Letters to the Editor • Opinion
The coronavirus might not be the worst of it
The Washington PostDemocracy Dies in Darkness

Coronavirus has crushed India’s health system. Patients are on their own.

The fiancee of a person who died of the coronavirus breaks down during a cremation in Guwahati, India, on Tuesday. (Anupam Nath/AP)
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NEW DELHI — When Rehmat Ahsan began to have trouble breathing last week, his family went from hospital to hospital in India’s capital looking for a bed in a covid-19 ward. Everywhere they tried was full.

Then they started a new search — for the oxygen that might save his life.

Ahsan’s older brother said he found an oxygen cylinder from a private vendor for $350, five times the normal price. It lasted eight hours. When he tried to refill the cylinder, he found hundreds of people waiting in line.

By the time he found more oxygen several hours later, Ahsan was struggling for every breath. Later that afternoon, he died at home.

“He was a strong man, a fighter who was defeated by an incompetent system,” said Mohammed Rizwan Alam, his elder brother. He believes his brother, a 49-year-old shopkeeper and father of two daughters, would still be alive had he received proper care.

In India’s devastating second wave of coronavirus infections, patients and their families are on their own, fighting to save their loved ones in an overwhelmed system where ambulances, hospital beds, oxygen, medicine and even cremation grounds are in short supply.

India’s health-care infrastructure is buckling as a record-breaking surge of infections exposes what experts say are decades of underinvestment combined with a lack of preparation by the government for a second wave. The country is reporting more than 300,000 cases and nearly 3,000 deaths a day, although official figures understate the scale of the calamity.

Some are dying not because they have covid but because they cannot access proper care. Late Tuesday in Delhi, there were just nine intensive care beds for covid patients available in a city of more than 17 million, a government dashboard showed, with 11 such beds reserved for pregnant women and children. Each day brings reports of people dying just outside hospitals.

Countries around the world, including the United States, have pledged to assist India with medicines, supplies of oxygen and raw materials for vaccines as it battles the new wave of infections. But the need in India is immediate, and it’s unclear how quickly help from abroad will arrive.

Indian Prime Minister Narendra Modi said a “storm has shaken the country” and urged all Indians to get vaccinated. The government is working to boost the supply of oxygen and increase the number of hospital beds and intensive care units.

For many Indians, the additional capacity will come too late. Vinay Srivastava was a 65-year-old retired journalist in the city of Lucknow. His family, like thousands of others in India, faced a gauntlet of obstacles when he contracted covid. Over two days, he documented the deterioration of his condition on Twitter.

With hospitals in India turning away patients and supplies running low, young tech-savvy volunteers are providing salvation for some. (Video: Reuters)

After Srivastava’s oxygen levels plunged on April 16, his son Harshit managed to find an empty cylinder and fill it. His father’s condition improved briefly, but by the next morning, his blood oxygen level had fallen to 70 percent, a level considered life-threatening.

Inside a Delhi hospital, oxygen runs fatally short as cases mount

When Harshit tried to get his father admitted to a covid ward, he was turned away from the same hospital twice. He was told that he would need both a positive result on a specific type of coronavirus test called an RT-PCR and a referral letter from a senior medical official. The former would take two days. The latter proved impossible to obtain, even after Harshit tried to visit the official in person.

His father’s tweets told of the family’s desperation: “No hospitals, labs or doctors are picking up the phone,” he wrote on April 16. When a government official asked for more details the next day, Srivastava replied with a photo of his pulse oximeter reading. “My oxygen is 31 when [someone] will help me,” reads the last tweet from his account. Harshit said his father collapsed soon after.

“Medical treatment could have saved him,” said Harshit, who blames the state government for his father’s death. “Nobody came to help.”

Days after news of Srivastava’s death spread, the state government ended the requirement that coronavirus patients obtain referral letters from a senior medical official before being admitted to private hospitals. “It came to our notice that people were facing difficulty so that system was withdrawn,” said Navneet Sehgal, a senior official in the state government.

In another part of the same city, Blessing Lyall, 32, first had to struggle to get her mother Claris tested for the coronavirus and then to get an oxygen cylinder as she became weaker and weaker. A doctor told Lyall to take her mother to the hospital, but every hospital she and her friends called was full — and her mother did not want to be separated from her only child. Lyall’s father died in December.

Lyall found an oxygen cylinder for her mother, but it ran out on April 17. She sent scores of messages, reaching out to everyone she knew, frantically calling every number anyone suggested to find a refill. Nothing worked.

It became difficult for her mother to speak.

“Mom was so scared,” Lyall said. “She knew she did not have much time.”

On the morning of April 20, Lyall woke to find that her mother had died. Two hours later, she learned that an oxygen cylinder had become available. For the following week, Lyall was entirely alone with her grief — she, too, had tested positive for the coronavirus and could not leave the house.

Sadaf Jafar, a political activist in Lucknow, was one of the people who tried to help Lyall find an oxygen cylinder. None of the official helplines are working, Jafar said, and the most-senior medical official in the area had switched off his phone. “The state is not available anywhere,” she said.

Countless volunteer efforts have emerged to try to fill the vacuum, but they only serve to highlight the direness of the situation. Gurpreet Singh Rummy, the founder of a Sikh social service organization, said Tuesday that he hadn’t slept for four days, ever since he and his team launched an effort to provide free oxygen to those who need it. The patients arrive all through the day and night in cars and three-wheeled auto rickshaws at a Sikh temple, or gurdwara, near Delhi.

“These are very serious patients who don’t have time to even reach hospitals,” said Rummy. His group is prioritizing those with oxygen levels under 50 who may be “on their last breath.”

Even when coronavirus patients die, the scarcity of resources continues. Vasundhara Bijalwan’s father, Pradeep, a 67-year-old doctor who dedicated his life to serving Delhi’s homeless, died at home of covid-19 last week. She and her mother — both coronavirus-positive themselves — had earlier spent hours calling hospitals trying to get a bed for her father. The numbers were either not working or busy.

Finally, they found a spot in a small hospital. The next morning, however, they discovered that the facility’s oxygen supply was on the verge of running out. They brought Pradeep home and gave him oxygen there using a machine that concentrates it from the air. When he continued to deteriorate, he told them he was fine at home, where he would be surrounded by family, no matter what happened.

After his death, the family called crematoriums, but there were no slots available. Ultimately they paid an agent to handle the process at the suggestion of a neighbor whose relative died of covid-19 at almost the same time.

Because she was in isolation, Bijalwan was unable to attend her father’s cremation. Her cousin told her there were so many bodies at the crematorium that four families were eyeing a single spot, hovering and angling for position.

“It’s not just about my father,” said Bijalwan. “Nobody should go like this.”

Saurabh Sharma in Lucknow contributed to this report.