Medics fear Covid-19 infections in India could climb to 500,000 per day before the virus-stricken nation reaches the peak of its second wave – as those who delay oxygen deliveries to New Delhi are threatened with the death penalty.
Another 2,263 deaths and 332,730 cases were reported in India yesterday, although limited testing means this is likely to significantly underestimate the total.
The infection total marked the highest one-day tally of any nation since the start of the pandemic – the second time in as many days India has broken the record.
However, leading virologist Shahid Jameel today warned that India has still yet to hit the peak of its second wave, with studies suggesting it may record 500,000 cases per day in the first week of May.
He told Radio 4: ‘People who do modelling studies do suggest that India will hit a peak somewhere towards the end of the first week of May, and we may climb up to about 500,000 cases per day, possibly more.’
India’s current fatality rate per 100,000 cases is 1.14 per cent, meaning if the nation reaches this anticipated peak there is the potential for 5,700 deaths per day.
Hospitals across India are buckling under the strain of a ferocious second wave, with some running out of oxygen and turning away patients due to overcrowding.
Harrowing images from a makeshift crematorium in New Delhi today illustrated the extent of the growing pandemic in India, with Sky News correspondent Alex Crawford describing the situation as the ‘tip of an iceberg’ to a larger crisis which may follow.
The crematorium was set up outside a hospital in the capital by people who ‘cannot cope’ with the number of dead, instead being forced to say goodbye to their loved ones at an ad hoc funeral pyre site.
As she spoke, men pulled firewood through into the site, with Ms Crawford explaining the dead had been arriving at the crematorium ‘virtually every second’ amid what she described as a ‘slightly chaotic’ vaccine roll-out.
The High Court in New Delhi, which is home to some 30million people, today met to impose a strict ruling that if anyone is found to be restricting oxygen supplies to hospitals they ‘will be hanged’.
Burning funeral pyres of Covid-19 victims are seen at a crematorium in India on Friday
Health workers carry bodies of people who were suffering from the coronavirus disease (COVID-19), outside the Guru Teg Bahadur hospital, in New Delhi, today
Hospitals across India are buckling under the strain of a ferocious second wave, with some running out of oxygen and turning away patients due to overcrowding. Pictured: New Delhi today
India’s current fatality rate per 100,000 cases is 1.14 per cent, meaning if the nation reaches this anticipated peak there is the potential for 5,700 deaths per day
Delhi Chief Arvind Kejriwal had complained that desperately needed supplies were being obstructed on state borders before entering New Delhi, crucially delaying delivery to hospitals.
Several medics have appealed for help on social media in recent days as the shortage worsened, with Max Healthcare and Fortis Hospital at one point both warning they could run out of supplies within an hour.
Yesterday morning, Ganga Ram hospital in Delhi said it only had oxygen for ‘another two hours’ despite treating some 500 Covid-19 patients.
Special train services began transporting tanks of oxygen to the worst affected areas yesterday in an attempt to relieve the crisis. In some areas, the shortages are so severe that armed police have been deployed to guard supplies from desperate families.
Delhi needs at least 480 metric tonnes of oxygen to affectively treat its Covid-19 patients, the Hindustan Times. On Friday, the capital received only 297 metric tonnes of the medical gas.
Dr Jameel, who is the director of the Trivedi School of Biosciences at Ashoka University, said the nation of around 1.4 billion people needs to contain the surge by ‘treating as many people as possible at home.’
He added the government needs to do ‘everything possible’ to speed up the supply of oxygen and medicine to those in need, revealing the harrowing plight of families desperately searching for supplies.
People have been begging for oxygen or medical help on social media, and crowds have gathered outside hospitals, with some dying on stretchers as they wait.
On Wednesday, 22 patients died at a hospital in Maharashtra when their oxygen supply ran out after a leak in the tank. Yesterday 13 Covid patients died when a fire broke out at a Mumbai hospital.
‘My family has gone through a harrowing experience in the past week, we had a cousin into hospital who passed away two days back and every 24 hours there was a threat of cut-off of oxygen,’ Dr Jameel said.
A family member of a Covid-19 victim is seen carrying an oxygen cylinder in West Bengal
Desperate families wait at an oxygen refilling shop in India as they attempt to secure supplies
Medics carry Covid patients outside the ICU at Guru Teg Bahadur hospital, in New Delhi, India
A health worker takes a nasal swab sample to test for Covid-19 in Jammu, India, today
Daily infections hit 332,730 on Friday, up from 314,835 the previous day when India set a new record, surpassing one set by the United States in January of 297,430 new cases
The daily death toll also jumped to a record 2,263 yesterday, though these fatalities could be at least ten times under-reported amid a second wave more than three times the size of the first
‘In the end he didn’t make it, but the mental torture of relatives searching for oxygen was just unbearable. Unfortunately the situation is very bad, we let down our guard and that’s why we’re in this situation.’
India is recording one in three of all worldwide Covid-19 cases, despite its Prime Minister Narendra Modi saying in February that the nation was ‘inspiring the world’ with its Covid fight.
Pictured: Dr Shahid Jameel, the director of the Trivedi School of Biosciences at Ashoka University
Ministers had declared a victory when there were around 11,000 cases a day.
The surge has been fuelled by a ‘double mutant’ variant, thought to be more infectious, but Dr Jameel says ‘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.
‘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.’’
The percentage change in daily Covid infections by Indian state today compared to at their peak, most of which were recorded last year
Funeral pyres of victims of Covid-19 burn at a ground that has been converted into a crematorium for mass cremation in New Delhi, India, today
Workers check medical oxygen cylinders to be transported to hospitals amid the Covid-19 pandemic at a facility on the outskirts of Chennai today
A man carries an oxygen canister to his car in West Bengal, India, amid the crisis today
The latest warning comes as Boris Johnson last night 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 recorded a record-breaking 332,000 new cases in a single day.
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.’
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 Prime Minister has also cancelled a trip to New Delhi this weekend where he had hoped to secure millions of vaccine doses.
People wait to receive the Covid-19 vaccine outside a vaccination centre In Mumbai, India
Men transport a Covid-19 patient on a stretcher as they leave a hospital in New Delhi today
Health workers are seen outside the casualty ward at Guru Teg Bahadur Hospital, in New Delhi
Yesterday 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.’
Families and medics have made desperate pleas for supplies on social media as the nation struggles to keep up with demand for oxygen inside its hospitals.
Dr Atul Gogia, who works at a hospital in New Delhi, said: ‘We do have oxygen but it’s now on a day-to-day basis. We got some oxygen last night, so we have some oxygen now.’
People wearing personal protective equipment console the relative of a person who died due to the coronavirus disease
He told Radio 4: ‘We do not have enough oxygen points, patients are coming in with their own oxygen, others without, we want to help them but there are not enough beds or oxygen points, and not enough oxygen to supply them.’
Max Healthcare, which runs hospitals in northern and western India, appealed on Twitter yesterday for oxygen.
‘We regret to inform that we are suspending any new patient admissions in all our hospitals in Delhi until oxygen supplies stabilise,’ it said.
The government has started shuttling trains containing tanks of oxygen across the country to hotspots.
Crematoriums are also overwhelmed, with one in Delhi resorting to building pyres, on which bodies are burnt, in its car park.
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.
Dying Covid sufferers lie on stretchers outside Indian hospitals while other medical centres stop accepting patients as the country sees ANOTHER record number of infections and deaths
Dying coronavirus patients have been left to lie on stretchers outside Indian hospitals as doctors were today forced to turn patients away amid another record-breaking rise in cases and deaths.
Daily infections hit 332,730, up from 314,835 on Thursday when India surpassed a grim record set by the United States in January.
Another 2,263 deaths were reported – though the true figure is believed to be up to ten times higher.
Delhi recorded more than 26,000 new cases and 306 deaths, or about one fatality every five minutes, the fastest since the pandemic began.
Doctors in the city of 29 million have no more beds left and police have been deployed around hospitals to prevent oxygen from being looted as infections stand at more than treble their peak last year.
Sky News captured images of dozens of people lying on stretchers outside one overcrowded hospital in the capital. In the minutes of the short live report, at least three dead bodies were seen being wheeled out of the front doors of the medical centre.
Patients lie on stretchers outside a hospital in Delhi during a live TV broadcast. Sky TV said during its report that they saw dozens of dead bodies being wheeled out of the hospital while they were there, while others wait with oxygen tanks rigged up beside outdoor stretchers for those who are unable to get inside
People stand in a queue to refill oxygen in cylinders in Delhi on Friday. Police have been deployed at hospitals in the city to prevent oxygen from being looted as people are prepared to pay thousands of rupees to fill up cylinders
A patient, wearing an oxygen mask, sits outside Lok Nayak Jai Prakash Narayan Hospital, one of India’s largest facilities for coronavirus disease, in Delhi today
But while northern states like Gujurat, Rajasthan and Uttar Pradesh are experiencing coronavirus infection rates which are more than quadruple what they were in the first wave, others to the south, like Andrha Pradesh, and in the far northeast, like Assam, have not yet experienced a second wave and aren’t under lockdown rules.
This suggests that though the overall numbers for India are colossal, they could still climb higher, putting further strain on the country’s overwhelmed healthcare system which is running short of basic anti-viral medications.
Britain banned travel from India today amid fears that a new variant is causing the virus to spread faster and hitting young people harder.
Prof James Naismith, of the University of Oxford, told MailOnline: ‘What is happening in India is stark illustration of the havoc that rapid spread of the virus does; healthcare overwhelmed and vulnerable people suffocating to death in ambulances waiting for help.
‘This might be an appropriate point for those who so blithely advocated ending the UK lockdown in the autumn and winter to reconsider their analysis.
Relatives carry the body of a man who died from coronavirus during his funeral in Delhi on Friday
Bodies of Covid victims are burned in funeral pyres at a cremation ground in Mumbai on Friday
A fire in a hospital in Virar, on the outskirts of Mumbai treating Covid 19 patients killed 13 people on Friday, the latest accident in the overcrowded health system. Prime Minister Narendra Modi called it ‘tragic,’ approving payouts for the victims’ relatives (pictured: the ICU ward of the hospital is inspected after the blaze)
‘The UK has avoided the fate that has befallen India (and many other countries who we do not see on our TV) because of the action of our governments and every one of us who wore a mask, distanced, washed our hands and isolated when sick. Vaccination now means that we will not ever see such scenes from Covid-19 here.’
It comes as a fire broke out at a packed hospital outside Mumbai on Friday, leaving 13 people dead.
Narendra Modi called it ‘tragic’ as he approved payouts for the victims’ relatives, but the PM faces growing criticism for staging election rallies despite hospitals running out of beds and oxygen tankers being escorted by armed guards.
On Wednesday, 22 patients died at a public hospital in Maharashtra state when their oxygen supply ran out after a leak in the tank. At least nine coronavirus patients died in a previous hospital fire in Mumbai on March 26.
As well as a lack of oxygen and even basic medicines, free beds have become scarce, with major hospitals putting up notices saying they have no room for any more patients and police being deployed to secure oxygen supplies.
Health workers shift a patient after a fire in Vijay Vallabh hospital in Virar, near Mumbai on Friday
Worshippers offer Friday prayers at a mosque during the Muslim holy month of Ramadan in Amritsar in Punjab, northern India
The burnt out inside of the intensive care ward at the hospital, which is just north of Mumbai, the latest accident in the country’s overwhelmed hospitals amid a colossal second wave of Covid. On Wednesday, 22 patients died at a public hospital in Maharashtra state when their oxygen supply ran out after a leak in the tank. At least nine coronavirus patients died in a hospital fire in Mumbai on March 26.
Atul Gogia, a front line doctor in Delhi, told Radio 4 this morning: ‘It’s really, really very hectic, both physically mentally emotionally, it’s a challenging day. Everything is full we are over-pressed, staff is catching the disease so we are short of staff as well.
‘We do have oxygen but it’s now on a day to day basis. We got some oxygen last night, so we have some oxygen now.
‘There is such a huge surge we do not have places in the emergency room. We do not have enough oxygen points, patients are coming in with their own oxygen, others without, we want to help them but there are not enough beds or oxygen points, and not enough oxygen to supply them even if they are were.’
Saswati Sinha, an intensive care doctor in Kolkota, said the situation in the city was similar to Delhi, though perhaps lagging around two weeks behind.
‘But we are already overwhelmed,’ he told the BBC. ‘All of our wards, all of our critical care beds are already at capacity.
‘We are getting direct calls from our patients, from our friends, from our neighbours, pleading with us to make some space for their next of kin.
‘In 20 years of working in intensive care I have never seen anything like this in the past. It is completely emotionally, physically and mentally exhausting.’
A policeman inspects a burnt-out room at the Vijay Vallabh Hospital in Virar, on the outskirts of Mumbai
The burnt out hospital in Virar, north of Mumbai, after a fire killed 13 Covid patients, in the latest accident in the country’s overcrowded hospitals
A patient suffering from the coronavirus disease is evacuated from the hospital after it caught fire in Virar, on the outskirts of Mumbai
Max Healthcare, which runs a network of hospitals in northern and western India, posted an appeal on Twitter on Friday for emergency supplies of oxygen at its facility in Delhi.
‘We regret to inform that we are suspending any new patient admissions in all our hospitals in Delhi … till oxygen supplies stabilise,’ the company said.
Similar desperate calls from hospitals and ordinary people have been posted on social media for days this week across the country.
Bhramar Mukherjee, a professor of biostatistics and epidemiology at the University of Michigan in the United States, said it was now as if there was no social safety net for Indians.
‘Everyone is fighting for their own survival and trying to protect their loved ones. This is hard to watch,’ he said.
In Delhi, people losing loved ones are turning to makeshift facilities that are undertaking mass burials and cremations because funeral services have been swamped.
A man walks past burning funeral pyres of people, who died due to the coronavirus disease at a crematorium ground in New Delhi, India, on Thursday
A mass cremation of victims who died due to the coronavirus disease is seen at a crematorium ground in Delhi yesterday evening
A body lies on a gurney as funeral pyres burn at a mass cremation ground in Delhi on Wednesday evening
Amid the despair, recriminations have begun.
Health experts say India became complacent in the winter – when new cases were running at about 10,000 a day and seemed to be under control – and lifted restrictions to allow big gatherings.
‘Indians let down their collective guard. Instead of being bombarded with messages exhorting us to be vigilant, we heard self-congratulatory declarations of victory from our leaders, now cruelly exposed as mere self-assured hubris,’ wrote Zarir F Udwadia, a pulmonologist and a member of the Maharashtra state government’s task force, in the Times of India.
Modi’s government ordered an extensive lockdown last year in the early stages of the pandemic.
But it has been wary of the economic costs and upheaval to the lives of legions of migrant workers and day labourers of a reimposition of sweeping restrictions.
New more infectious variants of the virus, in particular a ‘double mutant’ variant that originated in India, may have helped accelerate the surge, experts said.
Canada has banned flights from India, joining Britain, United Arab Emirates, Singapore and New Zealand in blocking arrivals.
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.