Out of Oxygen

Skye Arundhati Thomas

A man in New Delhi rolls an oxygen cylinder after waiting more than eight hours for it to be refilled. Photograph © Ishan Tankha

A tanker carrying medical oxygen from the eastern Indian state of Jharkhand to central Madhya Pradhesh was halted after it crossed the border into Uttar Pradesh on 25 April. India registered more than 350,000 new Covid-19 cases that day. The vehicle was on a tight deadline; patients on ventilators were urgently awaiting its arrival. The driver alleges that police commandeered the tanker at Varanasi and took it further off course into the state, to Jhansi. When the oxygen did not arrive at Sagar as scheduled, state chief ministers got involved. The UP government reluctantly parted with the tanker, but has since denied the incident ever took place. As India is overwhelmed by a second wave of the virus, the country has run out of oxygen.

The state government of Haryana has accused the city of New Delhi of ‘looting’ its oxygen: a tanker passing through Delhi was allegedly stopped by a team of policemen who filled a waiting set of cylinders. In other states, desperate family members, friends and even patients have seized cylinders from vans, hospitals and storage units. Tankers are being retrofitted with GPS tracking systems. Oxygen now travels with police convoys. But it can be lost even if it reaches a hospital: in Nashik, Maharashtra, a tanker replenishing hospital cylinders began to leak gas into the air. The fire department was called, but in the thirty minutes it took to identify and fix the fault, the oxygen supply to the hospital was suspended and twenty-four patients died.

According to a recent report in the Ken, during the first wave of the pandemic last year India needed about seven hundred tonnes of liquid oxygen per day. Demand is currently at eight thousand tonnes, and rising. Indian gas production plants are geared towards making oxygen primarily for manufacturing purposes: mining; the processing of iron and steel; the making of smartphones. While companies are trying to divert the supply to medical institutions, they don’t have the infrastructure to distribute it outside their existing networks. Oxygen travels by road from the industry-heavy east of the country to the west. The gas is a severe fire hazard and cannot easily be airlifted. Covid patients with low oxygen saturation levels may require twenty to sixty litres of oxygen a minute, and are dying because of the smallest stoppages in supply.

Understandably, the black market is thriving. Social media are full of requests for verified oxygen vendors, who evaluate the price of renting cylinders or providing refills based on demand. Volunteers across the country are verifying sources, or setting up alternate infrastructure. A striking set of images by the reporter Danish Siddiqui shows the parking lot of a Gurdwara in Indirapuram, Ghaziabad, packed with vehicles whose occupants are hooked up to oxygen tanks as relatives and friends monitor their stats or try to keep them cool in the relentless heat.

According to the Ken, many health insurance companies are authorising only a thousand rupees a day for oxygen. The cost of a fresh cylinder, especially if sourced through informal networks, easily reaches twenty times that. A single refill is two thousand rupees. Patients often need four refills a day. In hospital corridors and waiting rooms, groups of patients huddle together on stretchers, attached to the same oxygen cylinder. But thousands are unable to access healthcare because of the expense; several private clinics and hospitals are asking patients to pay deposits in advance of admission. The mass privatisation of the Indian healthcare system that has taken place over the last few decades is not only costing lives: it is actively segregating the population and offering care only to patients who can afford to buy in.

‘Need Oxygen cylinder, ASAP,’ Shashank Yadav, a young man from UP tweeted on 26 April, tagging a Bollywood actor to help amplify the post. State police tracked his phone and hauled him in for questioning. He was charged under the Epidemic Act for spreading rumours with the intent to create fear. His 88-year-old grandfather died the same day of cardiac arrest. The state argues that Yadav’s grandfather did not have Covid, which does not change the fact that it scapegoated him. The message sent by his arrest was clear: keep your grief private, especially if it pertains to the failure of state infrastructure.

The already fragile welfare state has collapsed. Parks are being converted into crematoriums, crematoriums have run out of firewood, pharmacies no longer have sufficient supplies even of paracetamol, there are weeks-long waiting lists at metropolitan test centres. The peak is yet to arrive. According to data scientists at the Indian Institute of Technology, mid-May could see a surge of up to 480,000 new registered cases a day. Not only does the Modi government actively deny the oxygen shortage, it has squashed high court orders calling for restrictions, containment zones or lockdowns. The Supreme Court has taken suo moto cognisance to centralise Covid policy under its aegis, effectively disabling the autonomy of state judicial authorities. The central government does not seem to have learned from last year’s crisis: expert advice on long-term infrastructure and planning to prepare for new strains of the virus, or even to anticipate a second wave, was ignored. A national Covid-19 taskforce, designed to advise the central government, didn’t convene in February or March. Treatment protocol has not been updated since July 2020.

New variants of concern have been detected; one of them may be responsible for the deaths of a significant number of younger people in Maharashtra. There are more paediatric cases, for which there is no official procedure. The Caravan lays out a rough chronology: on 1 February more than 11,000 new cases were recorded across the nation; by 1 April the number was up to 72,330; in four days, on 5 April, it had crossed 100,000 new cases; on 21 April it reached 295,041. The exponential rise was disregarded, while election rallies and Hindu festivals continued at full throttle. In January, at the World Economic Forum, Modi declared, with a flourish, that India had ‘saved humanity from a big disaster by containing corona effectively’. At the Kumbh Mela festival in Haridwar, millions of Hindu pilgrims took a collective dip in the Ganges. Posters for the event – full page ads in newspapers across the country – proclaimed it was ‘beautiful, clean, safe’. Congregating in large numbers was actively encouraged. The central government, and those in charge of privatised healthcare, are directly responsible for the loss of thousands of lives in the last two weeks alone.

The Modi government has pursued a programme of ‘vaccine diplomacy’, sending millions of doses to its neighbours and to countries in Africa. The Serum Institute of India is the world’s largest vaccine manufacturer, but Modi delayed the purchase of doses for Indians, buying only 11 million for frontline workers in January. Vaccines will now be sold at private hospitals at marked-up prices and have not yet been made available to the general public. Raw materials to produce the vaccine have also run out, but the United States government has now hesitantly agreed to send them, after acquiescing to global pressure.

Civil society has stepped into the vacuum left by the government. A group of volunteers calling themselves Mutual Aid India regularly update a list of individual and organisational fundraisers. They are collecting money to provide basic healthcare equipment and supplies to public hospitals and nursing homes; grocery boxes for daily wage labourers and financial support for those who have lost their income because of lockdown restrictions; food parcels for Dalit sanitation workers and waste pickers, the otherwise unnamed frontline workers of the pandemic. There are individual calls for urgent relief: a woman with lupus who has tested positive for Covid and can’t afford the hospital deposit; a single father on a ventilator that costs 150,000 rupees a day. For families whose sole earners have died of Covid complications; for sex workers and their children; for the trans community, which is facing increasing violence, isolation and loss of livelihood.

Relatives and crematorium staff bring a deceased Covid victim into the Ghazipur crematorium parking lot. Photograph © Ishan Tankha