Breathless India - Who Is To Blame And What Can Be Done?
India Today|May 10, 2021
A lethal second wave and critical shortage in oxygen supply have crippled india’s fight against covid. Why did india fail to foresee the crisis and what can it do to mitigate it?
Sandeep Unnithan

ON THE NIGHT OF APRIL 23, Subhash Varma, a 53-year-old healthcare professional, and his wife Anuja returned exhausted to their flat in Dwarka, a suburb in southwestern Delhi. They had spent a harrowing day trying to get Anuja’s severely ill sister Tanuja Vidyarthi into the emergency ward at the Jaipur Golden Hospital, a designated Covid-19 treatment center in Rohini, 22 kilometers away. A schoolteacher from Karol Bagh, Tanuja, 53, had tested positive for Covid on April 16 and rushed to the hospital after her blood oxygen level plummeted to under 70.

At around 1.30 am, the couple got a call from the hospital. Tanuja’s condition had deteriorated and she had to be put on a ventilator. “We don’t know what to do,” the hospital told them, “please come in the morning.” When the Varmas reached the hospital five hours later, they were informed that Tanuja hadn’t made it through the night. An anguished wail from distraught relatives of other patients made them realise why: “My sister died because the hospital ran out of oxygen….”

At least 20 patients at the hospital died that day because the medical oxygen running through the pipes in the emergency wards got exhausted. The patients slowly drifted into unconsciousness, most still hooked to their face masks, as the oxygen in their blood drained out, a condition called hypoxia.

“We are literally gasping for breath,” a lawyer for the hospital pleaded before the Delhi High Court later that day. The hospital had exhausted its supply of liquid oxygen by 10 pm—a tanker that was to reach the hospital at 5.30 pm arrived only at midnight. Hospital authorities say when they switched over to their backup cylinders, the drop in pressure killed the patients.

Hospitals have blamed the Delhi government for not getting them oxygen in time. The state government, in turn, has blamed the Centre for not ensuring the shipments were not delayed. The blame game continued even as a second, more ferocious wave of Covid-19 turned India into the ground zero of the global pandemic. The graph of infections that had begun soaring vertically breached a global record on April 26—350,000 new cases. At the peak of the first wave—September 16 last year—India had recorded 96,424 new cases.

Thousands of seriously ill patients, their lungs blotted out by a virulently invasive SARS-CoV2 strain, poured into hospitals across 12 of the most severely affected states. The demand for medical oxygen registered a 10-fold spike—from 700 metric tonnes per day (MTD) to over 6,000 MTD by late April. India’s creaky medical infrastructure began to give way under the deluge of new cases, and hospitals across the country began to register alarming dips in medical oxygen. Gujarat recorded a shortfall of 350 MTD; by mid-April, at least 19 people had reportedly died of lack of oxygen in districts like Rajkot, Banaskantha, Navsari, Mehsana and Surendranagar. Even industrial powerhouse Maharashtra, whose eight oxygen plants produce 1,250 MTD of medical oxygen, had to dial Gujarat, Chhattisgarh, and faraway Jharkhand and Andhra Pradesh for extra oxygen.

In Lucknow, the capital of India’s most populous state UP, demand spiked from 2,000 medical oxygen cylinders per day to 7,000. Rahmat Ali, a local resident, waited in the queue for five hours with an empty cylinder outside Murari Gases, one of the only two gas-making plants in the city. Midway, he recalls, sobbing, a phone call informed him that his critically ill mother had passed away. Plant manager Sushil Singh pleaded helplessness. “We have been running the factory day and night to produce 800 cylinders per day, but are unable to meet demand,” he said.

However, the worst-affected by far was Delhi. The national capital recorded 24,149 new cases and 381 deaths on April 27. With no oxygen-producing plants of its own, Delhi had to rely on tankers from Uttar Pradesh, Himachal Pradesh, and Rajasthan for medical oxygen. By April 20, Delhi’s hospitals needed 700 MTD of medical oxygen but got only 480 MTD. The Jaipur Golden Hospital tragedy, as it came to be called, was replicated across the city. Hospitals posted frantic appeals on social media as their oxygen stocks dipped perilously; staff asked kin to arrange for cylinders.

BLACK MARKETERS, sensing an opportunity to make a quick buck, hoarded scarce cylinders, and hawked jumbo ones for Rs 64,000 each. In Dashrathpuri in southwestern Delhi, the police seized 32 oxygen cylinders from the house of a black marketer who was decanting them into smaller cylinders and then selling them for Rs 12,500 each. In several places across the country, the oxygen supply broke down completely. Leakages and low pressure killed patients. It was left to civil society and volunteers to provide leads on cylinders and ICU beds, as desperate kin took to social media to post their requirements.

As Tanuja Vidyarthi’s relatives discovered, getting a critical care bed was only the beginning of their ordeal. One cannot be sure how many lost their lives to oxygen shortage, but timely supplies could have saved many lives and stemmed panic.

BOTTLING LIFE

A worker arranges medical oxygen cylinders at a facility near Hyderabad

The slow-moving government bureaucracy woke up only when the crisis exploded in their faces and realised it would be days before additional supplies from the industrial centres in eastern India could reach. In an affidavit before the Supreme Court on April 27, the Union government projected shortfalls in supply in six Covid-affected states (see graphic Oxygen Alarm) by April 30. UP, with a demand-supply gap of 400 tonnes, was likely to be the worst hit. To speed up the movement of oxygen trucks, the Hindon-based C-17 Globemasters, from the IAF’s strategic airlift squadron, flew empty trucks to oxygen factories in eastern India. The foreign ministry sent out SOS-es to other countries for medical aid such as cryogenic oxygen tanks, cylinders, and oxygen concentrators. But, for the grieving relatives, it was too late. “My sister-in-law could have been saved,” says an anguished Varma, “They killed her.”

LULL BEFORE THE STORM

On March 1, 2021, India recorded 12,286 new cases. It was a dip in the Covid-19 graph that had been flatlining since the beginning of the year. The pandemic, it seemed, was receding. India was getting back to normal. The surge of medical facilities that had been set up across the country during the first wave had begun to be dismantled. In February 2021, for instance, the Union home ministry had closed down a 10,000bed Covid care facility, the world’s largest, at the Radha Soami Satsang Beas in South Delhi’s Chhatarpur last June. By March 26, the Election Commission had announced the election schedules for the five states going to polls.

Then, on April 6, India crossed 115,000 infections in just 24 hours, its single-largest daily caseload since the start of the pandemic. The wall of the Covid tsunami had begun to loom over the horizon.

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