India at breaking point.

A lack of oxygen supplies for covid-19 patients is a national crisis as India hits record case numbers, reports Puja Changoiwala.

“OXYGEN Express” trains are rerouting supplies across India to meet a severe shortage of medical-grade oxygen, as the country's new coronavirus cases hit record peaks for six days in a row.

At Dr Zakir Hussain Hospital in Maharashtra, 24 people with covid-19 died due to disruptions in oxygen supply on 21 April. Many such deaths continue to be reported across the country.

“So many people, including my grandmother, died before my eyes,” says Vicky Jadhav, whose grandmother was at the hospital in Maharashtra. “I tried to revive her after borrowing an oxygen cylinder from a dead patient. But she did not live. I tried to do that for other patients too, but none of them survived. Many of those dead were young.”

India reported 352,991 new coronavirus cases and 2812 deaths on 25 April. As a result of the surge in cases, the demand for medical-grade oxygen to support people in intensive care has jumped by 600 per cent in recent days. Many hospitals have had to turn patients away. Family members of those who are ill have taken to social media to plead for help, and there have been reports of “looting” of oxygen cylinders as they enter hospital grounds.

“Beg, borrow or steal. It is a national emergency,” justices from the High Court of Delhi told government officials at a court hearing on 21 April.

India has failed to learn lessons from its first wave of the pandemic, when shortages of various essentials were reported, says Anant Bhan, a global health, policy and bioethics researcher at Kasturba Medical College in Karnataka, India. In August 2020, the World Health Organization created a forecasting tool to help countries predict their needs for essential supplies. “Our under-preparation has been exposed,” says Bhan.

In contrast to many other nations, India had only experienced one distinct wave of covid-19 infections by February 2021, with researchers hypothesising that a large percentage of the population may have already reached herd immunity. Others suggested that India's relatively young population – half are under the age of 25 – could mean fewer people are experiencing severe symptoms of covid-19, the risk of which increases with age.

It isn't clear what is driving India's delayed second wave, but it may be due to the appearance of the more transmissible B.1.1.7 variant from the UK, which is causing around 40 per cent of cases in Asia. Another 16 per cent of cases are due to the B.1.351 variant that evolved in South Africa, which can partly evade immunity from past infections or existing vaccines.

In response to the crisis, Indian Railways has created the Oxygen Express to distribute oxygen supplies around the country. Other countries have also sent aid: 23 mobile oxygen-generation plants from Germany, 10,000 oxygen concentrators from the US, high-capacity oxygen tankers from Singapore and ventilators from the UK and Europe. The US has also overturned an export embargo that ensured raw materials for vaccines were prioritised for its own population before being sent abroad, in order to send resources to India to help produce more vaccines.

Several obstacles remain, says K. Srinath Reddy, president of the Public Health Foundation of India. How quickly the problem can be overcome depends on how fast oxygen tankers can be moved across the country, and how much oxygen can be produced locally, he says. Meanwhile, only 8.5 per cent of the population has received at least one dose of vaccine. “We turned our backs on the virus,” says Reddy, “but the virus did not turn its back on us.”

India has failed to learn lessons from its first wave of the pandemic, when shortages were reported

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