Medical Technical Zone. “But given the Covid rush, all our suppliers are demanding full advance, and freight charges for imported components have gone through the roof,” he says.

The gap is visible in states like Tamil Nadu, which has about 3,000 ventilators in Covid wards in government hospitals and medical colleges, but not even 100 currently in use. Says Dr P Umanth, chairman, Tamil Nadu Medical Services Corporation: “We stepped up imports from Europe and USA as the pandemic spread and managed supplies. Our plans are not contingent on indigenous supplies.”

Last week, HLL informed some manufacturers that their current tender for ventilators was now “closed” and that there were no “directions” to place further orders.

“We have a three-month backlog for orders to state and Army hospitals but are still waiting for orders from the Centre,” says Ashok Patel, Managing Director, Vadodara-based AB Industries, which tied up with BHEL.

At the same time, there is a tacit admission in the industry and the health establishment that given the steadily rising Covid curve after easing of the lockdown, this problem of plenty could also be a solution if and when the need arises.

(Tomorrow: The state of oxygen supply)

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