Oxygen in Delhi: A personal story

It is an unwritten rule in journalism that hard-hitting news investigations do not make for good Sunday reading. But April 18 was no regular Sunday. A ferocious tidal wave of coronavirus was crashing over India and breathless people were dying, unable to find a hospital bed or oxygen.

My colleagues and I had spent a few days investigating India’s oxygen crisis. One of the startling facts we found was that it had taken the Narendra Modi government eight months after the pandemic began to invite bids for 162 oxygen generation plants. Most still weren’t up and running.

An hour after our report was published, my mother called: my uncle had tested positive for Covid-19. He was 62, diabetic, hypertensive – and his oxygen levels were falling.

I live in Delhi. By far the most privileged city in India, it has the best infrastructure in the country, including among the highest number of hospital beds per 1,000 population.

Last year, in the early weeks of the pandemic, the city had seen a run on hospital beds. But once capacity was expanded and systems were put into place, the situation had normalised. At the peak load of 8,600 daily cases in November, there was no scarcity of hospital space reported.

2021 began on a good note.

Daily cases in a city of 16 million people dropped below the 100-mark in January. The coronavirus was in retreat.

Spring is the best time in Delhi. This year, it was even lovelier. After months of working in isolation, my colleagues and I started meeting and operating out of a common space, masked up, but allowing the masks to fall when chai arrived.

We did not buy the triumphalism of the prime minister but cautiously wondered if there was indeed some population-level immunity that had cast a protective cover over Indians.

Worryingly, though, in eastern Maharashtra, mutations in the virus were detected in districts that saw a sharp surge in cases in February. In mid-March, Nagpur, the largest city in the region, went into a 15-day lockdown.

But Delhi felt less menacing. Until a small uptick in cases in March gradually swelled to 5,000 daily new coronavirus cases by the start of April.

Unhappily, we abandoned the common working space and hunkered down in our homes. But most of the city did not. Markets were packed, restaurants were abuzz, weddings continued. Having gone back to normal, the city refused to read the writing on the wall.

On April 8, I ventured out reluctantly to meet two people for some unavoidable personal work. The next day I came to know that one of them, a young woman, who had looked perfectly fine that afternoon, had been hospitalised overnight with high fever.

A day later came an even more shocking piece of news: my elderly, kind-hearted downstairs neighbour had abruptly died of low oxygen.

For weeks, I had driven past a Covid-19 test centre that had looked forlorn. Now, I was standing in a queue with ten anxious-looking people.

Thankfully, the report came within 12 hours: I had tested negative.

Even before cases had started rising in Delhi, states that share borders with Maharashtra – Chhattisgarh, Madhya Pradesh, Gujarat – had already started getting overwhelmed with the surge.

Less through the news media and more through friends and extended family in these states, I heard stories of hospital beds running out.

Surely, the Central government knew storm clouds were gathering. Yet, Prime Minister Narendra Modi and Home Minister Amit Shah, the only two men whose writ runs in the government, chose to focus elsewhere: on an election victory for the Bharatiya Janata Party in West Bengal.

In the foothills of Bharatiya Janata Party-ruled Uttarakhand, 200 km from Delhi, millions were gathering for the Kumbh Mela. Dismissing concerns that the event could become a super-spreader, the chief minister of the state proclaimed that the blessings of mother Ganga were enough to vanquish the virus. Days later, after the leader of one akhadas died, a Hindu ascetic order showed more sense than the government: it withdrew from the event.

Ignoring the crisis that was picking up steam, the health ministry in Delhi busied itself with cranking out useless press statements, either vituperative missives berating Opposition-led states that had complained of vaccine shortages, or self-congratulatory communiques talking up the work it was doing.

One such statement on April 15 caught my attention: “100 new hospitals to have their own oxygen plant under PM-Cares fund,” it said. But what had happened to the 162 oxygen plants that had been widely publicised as being funded from the same opaque corpus just a few months ago?

We found a tender document that a Central government agency had floated in October – eight months into the pandemic – inviting bids for 150 oxygen plants to be installed in district hospitals in 14 states. My colleagues, Arunabh Saikia and Vijayta Lalwani, started calling up the district hospitals listed in the document. They got through to 60 district hospitals. Only 11 hospitals reported that the oxygen plants had been installed. Of those, just five were operational.

The health ministry chose not to respond to our queries about the delay in getting the plants up and running. But soon after our report was published, it put out a set of tweets confirming that only 33 of the 162 plants had been installed yet.

On April 18, as soon as I hung up from the call with my mother, I went to the Delhi government’s “Delhi Fights Corona” website.

It has a dashboard showing the availability of hospital beds for Covid-19 care across the city. I looked through the list for private hospitals, knowing that, like most affluent Indians, my uncle would be wary of going to a government hospital. But I soon realised we had no choice: all private hospitals were full, as were most government hospitals, except two. I called both. Neither had beds available.

I called friends. The scene was bad, they said, look for home care.

I called three companies that provide home care services. We are completely overwhelmed, sorry, we simply don’t have any staff, they said.

A doctor I spoke to described the situation as “apocalyptic”.

My uncle’s oxygen saturation levels, meanwhile, had fallen to 86% – well below the 94-mark, seen as the threshold beyond which medical attention is needed. Luckily, my cousin was able to borrow an oxygen concentrator from a friend whose mother had used it until she had found a hospital bed.

But the doctors we consulted on the phone warned us that my uncle was in a high-risk category. His CT scan showed his lungs were badly affected. Inflammatory markers in his blood, which help determine the severity of disease, were alarmingly high. He needed to be immediately started on intravenous medicines, they said, urging us to take him to a hospital.

By now, my entire family, across continents, was working the phones, calling everyone they knew in Delhi to see if a bed could be found. But even the help desk of a corporate firm where one of my relatives works, which had been expressly set up to provide support to employees and their families battling Covid-19, drew a blank.

In the evening, a friend gave us a lead: we could try and take my uncle to the emergency ward of a non-profit hospital. We rushed.

Entering the emergency ward, double masked, I saw the familiar chaos of an Indian hospital was even more heightened and manic. A nurse checked my uncle’s vitals, then a doctor came to examine him, both in their PPE kits. “He needs to be shifted to an ICU,” the doctor said, without explaining why. “We don’t have the space, take him elsewhere.”

My heart sank. It had been hard enough to find a hospital bed. Where on earth would we get an ICU bed?

Unable to think, I pulled out my phone, went to Twitter and posted an appeal. Within minutes, there was a deluge of messages. But most of the information was redundant: we had spent a day trying to call on the very numbers that people were pointing us to. Among the people I was directed to was a leader of the Youth Congress, who had quickly earned a reputation for mobilising help for Covid-19 patients. I spoke to him on the phone. He was empathetic but admitted even he could not find an ICU bed.

A public health activist saw my tweet and called in with advice. “Stay in the hospital, don’t leave,” she said. “Put pressure on the hospital to find space for him.”

Eventually, that night, the hospital made room for my uncle in its ICU.

The next morning, the senior doctor in the ICU asked us to get six injections of remdesivir for my uncle.

The previous day, we had published an interview of a doctor in Mumbai who had sounded a cautionary note on the anti-viral drug, which he said was being prescribed recklessly, in ways not backed by evidence.

Sceptical, I questioned the ICU doctor, who explained to us at some length that my uncle fell in a small category of patients who had been found to benefit from the drug. To be abundantly cautious, I took a second opinion that validated the advice.

Thus began another round of phone calls. I called more than a dozen pharmacists listed by the Delhi government as authorised stockists of remdesivir. None had it. I asked a friend to go to a pharmacy near her house, which according to a forward on WhatsApp that many people had sent me, had stocks of remdesivir. It didn’t.

Family friends who had sourced remdesivir recently gave us phone numbers for agents who we soon found out were selling the drug at jacked-up prices. The lowest quote we got was Rs 25,000 per dose for an injection with a maximum retail price of Rs 899.

Desperate, we decided to pay. We drove 30 km with Rs 1.5 lakh in cash, only to find the injections on offer were counterfeit. The boxes had spelling mistakes on them.

That night, we had nearly given up hope on finding remdesivir when someone in the family managed to speak to an administrator in the hospital, who secured permission for the injection to be released from its pharmacy. It was lying there all along, perhaps being saved up for the hospital staff – two senior doctors were in the ICU.

Next morning, I went to the hospital, only to spend hours running from one end to the other to get the injection to move from the pharmacy to the ward. Perhaps to stem leakages, the hospital had made it mandatory for doctors to stamp and sign off on prescriptions – a task that doctors, who had much more on their hands, didn’t have the time to do.

Lost in the maze of the hospital building, parts of which were cordoned off to limit access to the Covid wards, at some point, I nearly broke down. A security guard consoled me and offered me a chair.

“Bahut bura haal hai,” he said. “People are dying like never before.”

I asked him if he had been vaccinated. After all, he was spending hours inside a Covid hospital. He said, yes. He had received the first dose.

Meanwhile, my colleague Rohan Venkatramakrishnan wrote about how daily vaccinations in India were falling even as the number of Covid-19 cases was rising, while also tracking the absurdities of the new vaccine policy. Aarefa Johari documented the devastation thatthe second wave was causing across the country. Vijayta Lalwani accessed government correspondence that showed, in the midst of the mounting death toll in Delhi, work on Modi’s Central Vista project continued – it had been declared an “essential service”.

But nothing seemed more urgent than the oxygen crisis.

Arunabh Saikia dug deeper to find out that alarmingly India was running short on everything from liquid oxygen to cryogenic tankers and cylinders needed to transport and store it. Setting up oxygen generation plants in hospitals on a war footing could have helped defuse this crisis. Had India spent just Rs 2,000 crore, it could have added 1,540 tonnes of daily medical oxygen capacity, enough to support 100,000 patients simultaneously.

While I was editing the story, news flashed on Twitter that the hospital to which my uncle had been admitted had only two hours of oxygen left. I froze. Luckily, the supplies reached the hospital on time.

Others were less fortunate. Nearly 50 people died at two hospitals in Delhi where the oxygen supply ran out.

At least, hospital administrators in Delhi were free to call out the government. In neighbouring Uttar Pradesh, the same crisis was playing out but the chief minister silenced criticism by threatening police action against those “spreading rumours” of shortages. Meanwhile, as an activist described it, people in the villages were “dropping dead like flies”.

In May last year, I had reported from Jaunpur district in eastern Uttar Pradesh, where the population of 52 lakh people had access to only 17 ventilator-equipped beds. One year later, the number has gone up to just 28, as Jyoti Yadav reported in The Print. “Look at the situation. It is exploding,” one of the doctors told her. “Each and every person we are attending is Covid positive. These are coming from villages.”

In Delhi, the ambulance sirens were growing louder, and pleas for help on Twitter growing more desperate. Not only had hospital beds run out in Delhi, so had Covid-19 tests and oxygen cylinders.

On a health journalists’ group that I am part of, where reporters exchange notes, expert contacts and jokes, what also circulated in the past fortnight are numbers for testing labs, pharmacists, oxygen suppliers.

Most Indians, of course, do not have access to such online resources.

One morning, I woke up to a phone call. A building contractor I knew was being driven around in an autorickshaw by his family. His oxygen levels were perilously low.

A few days before, he had tested positive for typhoid. A doctor had prescribed him typhoid medicines, while also recommending a Covid-19 test. But no test was available. Like many other patients, his condition suddenly and rapidly deteriorated.

I began making phone calls, messages, even posted an appeal on Twitter. The Covid Citizen Action Group, a small volunteer group, responded. They had managed to get seven beds for patients that morning – only because the previous occupants had died. They said they would start looking for another one.

But before a bed could be found, the contractor died.

When I had met him just a fortnight ago, he was getting ready to travel back home to Bihar. After decades of slogging in the city building other people’s homes, he had finally saved up enough to build one for his family. He was heading back for the grihapravesh or housewarming. But the coronavirus got to him first.

The virus was everywhere. My housekeeper’s husband had tested positive a few days ago, before the tests had run out. Now, the entire family, including her three daughters, was down with fever. They lived in one room house and had no space to isolate. Worrying, her lungs were already scarred by a bout of tuberculosis, a disease that disproportionately affects the poor in India, and even makes them more vulnerable to Covid-19. I dropped an oximeter outside their house. Don’t worry, just monitor your oxygen levels, I told her on the phone.

Last year, the Delhi government had claimed it was monitoring patients recovering at home, even supplying them oximeters. This year, the system has collapsed. There is no working helpline, no home monitoring, no hospital bed management, no triage. Patients’ families have been left to run helter-skelter from hospital to hospital, in the process helping the virus spread faster.

That evening, as I got back home, I got a call from my cousin: my aunt’s oxygen levels were dropping, and her blood tests had revealed high levels of inflammatory markers. I felt drained. I called a doctor who asked us to start her on dexamethasone, a steroid recommended by the World Health Organisation for severe Covid-19, while we located a hospital bed.

My cousin drove around South Delhi that night but could not find dexamethasone or its substitutes – standard and cheap medicines that would normally be available with every chemist.

Next morning, I continued the search, but to no avail. In disgust, I posted a tweet, this time not asking for help, but simply venting my frustration. For the first time, the responses threw up concrete leads.

By afternoon, I had found the steroid. But my aunt also needed oxygen support. Phone calls to oxygen suppliers threw up another facet: “Do you have a cylinder?” asked a supplier, saying all he could offer was a refill. Get-your-own-cylinder apparently was the new thing in town.

Again, luckily, my cousin found a friend he could borrow a concentrator from, but it did not have a mask or cannula to deliver the oxygen. Another round of pharmacies in the city yielded nothing. We looked online. Amazon had plenty of non-rebreather masks, but the delivery would take a few days.

Volunteers of the Covid Citizen Action Group, again, came to the rescue. By evening, they had located one for me.

Meanwhile, my mother called: another aunt and uncle were down with fever. Forget Covid-19 tests, we have not even been able to book inflammatory marker blood tests for them. The reagents have run out.

Healthcare in India, like much else, has always been inequitable.

My family has the money, the privilege and the networks that are usually enough to buy good healthcare in the country.

But the massive second wave of coronavirus has blown our cover. Even people like us are struggling. What is coming to our help are not connections, but a sense of community, whether it is an online community of Twitter users, or volunteer groups, or traditional spaces like gurudwaras creating open-air oxygen langars.

But if you believe this crisis will make the privileged rethink India’s deeply inequitable healthcare system, you are mistaken.

Already, those who can afford to buy oxygen concentrators are importing them from abroad. In a few weeks, the rich will have set up home ICUs, receding from the fray, leaving the rest of Indians to the mercy of the system.

Few will bother to study or critique the underlying faultlines that have brought us to this point, whether in our healthcare model, which is focused on expanding insurance instead of actual health capacities, be it hospitals or oxygen plants or doctors and nursing staff, or in our politics where even the oxygen crisis has devolved into a partisan battle, rife with propaganda and misinformation, much of it aimed solely at maintaining the fiction that the PM cares.