As India hits a million Covid cases in three days, ASHISH SRIVASTAVA’s harrowing first-hand account
No one in India is safe. This infection has seeped so deeply into the community that it is impossible to avoid the virus with its new, seemingly more infectious mutations, spreading through entire families like wildfire.
Yesterday, India recorded a record coronavirus death toll for the third day running.
Since Wednesday, there have been more than one million infections in what has now been described as the most deadly outbreak in the world. The worst affected areas, including New Delhi, Mumbai and the state of Maharashtra, have run out of hospital beds and oxygen, the lifesaver that Covid sufferers most desperately need.
And patients are suffocating to death because of the shortage – 21 in a single hospital, it was reported yesterday. The government is now deploying military planes and trains to rush oxygen to the capital while the High Court has ruled anyone found obstructing supplies will face the death penalty.
The first wave, which struck six months ago, proved to be manageable. Younger people were hardly affected. Now, the under-40s are sick too. Two-month-old babies are becoming infected. Pregnant women are dying. Hospitals have largely stopped taking patients. Ambulances are taking a whole day to reach some victims.
I’ve visited the Covid wards in several of New Delhi’s biggest state-run hospitals. One, Guru Teg Bahadur Hospital, turned its car park into an intensive care ward. Patients are on stretchers in the corridors. Each bed contains as many as three or four patients, all sharing a single cylinder of oxygen.
RELENTLESS: Funeral pyres burning yesterday in a makeshift crematorium set up in New Delhi as coronavirus rips through India like wildfire. Since Wednesday, there have been more than one million infections in what has been described as the most deadly outbreak in the world
Even the most seriously ill, those on ventilators, are having the amount of oxygen in their blood capped at 94 per cent. Normal levels are 95 per cent. Even being admitted is no guarantee they’ll be treated. Families are being forced to bring in their own food, medicines and oxygen. There are fights on the streets as relatives desperately battle for any supplies.
People call the virus India’s great leveller. No amount of money can secure a bed, or an oxygen cylinder, for dying loved ones.
State and private hospitals alike have been hit equally hard. In the absence of any real government action, as India’s officials squabble among themselves over who is to blame for the spiralling crisis, social media is the closest thing anyone has to aid. The smaller hospitals say their oxygen supply is being diverted to bigger units. Some are simply telling patients to go home, that they can’t be treated.
The doctors and nurses say they haven’t witnessed an emergency on this scale in their lifetimes. Some are working three or four shifts in a row as colleagues increasingly contract the virus themselves. They are exhausted. On one ward, they had been making their rounds once an hour to check up on everyone. Now, because of the sheer numbers, that’s only happening once or twice a day. The patient care is a shambles.
There are huge queues outside the gates as people, some desperately ill, await Covid tests. To be admitted, you need a test to prove you are positive. But the laboratories are overwhelmed. Huge numbers of their own staff have fallen sick with the virus or are in isolation at home. Labs that were processing 5,000 tests a day are now being sent 35,000 a day. It’s taking days to obtain a result.
Yesterday I saw three people who had died outside one large hospital because there was no one to attend to them. Their families were crying out for help, pleading for doctors rushing through the gates to take a look at them.
Pictured: Covid victims are wheeled out of a New Delhi Hospital. The worst affected areas, including New Delhi, Mumbai and the state of Maharashtra, have run out of hospital beds and oxygen, the lifesaver that Covid sufferers most desperately need
Shayam Narayan, a father-of-five, died without being admitted to hospital. His brothers had hauled him on to a rickshaw to take him back to hospital, after being told ten hours earlier he was not ill enough to be admitted. By the time he arrived, he was dead. ‘The system is broken,’ his younger brother, Raj, said.
Yesterday, the official death toll from Covid during the previous 24 hours in India was 2,263, more than 300 in Delhi alone. But such figures are a huge underestimation. Narayan’s death is unlikely to be counted, for example, as he technically died in the community.
There have never been so many cremations. The electric furnaces in crematoriums have started to melt because of the continuous burning. They are shut for hours to cool so they don’t break down.
The graveyards are full. So bodies just pile up. The failure of leadership is staggering. Prime Minister Narendra Modi has asked people to take precautions, to wear a mask, to practise social distancing. And yet, hours later, he appeared in a televised political rally attended by a crowd of thousands – not wearing a mask.
India had one of the world’s strictest lockdowns and, in March, the health minister declared India was in the ‘endgame’ of the pandemic. Vaccines intended for Indians were exported. Today, just 1.5 per cent of the population is fully vaccinated.
‘THE SYSTEM IS BROKEN’: Desperately needed oxygen being transported in New Dheli. Patients are suffocating to death because of the shortage
The government allowed vast crowds to gather in markets, at religious festivals and political rallies. Even though the rest of the world was experiencing second and third waves of the virus, India thought it would not happen. Yet everyone working in healthcare knew differently. People’s faith in government has been lost. They have watched their loved ones die.
And it will get worse yet. Millions of pilgrims gathered for the Kumbh Mela festival earlier this month. We wait to see the effect. Millions of migrant workers are heading back to villages – some as yet untouched – ahead of a potential lockdown.
Today is the festival of Mahavir Jayanti, when six million Jains will flock to temples to commemorate the birth of their spiritual leader, Lord Mahavira. It will take more than a miracle to save India today.
Coronavirus second wave is set to kill 5,700 people a DAY in India: Swamped hospitals turn away patients away while victims suffocate to death on wards amid oxygen shortage – and anyone who delays supplies is threatened with the DEATH penalty
By Faith Ridler For Mailonline and Ap
Medics fear Covid-19 infections in India could climb to 500,000 per day before the virus-stricken nation reaches the peak of its second wave – as those who delay oxygen deliveries to New Delhi were today threatened with the death penalty.
Another 2,624 deaths and 346,786 cases were reported in India on Saturday, although limited testing means this is likely to significantly underestimate the total.
The infection total again marked the highest one-day tally of any nation since the start of the pandemic – the third time in as many days India has broken this record.
However, leading virologist Shahid Jameel today warned that India has still yet to hit the peak of its second wave, with studies suggesting it may record 500,000 cases per day in the first week of May.
India’s current fatality rate per 100,000 cases is 1.14 per cent, meaning if the nation reaches this anticipated peak there is the potential for 5,700 deaths per day.
Overwhelmed hospitals have continued to beg for supplies today as Covid-19 infections soared overnight in a ‘tsunami’ of disease, with medics warning: ‘Every hospital is running out [of oxygen]. We are running out’.
At least 20 coronavirus patients died overnight at New Delhi’s Jaipur Golden Hospital on Friday as the ‘oxygen pressure was low,’ the hospital’s medical superintendent Dr Baluja said.
He added: ‘Our supply was delayed by seven-eight hours on Friday night and the stock we received last night is only 40 per cent of the required supply.’
Elsewhere, at the Sir Ganga Ram Hospital, some 25 Covid-19 patients died on Thursday with reports suggesting low oxygen supplies were again the cause of the fatalities.
As overburdened hospitals were forced to turn away patients, Indian Air Force planes and designated Oxygen Express trains were deployed in a bid to speed up the supply of this crucial medical gas.
Harrowing images from a makeshift crematorium in New Delhi today illustrated the extent of the pandemic in India, with Sky News correspondent Alex Crawford describing the situation as the ‘tip of an iceberg’ to a much larger crisis.
The crematorium was set up outside a hospital in the capital by desperate people who ‘cannot cope’ with the number of dead – and were forced to say goodbye to their loved ones in mass services at ad hoc sites.
As she spoke, men pulled firewood into the site, with Ms Crawford explaining the dead had been arriving at the crematorium ‘virtually every second’ amid what she described as a ‘slightly chaotic’ vaccine roll-out.
A man performs the last rites of his relative who died of the Covid-19 coronavirus disease as other funeral pyres are seen burning during a mass cremation in New Delhi
Medical staff and relatives help a Covid-19 coronavirus patient to get in a car at a hospital in New Delhi
Harrowing images from a makeshift crematorium in New Delhi today illustrated the extent of the pandemic in India, with Sky News correspondent Alex Crawford describing the situation as the ‘tip of an iceberg’ to a much larger crisis
The crematorium was set up outside a hospital in the capital by desperate people who ‘cannot cope’ with the number of dead – and were forced to say goodbye to their loved ones in mass services at ad hoc sites
India’s current fatality rate per 100,000 cases is 1.14 per cent, meaning if the nation reaches this anticipated peak there is the potential for 5,700 deaths per day
It comes as the High Court in New Delhi, which is home to some 30million people, today met to impose a strict ruling that if anyone is found to be restricting oxygen supplies to hospitals they ‘will be hanged’.
Delhi Chief Arvind Kejriwal had complained that desperately needed supplies were being obstructed on state borders before entering New Delhi, crucially delaying delivery to beleaguered hospitals.
Several medics have appealed for help on social media in recent days as the shortage worsened, with Max Healthcare and Fortis Hospital at one point both warning they could run out of supplies within an hour.
Max, which runs hospitals in northern and western India, said on Twitter: ‘We regret to inform that we are suspending any new patient admissions in all our hospitals in Delhi until oxygen supplies stabilise.’
Delhi needs at least 480 metric tonnes of oxygen to affectively treat its Covid-19 patients, according to the Hindustan Times. On Friday, the capital received only 297 metric tonnes of the medical gas.
Dr Jameel, who is the director of the Trivedi School of Biosciences at Ashoka University, today told Radio 4 that India desperately needs to contain the sudden surge by ‘treating as many people as possible at home.’
He added the government needs to do ‘everything possible’ to speed up the supply of oxygen and medicine to those in need, revealing the harrowing plight of families desperately searching for supplies.
People have been begging for oxygen or medical help on social media, and crowds have gathered outside hospitals, with some dying on stretchers as they wait.
On Wednesday, 22 patients died at a hospital in Maharashtra when their oxygen supply ran out after a leak in the tank. Yesterday 13 Covid patients died when a fire broke out at a Mumbai hospital.
‘My family has gone through a harrowing experience in the past week, we had a cousin into hospital who passed away two days back and every 24 hours there was a threat of cut-off of oxygen,’ Dr Jameel said.
A Covid-19 patient gets oxygen on the spot provided by Sikh Organization at Gurdwara in Indirapuram, Ghaziabad, Uttar Pradesh, today
A son looks for the last time to his mother who died due to COVID-19 disease duirng her last rites in Guwahati Assam today
A man mourns the death of his father due to Covid-19 at a crematorium in New Delhi, India, today
People wait to refill their medical oxygen cylinders for Covid-19 patients at an oxygen refilling station in Allahabad today
Health workers carry bodies of people who were suffering from the coronavirus disease (COVID-19), outside the Guru Teg Bahadur hospital, in New Delhi, today
Hospitals across India are buckling under the strain of a ferocious second wave, with some running out of oxygen and turning away patients due to overcrowding. Pictured: New Delhi today
A family member of a Covid-19 victim is seen carrying an oxygen cylinder in West Bengal
Desperate families wait at an oxygen refilling shop in India as they attempt to secure supplies
Medics carry Covid patients outside the ICU at Guru Teg Bahadur hospital, in New Delhi, India
A health worker takes a nasal swab sample to test for Covid-19 in Jammu, India, today
Daily infections hit 332,730 on Friday, up from 314,835 the previous day when India set a new record, surpassing one set by the United States in January of 297,430 new cases
The daily death toll also jumped to a record 2,263 yesterday, though these fatalities could be at least ten times under-reported amid a second wave more than three times the size of the first
‘In the end he didn’t make it, but the mental torture of relatives searching for oxygen was just unbearable. Unfortunately the situation is very bad, we let down our guard and that’s why we’re in this situation.’
India is recording one in three of all worldwide Covid-19 cases, despite its Prime Minister Narendra Modi saying in February that the nation was ‘inspiring the world’ with its Covid fight.
Pictured: Dr Shahid Jameel, the director of the Trivedi School of Biosciences at Ashoka University
‘In a country which is home to 18 per cent of the world population, that country has saved humanity from a big disaster by containing corona effectively,’ he said.
Ministers had declared a victory when there were around 11,000 cases a day.
But health experts say a downward trend in infections late last year lulled authorities into complacency, as they failed to plug the holes in the ailing health care system that had become evident during the first wave.
They also blame politicians and government authorities for allowing super-spreader events, including religious festivals and election rallies, to take place as recently as this month.
‘It’s not the virus variants and mutations which are a key cause of the current rise in infections,’ Dr. Anant Bhan, a bioethics and global health expert, said.
‘It’s the variants of ineptitude and abdication of public health thinking by our decision makers.’
The surge has also been fuelled by a ‘double mutant’ variant, thought to be more infectious, but Dr Jameel agrees ‘too much’ has been made of the mutation.
Instead, he claims the spiralling infection rates were impacted by the lack of messaging for people to take vaccinations in January and February when case numbers were down.
He added: ‘In all the euphoria, in all the patting of our backs that we have done so well, we are out of it, we weren’t. We were just as susceptible as anybody else.
‘So if there is a lesson here to be learned, it’s that you have to be on your guard. You have to prepare. We should have been stocking up on oxygen.
‘We should have been messaging clearly for people to take vaccines in the months of January and February when the cases were down.
‘If that happened at scale at that time, then we wouldn’t be facing this situation today.
A person walks past funeral fires of those who died from Covid-19 at a crematorium in New Delhi on Saturday
A Covid-19 patient gets oxygen on the spot provided by Sikh Organization at Gurdwara in Indirapuram, Ghaziabad, Uttar Pradesh, India, today
A man performs the last rites of his relative who died of the Covid-19 coronavirus disease as other funeral pyres are seen burning during a mass cremation
A priest who helps performing last rites, runs while covering his face amid the multiple burning funeral pyres of patients who died of the Covid-19
‘So many things have gone wrong but instead of crying over spilled milk I think it’s important to learn some lessons, get some good data, and plan for the future because this is not the end of it.”
Last week, the Supreme Court told the Indian government to produce a national plan for the supply of oxygen and essential drugs for the treatment of coronavirus patients.
Ministers said today they would exempt vaccines, oxygen and other oxygen-related equipment from customs duty for three months, in a bid to boost availability.
In addition, Modi’s emergency assistance fund, dubbed PM CARES, in January allocated some £19million ($27million) to set up 162 oxygen generation plants inside public health facilities in the country.
But three months on, only 33 have been created, according to the federal Health Ministry.
Despite this, the Defense Ministry is set to fly 23 mobile oxygen generating plants into India from Germany within a week to be deployed at army-run hospitals catering to Covid-19 patients.
Each plant will be able to produce 2,400 litres of oxygen per hour, a government statement said yesterday.
The percentage change in daily Covid infections by Indian state today compared to at their peak, most of which were recorded last year
Workers check medical oxygen cylinders to be transported to hospitals amid the Covid-19 pandemic at a facility on the outskirts of Chennai today
A man carries an oxygen canister to his car in West Bengal, India, amid the crisis today
The latest comes as Boris Johnson last night pledged to support India in its battle against the devastating Covid surge which has brought the country to its knees.
The UK is ‘looking at what we can do to help’ after India reported a record-breaking number of new cases in a single day for three days in a row.
Mr Johnson said: ‘We’re looking at what we can do to help and support the people of India, possibly with ventilators.
‘Thanks to the ventilator challenge, the huge efforts of British manufacturers, we’re better able now to deliver ventilators to other countries.
‘But also possibly with therapeutics, dexamethasone, other things, we’ll look at what we can do to help.’
So far 132 cases of the Indian variant have been detected in Britain, around half of which are in London.
People wait to receive the Covid-19 vaccine outside a vaccination centre In Mumbai, India
Men transport a Covid-19 patient on a stretcher as they leave a hospital in New Delhi today
Health workers are seen outside the casualty ward at Guru Teg Bahadur Hospital, in New Delhi
People wearing personal protective equipment console the relative of a person who died due to the coronavirus disease
The variant contains two mutations in the virus’s spike protein, which could help it spread more easily and evade vaccines.
India was added to the UK’s travel ‘red list’ yesterday, prompting a last-minute scramble for flights to Heathrow.
The Prime Minister has also cancelled a trip to New Delhi this weekend where he had hoped to secure millions of vaccine doses.
Yesterday Government scientists said border measures are not enough to prevent the spread of new variants, but they can delay it.
One senior source said there were likely to be ‘many more’ cases of the Indian variant in the UK than the 132 detected so far.
They added: ‘It does look like it’s more transmissible but we don’t know if it is more transmissible than the Kent variant and we don’t have any data on vaccine efficacy.’
INDIA’S GROWING OXYGEN PROBLEMS
Are hospitals running out of oxygen?
The main problem is that medical oxygen is not reaching hospital beds in time. This delay is a product of where production units are located, a stretched distribution network, and what critics have said is bad planning.
Several hospitals in Delhi, which has no significant oxygen production capacity, made frantic public calls this week seeking emergency supplies.
With COVID-19 cases also swamping its neighbouring states like Haryana and Uttar Pradesh, oxygen facilities there are over-stretched attempting to meet local demand.
To fulfill Delhi’s current needs, additional medical oxygen now has to be trucked in from industrial zones in eastern India.
Why are oxygen deliveries getting delayed?
The facilities from where Delhi will now receive oxygen are spread across seven states, some more than 625 miles (1,000km) away, according to a court document.
Given the hazardous nature of the substance, all liquid oxygen must be transported in a limited number of specialised tankers, requiring advance planning to ensure deliveries are made on time, a gas industry source told Reuters.
In recent days, as a scramble for oxygen among states worsened, local officials in some regions disrupted movement of tankers in a bid to keep supplies for themselves.
In part due to such blockades, Delhi only received about 177 tonnes of oxygen on Wednesday against its allocation of 378 tonnes, an official said.
But the industry source said that Delhi had also dragged its feet on planning ahead, without factoring in the time it takes to move oxygen cross-country by road.
‘This problem wouldn’t have happened if they had acted 2-3 weeks ago,’ the source said.
Delhi’s government did not respond to questions about the planning.
Does India have enough oxygen?
India has a daily production capacity of at least 7,100 tonnes of oxygen, including for industrial use, which appears to be enough to meet current demand.
This week, the government allocated 6,822 tonnes of liquid oxygen per day to 20 of the country’s worst-affected states, compared to their combined demand of 6,785 tonnes, Prime Minister Narendra Modi’s office said on Thursday.
India’s total medical oxygen demand was just 3,842 tonnes as of April 12, as the surge in cases really took hold.
States are typically allocated supplies by an inter-ministerial group of bureaucrats mandated to monitor and facilitate the flow of essential medical kit during the pandemic.
Modi’s office has noted that the availability of liquid medical oxygen had increased by about 3,300 tonnes in the past few days, with steel plants and other industrial units diverting their production.
What is India doing to solve the crisis?
The federal government has activated the Indian railways to move multiple tankers from refilling plants to where it is most needed.
Working with industrial gas major Linde India and others, the government is also using the Air Force’s cargo planes to fly empty tankers to production hubs. Refilled oxygen tankers will then move back by road.
The armed forces are importing 23 mobile oxygen generation plants from Germany.
Several other industries are offering oxygen to hospitals, while salt-to-software conglomerate Tata Group is importing 24 specialised containers to transport liquid oxygen.
The government has issued orders to convert argon and nitrogen tankers into oxygen ones.
But as some experts predict a trebling of daily infections in a few weeks, India will have to dramatically ramp up both oxygen production and distribution systems.
WHAT DO WE KNOW ABOUT THE INDIA VARIANT?
Real name: B.1.617
When and where was it discovered? The variant was first reported as being of concern by the Indian government in late March.
The first cases in India appear to date back to October 2020 and it was first detected in Britain in February, 2021.
It had been detected in 21 countries as of April 19, according to Public Health England’s Sharon Peacock.
How many people in the UK have been infected with it? Matt Hancock revealed there had been 103 cases so far.
But Public Health England’s latest report, published on April 15, says 77. These were detected in England and Scotland.
What mutations does it have? It has 13 mutations that separate it from the original Covid virus that emerged in China – but the two main ones are named E484Q and L452R.
Scientists suspect these two alterations can help it to transmit faster and to get past immune cells made in response to older variants.
Is it more infectious and can it evade vaccines?
The L452R mutation is also found on the Californian variant (B.1.429), discovered in December, even though the two evolved independently.
L452R is believed to make the American strain about 20 per cent more infectious.
The Indian variant’s E484Q mutation is very similar to the one found in the South African and Brazil variants known as E484K, which can help the virus evade antibodies.
The South African variant is thought to make vaccines about 30 per cent less effective at stopping infections, but it’s not clear what effect it has on severe illness.
Professor Peacock said there was ‘limited’ evidence of E484Q’s effect on immunity and vaccines.
Lab studies have suggested it may be able to escape some antibodies, but to what degree remains uncertain.
Should we be worried?
Scientists are unsure how transmissible or vaccine-resistant the Indian variant is because the E484Q mutation is new and not well understood.
The fact it appears to have increased infectivity should not pose an immediate threat to the UK’s situation, because the current dominant Kent version appears equally or more transmissible.
It will take a variant far more infectious strain than that to knock it off the top spot.
However, if the Indian version proves to be effective at slipping past vaccine-gained immunity, then its prevalence could rise in Britain as the immunisation programme squashes the Kent variant.
The UK currently classes the Indian strain as a ‘Variant Under Investigation’, a tier below the Kent, South African and Brazilian variants.
Experts studying Britain’s Covid variants said the Indian variant was unlikely to ever take off in the UK because its mutations were ‘not top tier’.
Dr Jeffrey Barrett, director of the Covid-19 Genomics Initiative at the Wellcome Sanger Institute, said it’s still not clear if India’s third wave has been caused by the new variant, or if it emerged at the same time by coincidence.
His comments have been echoed by PHE’s Professor Peacock, who said today: ”It is not clear at the present time whether B.1.617 is the main driver for the current wave.
‘The question is whether this is associated with the variant, with human behaviour (for example, the presence of large gatherings, and/or lack of preventive measures including hand washing, wearing masks and social distancing) or whether both are contributing.’
How deadly is it?
Again, scientists still don’t know for sure – but they are fairly certain it won’t be more deadly than the current variants in circulation in Britain.
This is because there is no evolutionary benefit to Covid becoming more deadly.
The virus’s sole goal is to spread as much as it can, so it needs people to be alive and interacting with others for as long as possible to achieve this.
And, if other variants are anything to go by, the Indian strain should not be more lethal.
There is still no evidence to show dominant versions like the Kent and South African variants are more deadly than the original Covid strain – even though they are highly transmissible.