At 3 p.m. on April 24, a woman walks out of the main building of Jaipur Golden Hospital, Delhi, her eyes red from crying. She is in her thirties. Three family members have their arms around her. The woman is silent and keeps her head down. Her relative, though, snaps out of her shock and cries, “He has been murdered!” The woman crosses the hospital gate, sits on the pavement and starts wailing. Her 37-year-old husband, Dinesh, a cabin crew member in an airline, was among the 20 critically ill COVID-19 patients at the hospital who had died the previous night over an “oxygen crisis”, according to the hospital authorities.
“These people killed him. They didn’t give him oxygen. They didn’t tell us anything about an oxygen shortage,” says a family member. The woman has two children aged three and five years.
It is a summer of fear and grief in the national capital. This wave of the COVID-19 pandemic has hit Delhi with tremendous force. The number of daily new cases and deaths is as high as 28,000 and 300, respectively, every day. There is sickness in the air and death too. The health system is being stretched to its limits, often cracking under the burden of cases. Many people with symptoms of COVID-19 are lining up outside testing centres as early as 4 a.m. Every day, the sick travel to about five-six hospitals in search of a bed. Many of them die outside hospitals just waiting for admission. Inside the hospitals, apart from deaths due to the infection and related complications, some lives have been lost due to oxygen shortages. The queues are long outside hospitals and they are long outside cremation grounds too. Pyres burn through the night.
Letting down its guard
How did it come to this? The Delhi government says the disaster is due to an unexpected spike in cases due to the spread of a variant of the virus, but medical experts say the government let its guard down too early. Believing that the worst was behind us, the government did not increase beds or build capacity at oxygen plants, they say.
“Not just Delhi, but nationally too the assumption was that there won’t be a second wave. Many experts in Delhi had announced on TV that we have achieved herd immunity and the pandemic has ended,” says Dr. K. Srinath Reddy, epidemiologist and president of the Public Health Foundation of India. He says people gave up social distancing and stopped wearing masks properly.
The picture was different just a few months ago. January 27 was a good day for the Delhi government. The number of new COVID-19 cases had dropped to 96, the lowest in nine months in the capital. On February 16, it dropped to 94. Delhi Health Minister Satyendar Jain took note of it. “I feel now that all the three waves of the coronavirus have hit the city. It’ll die down eventually. Now it is no more a pandemic but an endemic. The infection will not be eradicated much like other diseases, but the surge is on the wane. I hope we won’t see 8,600 cases a day. I feel we are out of the danger zone but we still need to take proper precautions. Masks and social distancing need to be maintained,” he said in a statement on February 19.
A few days later, on February 24, the number of new cases hit 200. Despite this, that month, Delhi Chief Minister Arvind Kejriwal addressed crowded election rallies for by-elections to five seats in municipal corporations. There was no social distancing at these rallies and several did not wear masks.
On March 7, Jain again stated that COVID-19 was nearing an “endemic” phase in the capital. “Experts say some cases will continue to occur in the endemic phase over the next few years, but it will not spread like it was in the pandemic phase. Delhi witnessed a swine flu outbreak around 10 years ago but still some cases are reported every year. COVID-19 is not going to end completely. We will have to learn to live with it,” he said. Jain provided encouraging data: the positivity rate had been lower than 1% for two months, he said. Nearly two months since that reassurance, the positivity rate stands at over 32%.
Before the cases began spiking, the Delhi government lifted most of the COVID-19 restrictions. The number of beds for COVID-19 patients was reduced in hospitals as cases were low.
“See, politicians are not technical experts. They get opinions from experts. They may project it in an over-enthusiastic way. So, don’t point a finger at the Minister alone, but also at the experts who advise him,” Dr. Reddy says.
Given that many other countries have experienced a second and even third wave, India should have taken note, Dr. Reddy says. “Even as early as January and February, there was an increase in cases in Maharashtra and other States. Not just Delhi, but other States should have also taken note,” he says.
Also read | Coronavirus bulletin issued by Delhi govt rife with major discrepancies
The Delhi government spokesperson and the Health Minister did not respond to questions sent by The Hindu .
Unable to keep up with demand
The “unexpected spike” has spiralled into an unimaginable crisis today with people running around to find beds, drugs and oxygen.
Around 11:30 a.m. on a hot April day, a woman in her early thirties walks with the help of her husband outside the emergency ward of Guru Teg Bahadur Hospital, commonly known as GTB Hospital, the second largest government hospital in Delhi. She is suspected of having COVID-19. Her condition slowly worsens. Unable to sit, she lies down at the entrance to the emergency ward. The ward is overwhelmed: stretchers are used as beds, with one touching the other, and people share beds. A long queue of hopeful people wait outside.
About half an hour later, the husband, Surender Kumar, 35, struggles alone with her body. With no one to help, he drags it from the stretcher into an ambulance. “She breathed her last while we were waiting,” says Kumar, a daily wage labourer from Bihar. Within just an hour, two people are declared dead outside the emergency ward.
Finding a bed is one of the biggest challenges today. “This is the fifth hospital I’m coming to with my mother. I called GTB Hospital. The government website showed that it had 292 vacant beds, but the hospital said it doesn’t have any. Her oxygen level is 80%. What will we do now,” asks an anxious 17-year-old standing outside the Lok Nayak Jai Prakash Narayan (LNJP) Hospital, the largest Delhi government hospital.
Though the number of new cases started rising from February 24, the Central and Delhi governments did not increase the city’s healthcare infrastructure through March. On March 1, the number of new cases was 175 and the number of active cases was 1,404. This quickly rose to 1,819 new cases and 8,838 active cases by March 31 — an increase of 939.4% and 529.4%, respectively. However, during the same period, the number of hospital beds for COVID-19 increased only by 1.6% — from 5,721 to 5,815, as per official data. Also, the number of beds in COVID Care Centres stayed stagnant at 5,525 throughout March. By April 28, the government increased the beds by 259.8%, to 20,926, compared to March 1, but this too fell terribly short of demand.
Dr. Girish Tyagi, Secretary of the Delhi Medical Council, says there is a huge gap between the demand and supply of beds, oxygen, medicines and ICU beds in Delhi. “The system has practically collapsed. The government didn’t anticipate such a spike. But there was an increase in Mumbai in February and March and we should have been better prepared,” he says.
Dr. Reddy says whatever happened in Delhi from December to April cannot be seen in isolation. “During this period, the U.K. variant of the virus, B.1.1.7., came into Delhi and Punjab and was in circulation. But people became careless. We went back to the routine practices of 2019 and we started non-COVID-19 treatment in hospitals. To convert hospitals to treat COVID-19 patients takes time,” he says. But the government should have added more beds, especially in COVID-19 Care Centres, he adds.
“The government cannot say it did not expect this situation. It has epidemiologists and experts advising it. They should have made predictions. Having said that, we do not know whether experts had advised the government and were ignored,” Dr. Tyagi says.
A senior official says there was no prediction on how the rise would be this time. “Last year, the V.K. Paul Committee had predicted that cases could go up to 15,000 a day. But this time no one knew how the rise would be. There were so many other factors in play,” the official says.
In May and June last year too, as cases started to rise, people were forced to travel from one hospital to another in search of beds. Many were unable to find a bed in a hospital, even when beds were available according to official data.
On June 27, 2020, in a video statement, Kejriwal accepted that there was a shortage of beds. “In the first week of June, there was a shortage of beds in Delhi and there were fewer tests [being conducted]. Due to a shortage of beds, some people did not get beds, and the number of deaths also started to increase,” he said. Kejriwal added that he used to get calls at nights about the shortage of beds and it was fixed later.
A COVID-19 patient being wheeled into the emergency ward of Lok Nayak Jai Prakash Narayan Hospital in New Delhi.
The situation is far worse this year as the vacancy of beds has been as low as 5% on many days and the number of vacant ICU beds has been lower than 20 for the whole of Delhi over the past one week. Last year, too, the government increased the number of beds only after the spike. Now, the government is trying to make available 1,500 more ICU beds and says these will be ready by May 10. On April 29, there were only 17 ICU beds vacant in the whole city.
Gasping for air
On April 18, Kejriwal tweeted that Delhi is facing an “acute shortage of oxygen” and it was becoming an “emergency”. On April 23, a day before the deaths at Jaipur Golden Hospital, 25 of the “sickest” patients died at Sir Ganga Ram Hospital due to an oxygen crisis . Several other hospitals also sent out distress statements reporting dwindling supplies even as the number of COVID-19 patients mounted. Many said oxygen was available at dangerously low levels. Often, oxygen supplies had reached just in time to save people, they said. Many hospitals stopped admitting patients and two major Delhi government hospitals — GTB Hospital and Rajiv Gandhi Super Speciality Hospital — reduced the total number of beds by a total of 1,100.
There has been a shortage of liquid medical oxygen in the city for over 10 days, but this urgent need is yet to be resolved. It has now turned into a political blame game. On April 21, Delhi Deputy Chief Minister Manish Sisodia blamed the Haryana and Uttar Pradesh governments for not allowing a smooth supply of oxygen from private oxygen plants in those States to Delhi. The Delhi government has submitted data before the Delhi High Court suggesting that while oxygen provided to the national capital by the Centre was well short of target, some States were getting more than what they had asked for. Since April 19, the Delhi High Court has been monitoring the situation in the capital and has castigated both the Centre and the Delhi government for the lack of availability of medical oxygen and its distribution.
Ideally, there should be a buffer stock of oxygen to last at least 48 hours in hospitals, say doctors. But since the record surge in cases, hospitals have been working with smaller stocks and are refilling oxygen almost on a daily basis.
People too are scrambling for oxygen. On April 28, Jitender Kumar, a resident of Paschim Puri, stands in the queue outside an oxygen-filling plant in Naraina. He has been there since 4 a.m. “I have already lost two relatives to COVID-19 because we couldn’t get a bed in a hospital. I am standing here trying to save the third person,” he says.
People queue up to refill empty oxygen cylinders at Naraina in New Delhi on Tuesday.
The struggle to cremate the dead
However, even if there are beds and oxygen, the capital’s problems would be far from over. On April 19, Ved Prakash, 40, died inside his car while waiting outside the Sardar Patel COVID Care Centre. The centre had more than 350 vacant beds, but did not allow him admission as he had not followed the procedure, which was not in place that day. Around 9:30 p.m., Megh Singh, 60, who was waiting in queue at a crematorium to do Prakash’s last rites said, “He was critical, but he was still responding to us when we reached the centre. Now he is gone. No hospital attended to him.”
Delhi’s municipal corporations are struggling to cope with the daily pile of bodies at crematoriums and and burial grounds administered by them across the city which have, over the last 11 days, witnessed the last rites of over 5,800 citizens who died of COVID-19.
Funeral pyres, according to the Mayors of the three Municipal Corporations, burn round the clock — sometimes even on the ground for want of space — at 29 funeral venues spread across the 11 municipal zones in Delhi. This is despite the enhancement of capacity dedicated for the last rites of COVID-19 patients at these venues by over 93% between April 19 and April 29.
Temporary platforms have been created hurriedly at crematoriums and extra space has been allotted at burial sites to deal with the sudden surge in the numbers of the dead. The Mayors say they hope to ensure that no citizen is turned away and denied the right to cremate their kin.
The sheer magnitude of the daily death toll has forced the Bharatiya Janata Party-run civic bodies to reach out to Kejriwal for help requesting resources ranging from more hearses to an uninterrupted supply of firewood to keep the pyres lit.
According to records of the Delhi Municipal Corporation, 5,808 cremations and burials with COVID-19 protocols were performed between April 19 and April 29 (6 p.m.). The Delhi government, however, recorded 3,271 COVID-19 deaths in this period. The capacity at crematoria and burial grounds on April 19 was 505; by April 29 this had increased to accommodate 978 bodies.
“North Delhi Municipal Corporation (DMC) had the capacity to cremate 230 bodies till April 15 but within 10-12 days, the total capacity has been increased to 570. Three new cremation grounds have been developed besides increasing the capacity of existing ones,” North DMC Mayor Jai Prakash said in a letter to Kejriwal on April 28.
A relative mourns next to the remains of a COVID-19 victim after a mass cremation at a cremation ground in New Delhi on April 30, 2021.
“Out of a total of 570, 304 wooden and 54 CNG pyres are fixed for COVID-19 deaths and the rest are for non-COVID-19 deaths. We are transforming ourselves as per the need of the hour,” he said. South DMC Mayor Anamika Mithilesh Singh said 20 funeral platforms recently created at two adjacent public parks in Sarai Kale Khan will be increased five-fold to 100 and beyond that if required in the coming days. East DMC Mayor Nirmal Jain said funerals at the facilities in his jurisdiction are undertaken from dawn till dusk and though waiting times have been getting longer, the corporation was trying its best to ensure that the last rites of as many citizens as possible were performed.
The North DMC Mayor has asked Kejriwal to provide at least 100 ambulances to the municipal corporations to transport patients to available healthcare facilities which could also be utilised as hearse vans in those cases of citizens losing their battle with COVID-19. He also demanded that the Delhi government direct the forest department to provide firewood from damaged or ailing trees for final rites given the increasing number of funerals.
The Mayors accused the Delhi government of giving incorrect figures related to COVID-19 deaths to hide its alleged failure at taming the pandemic. BJP spokesperson Harish Khurana alleged that the Delhi government was “politicking on deaths”.
Also read | In Delhi, over 1,000 last rites performed between April 18 and 20
A Delhi government source says a significant reason for the mismatch is the deaths of COVID-19 patients either on their way to hospital or at other places as they could not get admitted to a hospital on time. The discrepancy in funeral and COVID-19 deaths data maintained by the government could also be related to the fact that some are dying at home or are dying of critical illnesses aggravated by the virus, the source says.
Responding to reports on the mismatch between cremation figures and the COVID-19 death toll recorded by the Delhi government, the Health Minister told reporters on April 29 that the government has kept everything “transparent”. “This is not the time to politicise things. Six months ago, the same concern was seen, but it was proved that the numbers were accurate,” he said.
Published - May 01, 2021 12:15 am IST
