For three consecutive days earlier this week, Paromita, a young woman living at Noida Extension, drove from one hospital to another, looking for an oxygen bed for her 46-year-old husband, whose blood oxygen level had dipped to a dangerously low level. Her husband died without receiving any treatment.
A week before, it was the same horrific tale for Archana Datta, former director general of Doordarshan and press secretary to former president Pratibha Patil. Datta lost her husband and mother within a span of one hour after a desperate scramble to get them admitted to hospital failed.
Many such tragedies unfolded in the past few weeks as India’s healthcare system collapsed under the heavy Covid-19 burden.
Even big hospitals were not spared. From Batra hospital in Delhi to government-run hospitals in Chamarajanagar (Karnataka) and Chengalpet (Tamil Nadu), patients died due to oxygen shortage. At one private hospital in Gurugram, doctors and staff fled as six ICU patients died after oxygen ran dry.
But Health Minister Harsh Vardhan had on March 7 said India was in the “endgame” of the pandemic. The government’s narrative was that India need not worry about a second wave as the battle has almost been won.
Gasping for breath
With Covid-19 patients gasping for breath and relatives running from pillar to post looking for oxygen even after a month into the second wave, there is no denial that the Narendra Modi government failed to utilise the four-month window between November 2020 and February 2021 to prepare by augmenting the healthcare infrastructure and ramping up oxygen supply and logistics.
A classic example is the 1,000-bed DRDO Covid facility near Delhi airport, which was dismantled in February, only to be resurrected as a 500-bed version in April. Similarly, other facilities created during the first wave were taken apart assuming there would be no second wave.
“The government was busy telling us that the endgame was near, congratulating itself for conquering ‘Corona’ and boasting to the world. This surge is brought on by two things — complacency due to this narrative and more infectious variants. The interim period was spent in elections. Even available containment facilities were dismantled,” veteran virologist Shaid Jameel, director of the Trivedi School of Biosciences at Ashoka University, told DH.
Because of such a narrative, the administration never prepared for the second wave, though experts had forewarned about a possible surge, citing the global experience. The Election Commission went ahead with elaborate poll arrangements and the government did little to interact with religious groups to reduce the scale of Kumbh Mela.
“What we’ve seen is really a massive failure of leadership in India. This was a foreseeable and foreseen second wave. Rather than using the time after the first wave to be better prepared, we saw many political leaders actually become complacent, declare victory and allow the loosening of public health tools and policies that led to exactly where we are now,” said Krishna Udaykumar, professor of global health medicine at the Duke University, USA.
“Covid waves are a function of human behaviour. If your message is that Covid-19 is over and you allow people to mingle, then it’s inevitable to have a large second wave,” concurs Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics and Policy in Washington DC.
Oxygen shortage
Besides the false narrative, two other areas that mirror the government’s mismanagement are the issues of oxygen supply and logistics, and vaccine production.
It was only in the third week of April when more than 3,00,000 cases were reported daily, that the government initiated a series of steps including stopping most of the industrial use of oxygen and importing 50,000 MT of it to improve supply of medical oxygen. Since then, industrial production has been gradually increased — for instance, steel plants supplied 4,076 MT of oxygen on May 4 as against 1,700 MT in mid-April — and newer sources have been tapped.
But what adds to the confusion is a complete opacity on the part of the Centre to disclose the total internal production and import of oxygen vis-a-vis usage of oxygen by each state. In several affidavits, the Centre observed that it allocated the gas on the basis of an expert panel’s recommendation, which says only 50% of moderate cases may require oxygen at a rate of 10 litre per minute and 3% severe ICU cases would require oxygen at a rate of 24 litres per minute. According to the panel’s estimate, 22 states would together require 8,462 MT of oxygen.
Many states with heavy patient load didn’t agree with such a projection, following which the Centre came out with a revised allocation of 6,257 MT for 12 states on April 28. Later, the Supreme Court mandated 700 tonnes of oxygen for Delhi. It also refused to interfere with the Karnataka High Court order to ensure 1,200 tonnes of oxygen to the state. Gujarat and West Bengal too have demanded additional oxygen. While the apex court has ordered the constitution of a national task force to review the plan, it also asked the states to study and follow the Maharashtra model, as India’s most-affected state managed well with its allocated quota.
Experts are of the opinion that the oxygen crisis was largely avoidable had the government planned well in advance rather than waiting for a time when the number of cases ballooned. “People are dying not due to a virus that is more deadly but because the healthcare system can’t take care of them,” added Jameel.
Satyajit Rath, a veteran biologist formerly associated with the National Institute of Immunology, Delhi was not surprised with the bureaucratic delay in procurement and establishment of oxygen-related equipment and facilities. “This was part of a pattern of treating the epidemic as a short-term crisis, somewhat like natural disasters such as an earthquake. The government treated the relatively mild ‘first wave’ outbreaks as a triumph of its policies and of Indian exceptionalism, not as an opportunity to build a robust community and public health response for plausible future outbreaks,” he said.
Vaccine manufacturing
Another government failure was not to invest early in the Serum Institute of India (SII) and Bharat Biotech to improve their vaccine manufacturing capacities. India had by early October 2020 drawn up a tentative timeline for a vaccination programme — two doses to 250 million people by July 2021 — a number that has since been revised to around 350 million people. But there was no finance to scale up the production at SII and Bharat Biotech, the earliest possible sources of Covid-19 vaccines in India.
Because of such shortsightedness, there is now a shortage in vaccine supply. While both SII and Bharat Biotech have now received government funding, it will take several months to augment their production capacities. “Vaccine supply has been very badly managed. We have an acute shortage and daily vaccination rates have gone down consistently for about three weeks. This will prove problematic when we see a third wave,” said Jameel.
But will there be a nationwide third wave? Medical researchers say it is too early to talk about a third surge in the absence of a credible model, while the government made a 180-degree turn on such a wave after asserting that it was inevitable.
“Let us deal with the second wave rather than speculating on the third wave,” said K Srinath Reddy, president, Public Research Foundation of India.