India: Morgues run out of stretchers as deaths hit 2,800 a day

India‘s new coronavirus deaths reached a record peak on Monday as the country’s morgues ran out of stretchers, patients were seen wandering the streets in search of hospital beds, and trees from city parks were set be used to burn bodies as crematoriums are unable to keep up with demand.

Meanwhile, vital life-saving oxygen is in short supply and countries including Britain, Germany and the United States have pledged to send urgent medical aid to help battle the the second deadly wave that is collapsing India’s tattered healthcare system.

India recorded 2,812 Covid deaths overnight and infections in the last 24 hours rose to 352,991 on Monday – a record peak and a new global record for a fifth day running. 

On Sunday, Prime Minister Narendra Modi urged all citizens to get vaccinated and exercise caution, while hospitals and doctors have put out urgent notices saying they were unable to cope with the rush of patients. 

Overcrowded hospitals in Delhi and elsewhere are being forced to turn away patients after running out of supplies of oxygen and beds, leaving families to ferry people sick with coronavirus from hospital to hospital in search for treatment and patients dying on pavements outside.

Pictured: Burning pyres in a make-shift crematorium in Delhi, India, on April 24, 2021. India's new coronavirus deaths reached a record peak on Monday as the country's morgues ran out of stretchers, patients were seen wandering the streets in search of hospital beds, and trees from city parks were set be used to burn bodies

Pictured: Burning pyres in a make-shift crematorium in Delhi, India, on April 24, 2021. India's new coronavirus deaths reached a record peak on Monday as the country's morgues ran out of stretchers, patients were seen wandering the streets in search of hospital beds, and trees from city parks were set be used to burn bodies

Pictured: Burning pyres in a make-shift crematorium in Delhi, India, on April 24, 2021. India’s new coronavirus deaths reached a record peak on Monday as the country’s morgues ran out of stretchers, patients were seen wandering the streets in search of hospital beds, and trees from city parks were set be used to burn bodies

India, with a population of 1.3 billion, has a tally of 17.31 million infections and 195,123 deaths, after 2,812 deaths overnight, health ministry data showed, although health experts say the death count is probably far higher. Pictured: A graph showing new Covid-19 deaths per-day

India, with a population of 1.3 billion, has a tally of 17.31 million infections and 195,123 deaths, after 2,812 deaths overnight, health ministry data showed, although health experts say the death count is probably far higher. Pictured: A graph showing new Covid-19 deaths per-day

India, with a population of 1.3 billion, has a tally of 17.31 million infections and 195,123 deaths, after 2,812 deaths overnight, health ministry data showed, although health experts say the death count is probably far higher. Pictured: A graph showing new Covid-19 deaths per-day 

Coronavirus infections in India over the last 24 hours rose to 352,991 on Monday - a record peak for a fifth day running

Coronavirus infections in India over the last 24 hours rose to 352,991 on Monday - a record peak for a fifth day running

Coronavirus infections in India over the last 24 hours rose to 352,991 on Monday – a record peak for a fifth day running

‘Currently the hospital is in beg-and-borrow mode and it is an extreme crisis situation,’ said a spokesman for the Sir Ganga Ram Hospital in the capital, New Delhi.

India’s capital has been cremating so many bodies that authorities in the region are receiving requests to start cutting down trees in Dheli’s parks to be used as kindling, and in some of the worst-hit cities, including New Delhi, bodies were being burnt in makeshift facilities offering mass services.

Television channel NDTV broadcast images of three health workers in the eastern state of Bihar pulling a body along the ground on its way to cremation, as stretchers ran short. 

‘If you’ve never been to a cremation, the smell of death never leaves you,’ Vipin Narang, a political science professor at Massachusetts Institute of Technology (MIT) in the United States, said on Twitter.

‘My heart breaks for all my friends and family in Delhi and India going through this hell.’

On Sunday, President Joe Biden said the United States would send raw materials for vaccines, medical equipment and protective gear to India. Germany joined a growing list of countries pledging to send supplies.

India, with a population of 1.3 billion, has a tally of 17.31 million infections and 195,123 deaths, after 2,812 deaths overnight, health ministry data showed, although health experts say the death count is probably far higher.

The scale of the second wave knocked oil prices on Monday, as traders worried about a fall in fuel demand in the world’s third-biggest oil importer.  

Relatives and municipal workers prepare to bury the body of a person who died of COVID-19 in Gauhati, India, Sunday, April 25, 2021. vital life-saving oxygen is in short supply and countries including Britain, Germany and the United States pledged to send urgent medical aid to help battle crisis collapsing India's tattered healthcare system

Relatives and municipal workers prepare to bury the body of a person who died of COVID-19 in Gauhati, India, Sunday, April 25, 2021. vital life-saving oxygen is in short supply and countries including Britain, Germany and the United States pledged to send urgent medical aid to help battle crisis collapsing India's tattered healthcare system

Relatives and municipal workers prepare to bury the body of a person who died of COVID-19 in Gauhati, India, Sunday, April 25, 2021. vital life-saving oxygen is in short supply and countries including Britain, Germany and the United States pledged to send urgent medical aid to help battle crisis collapsing India’s tattered healthcare system

Politicians, especially Modi, have faced criticism for holding rallies attended by thousands of people, packed close together in stadiums and grounds, despite the brutal second wave of infections. 

Several cities have ordered curfews, while police have been deployed to enforce social distancing and mask-wearing.

Still, about 8.6 million voters were expected to cast ballots on Monday in the eastern state of West Bengal, in the penultimate part of an eight-phase election that will wrap up this week.

Voting for local elections in other parts of India included the most populous state of Uttar Pradesh, which has been reporting an average of 30,000 infections a day.

Modi’s plea on vaccinations came after inoculations peaked at 4.5 million doses on April 5, but have since averaged about 2.7 million a day, government figures show.

Several states, including Maharashtra, the richest, halted vaccinations in some places on Sunday, saying supplies were not available.

Supply has fallen short of demand as the inoculation campaign was widened this month, while companies struggle to boost output, partly because of a shortage of raw material and a fire at a facility making the AstraZeneca dose.

Pictured: Municipal workers prepare to bury the body of a person who died of COVID-19 in Gauhati, India, Sunday, April 25, 2021. Overcrowded hospitals in Delhi and elsewhere are being forced to turn away patients after running out of supplies of oxygen and beds

Pictured: Municipal workers prepare to bury the body of a person who died of COVID-19 in Gauhati, India, Sunday, April 25, 2021. Overcrowded hospitals in Delhi and elsewhere are being forced to turn away patients after running out of supplies of oxygen and beds

Pictured: Municipal workers prepare to bury the body of a person who died of COVID-19 in Gauhati, India, Sunday, April 25, 2021. Overcrowded hospitals in Delhi and elsewhere are being forced to turn away patients after running out of supplies of oxygen and beds

The percentage change in daily Covid infections by Indian state today compared to at their peak, most of which were recorded last year

The percentage change in daily Covid infections by Indian state today compared to at their peak, most of which were recorded last year

The percentage change in daily Covid infections by Indian state today compared to at their peak, most of which were recorded last year

INDIA’S GROWING OXYGEN PROBLEMS 

Are hospitals running out of oxygen?

The main problem is that medical oxygen is not reaching hospital beds in time. This delay is a product of where production units are located, a stretched distribution network, and what critics have said is bad planning.

Several hospitals in Delhi, which has no significant oxygen production capacity, made frantic public calls this week seeking emergency supplies.

With COVID-19 cases also swamping its neighbouring states like Haryana and Uttar Pradesh, oxygen facilities there are over-stretched attempting to meet local demand.

To fulfill Delhi’s current needs, additional medical oxygen now has to be trucked in from industrial zones in eastern India.

Why are oxygen deliveries getting delayed?

The facilities from where Delhi will now receive oxygen are spread across seven states, some more than 625 miles (1,000km) away, according to a court document.

Given the hazardous nature of the substance, all liquid oxygen must be transported in a limited number of specialised tankers, requiring advance planning to ensure deliveries are made on time, a gas industry source told Reuters.

In recent days, as a scramble for oxygen among states worsened, local officials in some regions disrupted movement of tankers in a bid to keep supplies for themselves.

In part due to such blockades, Delhi only received about 177 tonnes of oxygen on Wednesday against its allocation of 378 tonnes, an official said.

But the industry source said that Delhi had also dragged its feet on planning ahead, without factoring in the time it takes to move oxygen cross-country by road.

‘This problem wouldn’t have happened if they had acted 2-3 weeks ago,’ the source said.

Delhi’s government did not respond to questions about the planning.

Does India have enough oxygen?

India has a daily production capacity of at least 7,100 tonnes of oxygen, including for industrial use, which appears to be enough to meet current demand.

This week, the government allocated 6,822 tonnes of liquid oxygen per day to 20 of the country’s worst-affected states, compared to their combined demand of 6,785 tonnes, Prime Minister Narendra Modi’s office said on Thursday.

India’s total medical oxygen demand was just 3,842 tonnes as of April 12, as the surge in cases really took hold.

States are typically allocated supplies by an inter-ministerial group of bureaucrats mandated to monitor and facilitate the flow of essential medical kit during the pandemic.

Modi’s office has noted that the availability of liquid medical oxygen had increased by about 3,300 tonnes in the past few days, with steel plants and other industrial units diverting their production.

What is India doing to solve the crisis? 

The federal government has activated the Indian railways to move multiple tankers from refilling plants to where it is most needed.

Working with industrial gas major Linde India and others, the government is also using the Air Force’s cargo planes to fly empty tankers to production hubs. Refilled oxygen tankers will then move back by road.

The armed forces are importing 23 mobile oxygen generation plants from Germany.

Several other industries are offering oxygen to hospitals, while salt-to-software conglomerate Tata Group is importing 24 specialised containers to transport liquid oxygen.

The government has issued orders to convert argon and nitrogen tankers into oxygen ones.

But as some experts predict a trebling of daily infections in a few weeks, India will have to dramatically ramp up both oxygen production and distribution systems.

 

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Hospitals in Modi’s home state of Gujarat are among those facing an acute shortage of oxygen, doctors said.

Just seven ICU beds of a total of 1,277 were available in 166 private hospitals designated to treat the virus in the western state’s largest city of Ahmedabad, data showed.

‘The problem is grim everywhere, especially in smaller hospitals, which do not have central oxygen lines and use cylinders,’ said Mona Desai, former president of the Ahmedabad Medical Association.

For the fifth straight day, India on Monday set a global daily record of new Covid-19 infections, spurred by an insidious, new variant that emerged in the country, undermining the government’s premature claims of victory over the pandemic. 

Experts have warned that official death toll could be a huge undercount, as suspected cases are not included, and many deaths from the infection are being attributed to underlying conditions. 

The crisis unfolding in India is most visceral in its graveyards and crematoriums, and in heartbreaking images of gasping patients dying on their way to hospitals due to lack of oxygen.

Burial grounds in the Indian capital New Delhi are running out of space and bright, glowing funeral pyres light up the night sky in other badly hit cities.

In central Bhopal city, some crematoriums have increased their capacity from dozens of pyres to more than 50. Yet, officials say, there are still hours-long waits.

At the city’s Bhadbhada Vishram Ghat crematorium, workers said they cremated more than 110 people on Saturday, even as government figures in the entire city of 1.8 million put the total number of deaths at just 10.

‘The virus is swallowing our city’s people like a monster,’ said Mamtesh Sharma, an official at the site.

The unprecedented rush of bodies has forced the crematorium to skip individual ceremonies and exhaustive rituals that Hindus believe release the soul from the cycle of rebirth.

‘We are just burning bodies as they arrive,’ said Sharma. ‘It is as if we are in the middle of a war.’

The head gravedigger at New Delhi’s largest Muslim cemetery, where 1,000 people have been buried during the pandemic, said more bodies are arriving now than last year. ‘I fear we will run out of space very soon,’ said Mohammad Shameem.

The situation is equally grim at unbearably full hospitals, where desperate people are dying in line, sometimes on the roads outside, waiting to see doctors.

Health officials are scrambling to expand critical care units and stock up on dwindling supplies of oxygen. Hospitals and patients alike are struggling to procure scarce medical equipment that is being sold at an exponential markup.

The crisis is in direct contrast with government claims that ‘nobody in the country was left without oxygen,’ in a statement made Saturday by India’s Solicitor General Tushar Mehta before Delhi High Court.

The breakdown is a stark failure for a country whose prime minister only in January had declared victory over COVID-19, and which boasted of being the ‘world’s pharmacy,’ a global producer of vaccines and a model for other developing nations.

Caught off-guard by the latest deadly spike, the federal government has asked industrialists to increase the production of oxygen and other life-saving drugs in short supply. But health experts say India had an entire year to prepare for the inevitable – and it didn’t.

Dr. Krutika Kuppalli, assistant professor of medicine in the division of infectious diseases at the Medical University of South Carolina, said the Indian government has been ‘very reactive to this situation rather than being proactive.’

She said the government should have used the last year, when the virus was more under control, to develop plans to address a surge and ‘stockpiled medications and developed public-private partnerships to help with manufacturing essential resources in the event of a situation like this.’

‘Most importantly, they should have looked at what was going on in other parts of the world and understood that it was a matter of time before they would be in a similar situation,’ Kuppalli said.

Kuppalli called the government’s premature declarations of victory over the pandemic a ‘false narrative,’ which encouraged people to relax health measures when they should have continued strict adherence to physical distancing, wearing masks and avoiding large crowds.

Prime Minister Narendra Modi is facing mounting criticism for allowing Hindu festivals and attending mammoth election rallies that experts suspect accelerated the spread of infections.

His Hindu nationalist government is trying to quell critical voices.

On Saturday, Twitter complied with the government’s request and prevented people in India from viewing more than 50 tweets that appeared to criticize the administration’s handling of the pandemic. The targeted posts include tweets from opposition ministers critical of Modi, journalists and ordinary Indians.

A Twitter spokesperson said it had powers to ‘withhold access to the content in India only’ if the company determined the content to be ‘illegal in a particular jurisdiction.’

The company said it had responded to an order by the government and notified people whose tweets were withheld.

India’s Information Technology ministry did not respond to a request for comment. 

A man performs the last rites of his relative as pyres of Covid-19 deceased people burn at a crematorium in New Delhi

A man performs the last rites of his relative as pyres of Covid-19 deceased people burn at a crematorium in New Delhi

A man performs the last rites of his relative as pyres of Covid-19 deceased people burn at a crematorium in New Delhi

With crematoriums overflowing in the country, families have been forced to burn their relatives on wooden pyres instead

With crematoriums overflowing in the country, families have been forced to burn their relatives on wooden pyres instead

 With crematoriums overflowing in the country, families have been forced to burn their relatives on wooden pyres instead

Dr. Anant Bhan, a bioethics and global health expert, has been critical of the government’s handling of the crisis, and has said that the significance of the new variant has been over-played.

‘It’s not the virus variants and mutations which are a key cause of the current rise in infections,’ he said. ‘It’s the variants of ineptitude and abdication of public health thinking by our decision makers.’      

The surge has also been fuelled by a ‘double mutant’ variant, thought to be more infectious, but Dr Jameel believes ‘too much’ has been made of the mutation.

Instead, he claims the spiralling infection rates were impacted by the lack of messaging for people to take vaccinations in January and February when case numbers were down.

He added: ‘In all the euphoria, in all the patting of our backs that we have done so well, we are out of it, we weren’t. We were just as susceptible as anybody else.

‘So if there is a lesson here to be learned, it’s that you have to be on your guard. You have to prepare. We should have been stocking up on oxygen. 

Relatives wearing PPE kit mourning next to pyres of people who have died from Covid-19 at a crematorium in New Delhi

Relatives wearing PPE kit mourning next to pyres of people who have died from Covid-19 at a crematorium in New Delhi

Relatives wearing PPE kit mourning next to pyres of people who have died from Covid-19 at a crematorium in New Delhi

Burning pyres of Covid-19 victims at a crematorium in New Delhi, April 24

Burning pyres of Covid-19 victims at a crematorium in New Delhi, April 24

Burning pyres of Covid-19 victims at a crematorium in New Delhi, April 24

‘We should have been messaging clearly for people to take vaccines in the months of January and February when the cases were down. If that happened at scale at that time, then we wouldn’t be facing this situation today. 

‘So many things have gone wrong but instead of crying over spilled milk I think it’s important to learn some lessons, get some good data, and plan for the future because this is not the end of it.” 

Last week, the Supreme Court told the Indian government to produce a national plan for the supply of oxygen and essential drugs for the treatment of coronavirus patients.

Ministers said today they would exempt vaccines, oxygen and other oxygen-related equipment from customs duty for three months, in a bid to boost availability.

In addition, Modi’s emergency assistance fund, dubbed PM CARES, in January allocated some £19million ($27million) to set up 162 oxygen generation plants inside public health facilities in the country.

But three months on, only 33 have been created, according to the federal Health Ministry.

Burning pyres of Covid-19 victims at a crematorium in New Delhi, April 24

Burning pyres of Covid-19 victims at a crematorium in New Delhi, April 24

Burning pyres of Covid-19 victims at a crematorium in New Delhi, April 24

India's surging Covid second wave has so overwhelmed crematoriums that grieving families are being forced to burn victims in their own gardens. Pictured: A crematorium in Delhi

India's surging Covid second wave has so overwhelmed crematoriums that grieving families are being forced to burn victims in their own gardens. Pictured: A crematorium in Delhi

India’s surging Covid second wave has so overwhelmed crematoriums that grieving families are being forced to burn victims in their own gardens. Pictured: A crematorium in Delhi

Despite this, the Defense Ministry is set to fly 23 mobile oxygen generating plants into India from Germany within a week to be deployed at army-run hospitals catering to Covid-19 patients. 

Each plant will be able to produce 2,400 litres of oxygen per hour, a government statement said yesterday. 

The latest comes as Boris Johnson pledged to support India in its battle against the devastating Covid surge which has brought the country to its knees. 

The UK is ‘looking at what we can do to help’ after India reported a record-breaking number of new cases in a single day for four days in a row.

Mr Johnson said: ‘We’re looking at what we can do to help and support the people of India, possibly with ventilators. 

‘Thanks to the ventilator challenge, the huge efforts of British manufacturers, we’re better able now to deliver ventilators to other countries. 

‘But also possibly with therapeutics, dexamethasone, other things, we’ll look at what we can do to help.’ 

In Delhi, 348 deaths were recorded on Friday, one every four minutes, and in the southern state of Karnataka, the government has been forced to allow families to cremate or bury victims in their own farms, land or gardens

In Delhi, 348 deaths were recorded on Friday, one every four minutes, and in the southern state of Karnataka, the government has been forced to allow families to cremate or bury victims in their own farms, land or gardens

In Delhi, 348 deaths were recorded on Friday, one every four minutes, and in the southern state of Karnataka, the government has been forced to allow families to cremate or bury victims in their own farms, land or gardens

India, with a population of 1.3 billion, has a tally of 17.31 million infections and 195,123 deaths, after 2,812 deaths overnight, health ministry data showed, although health experts say the death count is probably far higher

India, with a population of 1.3 billion, has a tally of 17.31 million infections and 195,123 deaths, after 2,812 deaths overnight, health ministry data showed, although health experts say the death count is probably far higher

India, with a population of 1.3 billion, has a tally of 17.31 million infections and 195,123 deaths, after 2,812 deaths overnight, health ministry data showed, although health experts say the death count is probably far higher

Meanwhile, U.S. President Joe Biden said the United States was ‘determined to help India in its time of need,’ immediately making available supplies of vaccine-production material, therapeutics, tests, ventilators and protective equipment. 

So far 132 cases of the Indian variant have been detected in Britain, around half of which are in London. 

The variant contains two mutations in the virus’s spike protein, which could help it spread more easily and evade vaccines. 

India was added to the UK’s travel ‘red list’ yesterday, prompting a last-minute scramble for flights to Heathrow.

The British Prime Minister had also cancelled a trip to New Delhi over the weekend where he had hoped to secure millions of vaccine doses.

Government scientists said border measures are not enough to prevent the spread of new variants, but they can delay it. 

One senior source said there were likely to be ‘many more’ cases of the Indian variant in the UK than the 132 detected so far.

They added: ‘It does look like it’s more transmissible but we don’t know if it is more transmissible than the Kent variant and we don’t have any data on vaccine efficacy.’ 

WHAT DO WE KNOW ABOUT THE INDIA VARIANT? 

Real name: B.1.617

When and where was it discovered? The variant was first reported as being of concern by the Indian government in late March. 

The first cases in India appear to date back to October 2020 and it was first detected in Britain in February, 2021. 

It had been detected in 21 countries as of April 19, according to Public Health England’s Sharon Peacock.

How many people in the UK have been infected with it? Matt Hancock revealed there had been 103 cases so far.

But Public Health England’s latest report, published on April 15, says 77. These were detected in England and Scotland.

What mutations does it have? It has 13 mutations that separate it from the original Covid virus that emerged in China – but the two main ones are named E484Q and L452R.

Scientists suspect these two alterations can help it to transmit faster and to get past immune cells made in response to older variants. 

Is it more infectious and can it evade vaccines? 

The L452R mutation is also found on the Californian variant (B.1.429), discovered in December, even though the two evolved independently.

L452R is believed to make the American strain about 20 per cent more infectious. 

The Indian variant’s E484Q mutation is very similar to the one found in the South African and Brazil variants known as E484K, which can help the virus evade antibodies.

The South African variant is thought to make vaccines about 30 per cent less effective at stopping infections, but it’s not clear what effect it has on severe illness.  

Professor Peacock said there was ‘limited’ evidence of E484Q’s effect on immunity and vaccines. 

Lab studies have suggested it may be able to escape some antibodies, but to what degree remains uncertain.

Should we be worried?

Scientists are unsure how transmissible or vaccine-resistant the Indian variant is because the E484Q mutation is new and not well understood.

The fact it appears to have increased infectivity should not pose an immediate threat to the UK’s situation, because the current dominant Kent version appears equally or more transmissible. 

It will take a variant far more infectious strain than that to knock it off the top spot.

However, if the Indian version proves to be effective at slipping past vaccine-gained immunity, then its prevalence could rise in Britain as the immunisation programme squashes the Kent variant. 

The UK currently classes the Indian strain as a ‘Variant Under Investigation’, a tier below the Kent, South African and Brazilian variants. 

Experts studying Britain’s Covid variants said the Indian variant was unlikely to ever take off in the UK because its mutations were ‘not top tier’.

Dr Jeffrey Barrett, director of the Covid-19 Genomics Initiative at the Wellcome Sanger Institute, said it’s still not clear if India’s third wave has been caused by the new variant, or if it emerged at the same time by coincidence. 

His comments have been echoed by PHE’s Professor Peacock, who said today: ”It is not clear at the present time whether B.1.617 is the main driver for the current wave.

‘The question is whether this is associated with the variant, with human behaviour (for example, the presence of large gatherings, and/or lack of preventive measures including hand washing, wearing masks and social distancing) or whether both are contributing.’

How deadly is it?

Again, scientists still don’t know for sure – but they are fairly certain it won’t be more deadly than the current variants in circulation in Britain.  

This is because there is no evolutionary benefit to Covid becoming more deadly. 

The virus’s sole goal is to spread as much as it can, so it needs people to be alive and interacting with others for as long as possible to achieve this. 

And, if other variants are anything to go by, the Indian strain should not be more lethal.

There is still no evidence to show dominant versions like the Kent and South African variants are more deadly than the original Covid strain – even though they are highly transmissible.  

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