‘The horror is real’: India faces oxygen crisis alongside world’s highest COVID-19 caseload

India’s health system collapsed as it recorded the world’s highest COVID-19 caseload this week, with upwards of 330,000 new infections and more than 2,000 deaths a day. As the humanitarian catastrophe unfolded, hospitals – filled to capacity and with oxygen supplies running dangerously low – made urgent appeals for intervention to government authorities through the courts and social media.

The Delhi high court exhorted the central government “to beg borrow and steal” and divert oxygen from industries for medical use. After that, the Supreme Court demanded to see a national plan on the supply of oxygen and essential drugs.

India is facing an oxygen crisis in some cities owing to uneven supply and logistical issues (such as transportation and permits to carry it across state borders). Several new plants are being hurriedly installed.

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After a major dip in COVID-19 cases in February, when India recorded fewer than 10,000 a day, a devastating second wave crippled several states including Delhi, Uttar Pradesh, Maharashtra and Gujarat. The situation prompted Canada earlier this week to ban flights from India and Pakistan for 30 days.

“It’s a tsunami. It’s much worse this time, it makes last year’s crisis look like a small wave,” said Kartikeya Kohli, an associate consultant of internal medicine, at Delhi’s Sitaram Bhartia Institute of Science and Research. Dr. Kohli has been fielding 400 to 500 requests for teleconsultations a day for the past week. Several of his colleagues have contracted the infection, further shrinking the hospital’s coping capacity as patients line up in endless queues, panicked and on the verge of collapse.

Outside another Delhi health care facility, Shanti Mukund Hospital, a notice hung over the gates: “We regret we are stopping admission in hospital because oxygen supply are not coming.”

The chief executive officer, Sunil Saggar, broke down on camera: “We’re hardly left with any oxygen. … It is a deplorable, unfortunate condition. We as doctors, as a hospital, we are supposed to give life. If we can’t give oxygen even … patients will die.”

One of India’s top private hospital chains sent out an SOS to top government officials through Twitter: “Fortis Hospital in #Haryana has only 45 minutes of oxygen left …” An oxygen tanker reached the hospital later that evening.

Similar pleas for emergency oxygen from hospitals that had just a few hours of supply left – as the lives of thousands of patients in multiple cities hung in the balance – were amplified on social media by concerned citizens. Finally, the Indian Air Force was pressed into action to airlift oxygen tankers and emergency medical aid.

“The situation is getting out of hand. We are crippled. Everybody is overburdened,” Dr. Kohli said. “The turnaround time for testing and getting reports has increased. There are no beds, there is a shortage of medicines. There is black marketing of medicines like Remdesivir. Non-COVID care has taken a backseat. It’s like a mad train.”

What led to this desperate situation?

“People had let down their guard, thinking the pandemic had ended,” Dr Kohli said. “The pharmaceutical companies had bottled down their production. Then the numbers skyrocketed in the last seven days. Hit with the sudden surge, the supply is not able to meet the overwhelming demand.”

In Delhi, the positivity rate rose to 36 per cent with a record 26,000 cases a day, prompting a temporary lockdown in the capital. Meanwhile, the central health ministry released comparative data this week, saying the severity and demography of those affected in the second wave was nearly the same as the first wave.

In order to accelerate the vaccine rollout, India will open it up to all people 18 and older from May 1. But the initial enthusiasm over immunization has been replaced by public anger and despair over the explosion of cases; patients in critical condition were unable to access urgent medical care even as massive political and religious gatherings took place across the country in recent weeks.

Experts said weakening immunity against the virus, mixed messaging from authorities and possible mutations may be behind the rapid spread of infection, though there is little evidence to prove the variant in the second wave is more deadly. “It may be a more infectious strain, but I have not seen a change in mortality rates,” Dr. Kohli said. “It is a complex issue at this point because whenever cases rise to this level, the mortality also rises, because many people are not getting the medical care they need and therefore can’t be saved.”

Public-health experts did anticipate a second wave but the arrival of vaccines made everyone lax in terms of following safety guidelines, said Rakesh Parashar, a public-health specialist and physician in Mumbai. “The horror is real. I am very worried about the small towns where the population density is very high and health facilities are very weak.

“It’s time we start setting up oxygenated beds there – in empty buildings, hotels, wherever there is space,” Dr. Parashar said.

With the formal health care machinery under tremendous stress, community and individual initiatives are trying to fill the gap, with social media serving as an unofficial helpline. Twitter, Facebook, Instagram and messaging apps such as Telegram and WhatsApp are flooded with urgent pleas for oxygen, medicines, ICU beds and ventilators as citizens, both ordinary and influential, are pooling efforts to connect COVID-19 patients with resources. Initiatives such as COVID Citizen Action Group and Plasma Donors Delhi have sprung up to crowdsource verified information on emergency equipment and availability of beds.

Dr. Parashar is among hundreds who are volunteering.

“I took time off work to do primary-level health consultations for people in my network to calm nerves, control the panic and advise them against hoarding medicines,” he said. “Volunteer efforts are important. I see many who post on Twitter manage to find help in a few hours.”

When a family member of Asmita Kulshreshtha needed urgent medical attention recently, the Gurugram-based designer put word out for an ICU bed on neighbourhood WhatsApp networks and rang up dozens of hospitals and organizations based on the leads she received. They eventually found a bed through a personal connection. “With no government machinery available, we’re on our own and social media is where everyone is turning to,” she said.

Her family member did not survive, but moved by community efforts, Ms. Kulshreshtha decided to donate to Hemkunt Foundation, a charity holding large-scale oxygen drives across Delhi, Mumbai, Gurugram and Lucknow.

“I have been part of many relief operations but this is the worst situation I have seen,” said Harteerath Singh, Hemkunt’s community development director. “We work from 7 a.m. to 3 a.m., attending to roughly 12,000 SOS calls a day, about 14,000 messages on social media, negotiating with vendors and setting up the operation for the next day. We’re sourcing cylinders from Tamil Nadu and Punjab and offering it to patients for free. We have 150 volunteers and many of them have resigned from their jobs to focus on this effort.”

In this unprecedented crisis, help is coming frequently from strangers. In Mumbai, real estate developer Bharat Jhunjhunwala hit pause on his work to mobilize relief efforts when he started receiving frantic calls last month. “It’s a nightmare. I realized there is a big gap and people are dying because they are not getting beds. So along with my friends and members of the Rotary Club of Mumbai West End, we started buying emergency aid for people who need it across social strata in private and municipal hospitals,” he said.

“I try to arrange for beds for critical patients. There are days when I am super-depressed and anxious. I check on patients to see how they are doing, if are they able to pay the bills. I am not able to detach myself and I feel responsible for them.”

Health experts predict the situation – at the very least the shortage of oxygen – will ease by next week. But, Dr. Kohli warned, India needs a serious disaster-management plan to deal with a crisis of this magnitude. Medical professionals are working overtime, stretched to their absolute limit, he said.

“At the moment, we are trying to give everyone a bare minimum chance to survive.”

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