Rapid glut of cases stretches supplies of beds in intensive care units, ventilators and oxygen

Health workers join their shift to attend to Covid patients at a centre in Mumbai, India.
Health workers join their shift to attend to Covid-19 patients at a centre in Mumbai, India. Photograph: Divyakant Solanki/EPA
India has reported 314,835 new coronavirus cases in the last 24 hours – the highest one-day tally recorded anywhere in the world. Deaths rose by 2,104 in the same time period, India’s worst daily toll.

Guardian (UK) Hundreds of Indians, including Delhi government administrators, have begged for help finding oxygen and other crucial medical supplies on social media as India reels from a devastating second wave of coronavirus, leading to caseloads growing by nearly 300,000 every day.

Faulty oxygen supplies at a western Indian hospital have killed more than 20 Covid-19 patients, adding to the country’s highest-ever daily death toll from the virus.

The Indian prime minister, Narendra Modi, who has been fiercely criticised for continuing to hold large election rallies throughout last week as the scale of the outbreak was becoming clear, said the virus was hitting the country “like a storm”. Hospitals are overwhelmed, many migrant workers are leaving cities and people are turning to social media for help finding medical attention, hospital beds and drugs.

The rapid rise in cases – including a record 295,000 on Tuesday, close to the largest number recorded on a single day anywhere since the pandemic emerged – has stretched supplies of beds in intensive care units, ventilators and oxygen. There was shock across the capital, Delhi, on Tuesday night when the city’s chief minister warned on Twitter that oxygen supplies in the city’s hospitals could run out within eight hours in public hospitals and sooner in some private facilities.

Adding to the sense of crisis, at least 22 patients died in a hospital in western India on Wednesday after a leak interrupted its oxygen supply, the Maharashtra state health minister said. The incident in the city of Nashik, one of India’s worst-hit areas, happened after the tank of gas leaked, said Rajesh Tope, the minister.

“Patients who were on ventilators at the hospital in Nashik have died,” he said in televised remarks. “The leakage was spotted at the tank supplying oxygen to these patients. The interrupted supply could be linked to the deaths of the patients in the hospital.”

Indian hospital staff fix the leak in their oxygen plant after a leak killed 22 Covid-19 patients in Nashik, India.

 

Indian hospital staff fix an oxygen plant after a leak killed 22 Covid-19 patients in Nashik, India. Photograph: Anadolu Agency/Getty

With medical infrastructure overwhelmed even in large cities, residents have been forced to use their own networks to find medical assistance and equipment. Seema Choudhury, an English tutor in a south Delhi neighbourhood, put out a plea for help on WhatsApp when she discovered her neighbours, a couple in their 70s with Covid-19, were becoming iller.

“Urgent help needed. The Guptas are in pretty bad shape. They need oxygen but can’t find any. Please help,” she wrote to a neighbourhood group. By the evening, the couple had managed to source oxygen tanks marked up to twice their ordinary price.

Such assistance was harder to get in smaller cities such as Lucknow in northern India, where Anil Tiwari said he spent Monday trying to find medical assistance for his father, Ranjan, whose Covid-19 symptoms had worsened in their 10th day.

Tiwari said he had tried 10 hospitals without finding a free bed. When he did find room at a smaller medical facility, he was told on Tuesday that supplies were running low and his father – whose oxygen levels were dipping – needed to be moved to another hospital.

“Some friends, God knows how, managed to get a small oxygen cylinder and I drove around with Papa in the back seat attached to the cylinder hoping to get a bed,” Tiwari said. “His anxiety level was high. I kept reassuring him, giving him hope. But he died in the car.”

He said his blamed his father’s death not on Covid but, “a failure of the system, of the leadership, to create medical infrastructure for which I pay taxes”.

Testing infrastructure has also been overwhelmed by the wave, which is combined with bureaucratic hurdles to prevent many from being admitted to hospital. “When I tested positive on Saturday, I wanted my parents to get tested too, but the lab told me not to come until Friday as it had a huge backlog,” said Swati Arora, 28, in Delhi.

Oxygen leak kills 22 in Indian hospital as Covid crisis worsens

Without a positive test result, many hospitals are refusing to admit patients, and some are dying in the interim as they await proof they have the disease. “With this delay in testing, we are getting patients who have deteriorated while waiting and when they reach us in this condition, we can’t save them,” said a doctor in Delhi who asked not to be named.

Experts have speculated the resurgence of cases over the past eight weeks may be the result of highly infectious variants that have taken advantage of the resumption of normal life in most of India in recent months as cases sharply declined. Modi and other political leaders have held mass rallies in West Bengal, where elections are being fought, while the Kumbh Mela religious festival attracted more than 10 million adherents to the northern city of Haridwar this month.

Supporters of India’s ruling Bharatiya Janata party (BJP) take part in a mass election rally in Kolkata, India, in early April.
Supporters of India’s ruling Bharatiya Janata party (BJP) take part in a mass election rally in Kolkata, India, in early April. Photograph: Bikas Das/AP

The latest daily death toll of 2,023 people on Tuesday suggests the virus is still significantly less deadly among India’s young population than it has been elsewhere in the world, although official statistics are thought to be highly unreliable and sometimes deliberately undercounted.

“The best way to figure out [the death toll] is to see the jump in use of crematoria and graveyards,” said Dr Shahid Jameel, a virologist and director of the Trivedi school of biosciences at Ashoka University. “There are reports that crematoria that would take 10 to 20 bodies a day are now piling up about 100 a day.”

The central government said on Monday it would lift age restrictions on Covid-19 vaccines to anyone over 18 from 1 May, although supplies are already thought to be under pressure and it is unclear whether the vaccination rate could exceed 3m a day, one of the fastest rates in the world but short of what is required to rapidly inoculate an adult population of about 900 million people.

Underscoring the fact that India will not be able to vaccinate its way out of the crisis in the medium term, the country’s largest vaccine manufacturer, the Serum Institute of India, said on Wednesday it would not be able to increase its production rate to 100m until July, later than its earlier estimate of the end of May. It currently produces between 60m and 70m doses a month.

Despite the soaring infections, Indian leaders are reluctant to reimpose widespread lockdowns of the kind that led to an exodus of migrant workers from cities last year, the largest mass migration in the country since partition in 1947.

Modi has instead advised state leaders to try to quarantine neighbourhoods and villages where infections are most acute, though bus and railway stations have been packed over the past week with people fearing they might again be forced to stop going to work and be stranded in cities without salaries.

==================================================

India to Sell Astra Zenica Vaccine to Governments, Private Hospitals

NEW DELHI (Reuters) – The Serum Institute of India said on Wednesday it would sell the AstraZeneca vaccine to the country’s state governments at 400 rupees ($5.30) per dose and to private hospitals at 600 rupees ($7.95).

“Furthermore, owing to the complexity, and urgency of the situation it is challenging to supply it independently to each corporate entity,” it said in a statement. “We would urge all corporate and private individuals to access the vaccines through the state facilitated machinery and private health systems.”

==============================================

US: Vaccination slowdown could threaten recovery

The Hill- The slowdown in the daily pace of COVID-19 vaccinations has sparked concerns from health experts that it could slow the U.S. recovery from the pandemic.

As the Biden administration touted the accomplishment of administering 200 million vaccine doses, doubling the president’s goal of 100 million vaccines administered in his first 100 days in office, the country has seen a drop in the seven-day average of daily vaccinations following weeks of steady upticks.

The U.S. hit a peak in early April of getting 4.63 million COVID-19 vaccines into arms in a single day before Tuesday saw a total of 1.81 million doses administered, according to Our World in Data.

Overall, the seven-day average reached a highpoint of 3.38 million vaccines per day last week before it declined to 3.02 million on Tuesday.

Public health experts warn this deceleration of vaccine administration could jeopardize the country’s ability to get the virus under control as variants spread worldwide. It could also signal a decrease in demand due to lack of access or public hesitancy.

Administration officials attempted to alleviate concerns about the slowed rate of vaccinations, pointing to the increased availability of and confidence in vaccines amid efforts to encourage more people to get their shots.

When asked about the vaccination rate slowing compared to previous weeks, White House press secretary Jen Psaki said the administration is trying to address “barriers” that stop people from getting vaccinated, such as the administration’s plan to offer a tax credit to employers who offer paid time off for workers to get and recover from the vaccine.

“We will …  get to a point where we have greater supply than we have demand is because – only in some regions of the country, I should say, as you know, not everywhere – is because we work quickly to increase supply and provide thousands of easy and convenient locations for people to get vaccinated,” she said.

Centers for Disease Control and Prevention (CDC) data indicates there are more than 60 million unused vaccines that have been delivered but not yet administered. As of Monday, all Americans 16 and older are qualified to get the vaccine, meaning eligibility soon will not be a factor in the vaccination rate.

On a call with reporters, an administration official downplayed the notion of hesitancy, instead saying it’s not easy to “pinpoint and generalize” whether supply has outpaced demand across the entire country, opting instead to call it a “spectrum.”

“We don’t think that we’re talking about a group of people that are quote unquote vaccine hesitant,” the official said. “We think we are now approaching groups of people who are – just by the fact that they’re younger, they are less at risk, and therefore, the urgency might be a little bit lower.”

“It doesn’t mean that they’re hesitant to get the vaccine,” they said. “It just means it needs to be more convenient for them.”

Polls measuring vaccine hesitancy have consistently shown greater reluctance among Republicans rather than just a certain age group. A recent Quinnipiac University poll found 45 percent of Republicans said they don’t plan to get the shot, and a Monmouth University poll determined that 43 percent of Republicans “likely will never” get the vaccine.

The Biden administration has attempted to combat hesitancy through advertising campaigns as well as the COVID-19 Community Corps, which recruits a network of community leaders, including faith leaders, to promote vaccinations.

The president, during a speech on Wednesday celebrating celebrated surpassing his vaccine goal. Biden compared the vaccination rate to that of his predecessor, saying it would have taken seven months to reach a rate of 200 million doses at the pace the former Trump administration was going.

Biden labeled the accomplishment “great progress” but issued a warning about continuing COVID-19 precautions and restrictions in the coming months.

“If we let up now and stop being vigilant, this virus will erase the progress we’ve already achieved, the sacrifices we’ve made, the lives have been put on hold, the loved ones who have been taken from us, time we’re never going to get back, to celebrate our independence from this virus on July 4 with family and friends in small groups,” Biden said.

When asked if the U.S. had reached the point where less demand for vaccines is the “biggest challenge” instead of ramping up supply, Biden responded, “Not yet.”

The drop-off in vaccinations has also occurred in the days after the CDC and the Food and Drug Administration (FDA) recommended a pause for the Johnson & Johnson vaccine after reporting six rare cases of blood clots.

Officials emphasized last week that the temporary halt of the Johnson & Johnson vaccine should not impact the vaccination rollout across the country as the Pfizer-BioNTech and Moderna vaccines have made up the majority of doses given out.

Tara Kirk Sell, a senior scholar at the Johns Hopkins Center for Health Security, said it’s “unclear” whether the dip in vaccinations is an “aberration” but could be occurring partly due to the effects of the Johnson & Johnson pause.

“There may be a combination of vaccine hesitancy across the board from that, or probably more likely, there were a bunch of clinics scheduled with the J&J vaccine,” she said. “Those have to shift to using Pfizer and Moderna, and so there needs to be sort of a planning and logistical process to set up that switch.”

Health experts expressed concerns last week that the pause in the use of Johnson & Johnson vaccines could spark more hesitancy across the U.S. But polls released this week indicated that the pause wouldn’t affect most people’s willingness to get their shot.

Josh Michaud, the associate director for global health policy at the Kaiser Family Foundation, called the overall downward trend “concerning if not entirely surprising,” warning that places with less “vaccination coverage” could be at risk to face additional variants of COVID-19 that could be more transmissible or severe.

“If adults can’t be vaccinated at high levels then we might fall short of the level of population immunity that we need to really tamp down outbreaks and might play out as sort of the patchwork of immunity across the country,” he said.

==============================================