Indian hospitals choke, patients struggle at home

ISLAMABAD: As hospitals in Delhi and many other cities in India run out of beds, people have been forced to find ways to get treatment for sick patients at home. Many have turned to the black market, where prices of essential medicines, oxygen cylinders and concentrators have skyrocketed and questionable drugs are now proliferating.

On Monday, the country reported another 319, 435 infections and 2,764 deaths, with roughly 117 Indians succumbing to the disease every hour — and experts say even those figures are likely an undercount. The new infections brought India’s total to more than 17.6 million, behind only the United States.

India has ordered its armed forces to help tackle surging new coronavirus infections. In a meeting with Prime Minister Narendra Modi, the Chief of Defence Staff General Bipin Rawat said oxygen would be released to hospitals from armed forces reserves and retired medical military personnel would join COVID-19 health facilities.

Anshu Priya could not get a hospital bed in Delhi or its suburb of Noida for her father-in-law and as his condition continued to deteriorate. She spent most of Sunday looking for an oxygen cylinder but her search was futile.

So she finally turned to the black market. She paid a hefty amount - 50,000 rupees ($670; £480) - to procure a cylinder that normally costs 6,000 rupees. With her mother-in-law also struggling to breathe, Anshu knew she may not be able to find or afford another cylinder on the black market.

This is a familiar story not just in Delhi but also in Noida, Lucknow, Allahabad, Indore and so many other cities where families are desperately cobbling together makeshift arrangements at home.

But most of India's population cannot afford to do this. There are already several reports of people dying at the doorsteps of hospitals because they couldn't afford to buy essential drugs and oxygen on the black market.

According to international media reports, most of the oxygen suppliers are asking for at least 10 times more than the normal price. The situation is particularly dire in Delhi where there are no ICU beds left. Families of those who can afford it are hiring nurses and consulting doctors remotely to keep their loved ones breathing.

But the struggles are huge from getting blood tests done to getting a CT scan or x-ray. Labs are overrun and it's taking up to three days for test results to come back. This is making it harder for treating doctors to assess the progression of the disease. CT scans are also used by doctors to assess the condition of the patient but it's taking days to get an appointment.

Doctors say that these delays are putting many patients at risk. RT-PCR tests are also taking days. I know several sick patients who found a bed but couldn't get admitted as they didn't have a positive corona report.

Anuj Tiwari hired a nurse to assist in the treatment of his brother at home after he was refused admission in many hospitals. Some said they didn't have any free beds and others said they were not taking new patients due to continuing uncertainty over the supply of oxygen. A number of patients have died in Delhi due to a lack of oxygen supply. The city's hospitals are desperate and some have been issuing daily warnings, saying they are left with just a few hours of oxygen. Then the government swings into action and tankers are sent, which is often enough to run the hospital for a day.

A doctor in Delhi said that was how hospitals were working and "there are real fears now that a big tragedy may happen". Given the scenario at hospitals, Tiwari paid a hefty amount to procure a concentrator - which can extract oxygen from the air - keep his brother breathing. The doctor also asked him to arrange the anti-viral drug remdesivir, which has been given emergency-use approval in India and is being prescribed widely by doctors. The benefits of the drug - which was originally developed to treat Ebola - are still being debated across the world.

Tiwari couldn't find the drug in any medicine shop and eventually turned to the black market. His brother's condition continues to be critical and the treating doctor says he may soon need a hospital where remdesvir could be administered.

"There are no beds. What will I do? I can't even take him anywhere else as I have already spent so much money and don't have much left," he said. He added that "the desperate battle to save corona patients has shifted from hospitals to home", and even that is proving to be a daunting task as "we don't have easy access to oxygen".

Remdesivir is in such short supply that families of the patients who are being treated at home are rushing to procure it. They want to have the drug in case the patient is required to go to hospital and may need the drug.

Dealers on the black market said the supply was tight and that was why they were charging such high prices. The government has allowed seven firms to manufacture remdesvir in India and they have been told to ramp up production.

But several promises of adequate supply from the government have failed to show any result on the ground. Epidemiologist Dr Lalit Kant says the decision to ramp up production was taken too late and the government should have been prepared for the second wave.

"But somehow the drug is available in the black market, so there is some leakage in the supply system which the regulators haven't been able to plug," he says. "We learnt nothing from the first wave."

India was initially seen as a success story in weathering the pandemic, but the virus is now racing through its massive population of nearly 1.4 billion, and systems are beginning to collapse.

In addition to oxygen supplies running out, intensive care units are operating at full capacity and nearly all ventilators are in use. As the death toll mounts, the night skies in some Indian cities glow from the funeral pyres, as crematoria are overwhelmed and bodies are burned outside in the open air.

The White House said the US is “working around the clock” to deploy testing kits, ventilators and personal protective equipment, and it would seek to provide oxygen supplies as well. It said it would also make available sources of raw material urgently needed to manufacture Covishield, the Oxford-AstraZeneca vaccine made by the Serum Institute of India.

“Just as India sent assistance to the United States as our hospitals were strained early in the pandemic, we are determined to help India in its time of need,” President Joe Biden said in a tweet.

Help and support were also offered from arch-rival Pakistan, which said it could provide relief including ventilators, oxygen supply kits, digital X-ray machines, protective equipment and related items.

Germany’s Health Ministry said it was “urgently working to put together an aid package” for India consisting of ventilators, monoclonal antibodies, the drug Remdesivir, as well as surgical and N95 protective masks.

Saudi Arabia is also shipping 80 metric tonnes of liquid oxygen to India as the country is running low on supplies. China has also offered to help India battle its COVID-19 outbreak.

“The Chinese government and people firmly support the Indian government and people in fighting the coronavirus. China is ready to provide support and help according to India’s needs, and is in communication with the Indian side on this,” foreign ministry spokesman Zhao Lijian said.

In January, Indian Prime Minister Narendra Modi declared victory over the coronavirus, telling the virtual gathering of the World Economic Forum that India’s success couldn’t be compared with anywhere else.

A little less than a month later, his Bharatiya Janata Party passed a resolution hailing Modi as a “visionary leader” who had already “defeated” the virus. By the second week of March, India’s health minister declared that the country was “in the endgame” of the pandemic.

At the same time, the patients arriving at India’s hospitals were far sicker and younger than previously seen, prompting warnings by health experts that India was sitting on a ticking time bomb, which went either unnoticed or ignored.

Millions of Hindu devotees celebrated the festival of Holi across the country at the end of March, foregoing social distancing guidelines and masks. Politicians, including Modi, spearheaded mammoth election rallies where tens of thousands participated without masks. And millions more gathered by the Ganges River for special Hindu prayers as recently as last week.

Now it’s suspected all these events might have accelerated the unprecedented surge India is seeing now. Amid a record surge in COVID-19 cases in the country, around 93,000 employees of Indian Railways have also tested positive for the virus, Railway Board Chairman and CEO Suneet Sharma said, according foreign media.