The Scream

This is a time to register our anger. A deep, gut-spilling, helpless anger. A wordless articulation of it would be best, but that would take us to the realm of art and performance. We are not Edvard Munch. We are committed to telling stories, of thick smoke spuming forth from ­crematorium chimneys and blackening our cityscapes, of wholesale sidewalk funeral pyres, of the heard and unheard screams emitting forth from uncountable Indians who see their love, their life, their universe ripped apart in a trice. Never again can we use ‘gasping for oxygen’ as a metaphor. Never can we now say that tragic hysteria, or fear and trembling, belongs to others. That old Indian parable about people gathering around an accident site, whispering but not helping—because ‘these things always happen to others’ and we only need to play it in our minds as an inner drama—that parable has died this time. As an editorial here suggested last week, this is now everyone’s holocaust.

The sight of a patient dying outside hospitals or in the wards, ­because there are no more beds, that sight is now tinged with a strange proximity—we all now know that patient as one of our own. When hospitals gasp for oxygen, or scream for medicine supplies, we feel a loved one’s last desperate desire to live deep in our marrow. When we see that unearthly orange glow hovering over cremation grounds, each one of wonders if our own dreams, the roads we traversed, our successes and failures, and our endless strivings will also add a tiny luminescence to that collective halo of doom.

How did we come to this? Who is to blame?

First, those who are running this marionette show, those with the strings in their hands, those in government. The one at the Centre, and those in the states, with the order of preference leaning to the former because of its arrogation to itself of Covid policy. For ­sleeping on the job. For being busy elsewhere. For patting themselves ­prematurely on the back, claiming the virus has been ­‘conquered’. Lulled into complacency—dulled, rather—they were caught hopelessly flat-footed on the crease when the second, nastier bouncer came. Where are the oxygen plants that should have been in place by now? Was it impossible for a country of India’s manufacturing ­capacity to have planned in November and delivered a few lakh life-giving breaths by April? Where are the hospital beds that were sanctioned last year? Medicines? Vaccine shots, even? Vaccination is a festival. Everything in India is a festival. Even our ­governments like to celebrate. No government, no party is blameless as we plunge headlong into this new, morbid festival of death.

Nor are our institutions. The Election Commission may have its own remit, but a two-month-long festival of voting amidst a pandemic? Of unbounded aggression from the podium and the unmasked ecstasy of lakhs out there? The last-minute offer to curtail campaigning—one party first, with the others first mocking, then grudgingly following—can only be belated tokenism. The real and symbolic damage had been already done. For their primal need to grab power, they had already sacrificed any commitment to India’s health—even their own gestural onus of setting an example.

So we have blamed the politicians and the government, as is our wont. But what about ourselves? As a society, do we not stand condemned collectively? Where’s the Indian gene of perseverance, our fabled capacity to handle deprivation with stoic calm? Have we allowed our new taste for flippancy to take over our lives? Groaning about lockdowns, cavalier about basic safety ­protocols, hesitant about the vaccine even when it was available, rushing at first opportunity to prayer congregations, temple ­festivals, ­marriages, shopping, ­restaurants, we have signalled an utter collapse of our own old fortitude. The sporting world is showing more ­maturity: playing international matches in empty stadiums, even the Olympics going online. But we ­succumbed to our childish delight in sport, to deceptive signs of normality, drawing a cloak over the constant vigil that should have been maintained. Or to our desire to allay fear through ­mystic transport. So what if our ­religious heads had beckoned, or the state government had tom-tommed the event? Why would lakhs of ­devotees lower their guards and ­knowingly walk into corona territory at the Kumbh? Even the shastras are clear on this: such observances must be suspended in times of emergency. We followed neither ­modern experts nor our ancients. Only our infantile desire.

Look at the impact of our stupidity. As our reporters set out to chronicle the disaster this week, they found a replay of 2020—with a grim awareness that 2021 could be worse. Business and trade, the lifeblood of economy, again jammed in the veins. Migrant labourers on a second lonely exodus, and just when the economy was ­sputtering back to life. Students staring at an uncertain future. Daily wage-earners staring at hunger. The elderly staring at a grim, fearful winter, knowing they may not see a joyful spring again. Frontline workers thrown to the edge of doom a second time. They had all believed the government when it assured them that Covid was behind us and that India has come out relatively unscathed. Only to find themselves being infected or their close ones struggling to stay alive. Instead of a planned expansion of robust health ­infrastructure and a newly aware citizenry, we have an apocalypse on our hands. It was a sturdy fight in 2020, but alas, its timber was too hollow. No lessons were learnt. Last time, lives took priority over livelihood. This time, both stand compromised. 

Vikas Kumar 46

Businessman, Patna

If it was anything less macabre, one could have said it runs in the family. But tragedy cannot be genetic, nor a family heirloom—what else would anyone wish to keep their kids away from? Vikas Kumar, a businessman from Khagaul in Bihar’s capital, has tested positive for COVID-19. So has his elder brother Gyan Prakash. And yet, they can hardly afford to go into complete isolation. Their 86-year-old mother is battling for her life in a hospital; so is another brother, in a different hospital. They have to attend to them. In between, the break they took in the last few days was to cremate two other family members—a fourth brother and a sister-in-law. Theirs is an ­11-member joint family. That includes his three-year-old son, who too caught the baleful wind this month. Covid has been coming at them like a fast bowler at the death.

It started, perversely enough, with festivity. “My Bangalore-based brother and bhabhi came to our place to host a reception for their son’s wedding,” Vikas says over the phone. “Then they went to Bhagalpur to meet bhabhi’s parents. On their return, she developed symptoms.” The doctor initially misdiagnosed it as typhoid and ­prescribed an RT-PCR test only after her condition deteriorated three days later. It was too late. Her death was only the start. “To our ­horror, all of us tested positive,” he says. “Somehow we got our brother admitted to an army hospital. He’s still fighting for his life.”

Meanwhile, the condition of another brother deteriorated...and that set off a morbid run through a broken Indian city’s entire Covid ­landscape. “We rushed him to a private hospital, but no improvement. Bhaiya was still gasping for breath. He wanted us to take him elsewhere,” he says. This hospital agreed, and coolly handed over a bill of Rs 1.12 lakh. Vikas felt an ICU bed at the government-run Nalanda Medical College Hospital (NMCH) could be a good option for his brother. When they reached, they found there were three other claimants, all fighting for their lives, to one bed. “They told us to settle it among ourselves. I was ­appalled to see the condition of this ‘Covid-dedicated’ hospital. No doctor around, only one male nurse in ICU. I thought my brother would die there, and took him to another private hospital,” he says. That’s where his brother died the next day. “They charged us Rs 70,000 and handed over his body wrapped in just a PPE kit and an old bedsheet.” No dignity, no protocol. When they took the body to the Bansghat ­crematorium ground, they were asked to pay Rs 2,000 before four people came to lift it from the ambulance. “None of them were ­wearing any PPE kit. Two didn’t even have a mask on.”

The local administration has offered no help to his family yet. “They have just declared our house a micro-containment zone,” says Vikas. “Even our neighbours have begun to treat us as pariahs. My mother and a brother are still in hospital. My wife and kids are on separate floors in the house and I have put up a barricade on the stairs to keep my children away from me. I don’t even know whether I am still positive. I have cremated two bodies, one yesterday…. I have got the RT-PCR done again, but I don’t know when the report will come.” They bear witness to the utter collapse of health ­infrastructure in Bihar. “Private hospitals are looting patients and their kin in the name of treatment. I don’t even know whether my brother was given oxygen,” says Vikas. “As for government hospitals, the less said the better. It seemed as if they were themselves ­gasping for breath in the ICU.”

—Giridhar Jha

Ashlesha Daga 12

Class 8 student, Noida

Black had already fringed their lives a day before Holi. On March 28, the Daga family got to know their neighbours were Covid positive. Fear gripped them. Their daughter Ashelsha used to play with the neighbours’ kids regularly…. And black entered the house on Holi. Ashelsha had fever, and was feeling weak. Her father, Kishan Daga, immediately ­ordered Covid tests for the whole family. The reports came in the next day. And what a bizarre paradox it was. Ashlesha’s parents, grandparents and her younger sister were all Covid negative. But Ashlesha….

Everybody was inconsolable. “We thought kids are more ­immune. This time, it has gripped them,” says Kishan. A silent fear gripped everyone. “Even I couldn’t handle myself,” says Kishan. “I’d go out on the excuse of bringing medicines and give vent to my emotions.” The family decided to isolate Ashlesha in a room with her mother. They knew the mother was being put at risk, but there was no alternative. Grandparents, younger sister, they were all vulnerable. Besides, Ashlesha was a thinking, feeling child. She had heard all the horror stories....

In a day, they worked out a new arrangement. This included having the grandparents and younger sister in one room, ­father and mother in the drawing room—he on the sofa, she on a floor bedding—and Ashlesha in another room with an open door. All together but apart. For two weeks, this was life for the Daga family—the Noida municipal authorities had stuck a poster outside their house mandating a fortnight’s isolation for them. Kishan washed and cleaned Ashlesha’s plates and clothes, the mother took care of her food—planning, cooking and keeping it at Ashelsha’s doorstep, and also upstairs.

They count themselves lucky. Ashlesha never needed a ­doctor—there were no major symptoms, only a minor ­headache and fever on a couple of days. They still kept the helpline in the loop; the latter called twice a day to check on Ashlesha’s status. The days were almost bipolar, says Kishan. Moments of pin-drop silence were interspersed with moments when everyone would laugh and shout at their highest pitch just to beat back the blues. “At times, we would put on Ashlesha’s favourite show on TV. She would hover near the door to catch a glimpse, yearning to come out. We felt so helpless,” he says. Fortunately, there were things to keep Ashlesha busy—an eighth class student, she had her online classes and tuitions. She also kept her mother’s phone. YouTube and Instagram were life-savers.

The second wave, between March 1 and April 4, has hit over 80,000 kids below 18 in Maharashtra, Chhattisgarh, Karnataka, Uttar Pradesh and Delhi. It’s a new and alarming trend. Experts say the severity of infection is still low with kids and they mostly do not require hospitalisation. But in rare cases, they can develop the severe, life-threatening ­inflammatory syndrome. And vaccination policy went by the old logic, keeping kids kept out of its range for now. We have many Ashleshas out there to show for this lapse, living the nightmare, and occasionally not even that lucky.

—Jyotika Sood

Vinay Soni 32

Plumber, Gonda/Delhi

A familiar sense of dread and ­urgency filled him when he heard about the new, week-long lockdown in Delhi. He simply had to get back to Balrampur, his ­village in UP’s Gonda district. His wife and small twin sons are with Vinay, but keeping everyone alive and well is not just about evading Covid. “For several weeks now, it’s become difficult to get any work,” he says. Vinay’s work would earn him around Rs 500 a day, but who calls a plumber into the house these days? Yes, life would be tough back in the village—his family owns only a two-bigha land, and his elder brother and family cultivate it. Still, Vinay feels it would be better than staying on in Delhi. Here, whether his family eats or not, he’ll have to shell Rs 3,000 as monthly rent for their ­hutment in the JJ Basti near Anand Vihar.

Things started becoming tough for them in January, when his wife stopped working as a part-time domestic help in the nearby colonies of east Delhi. “Many times, the cops would stop us from crossing the ­railway overbridge. They would see us as potential Covid carriers. As we have small children, my wife also felt it was better not to risk falling sick,” says Vinay.

He had moved to Delhi four years back in the hope of being able to earn more and get his children a good education. The first shock came last year, during the lockdown. They moved back to their village in April. But if the migrant Indian worker is rich in anything, it’s perseverance. They returned in May, as the situation eased. Having paid a tidy sum to a mediator to get his twin boys admitted to different private schools in Anand Vihar, they would rather be here, he thought. That’s when the second shock came.

It was already tough. Over the past few months, he has incurred around Rs 4,000 as debt, and frets gloomily about it. Now, despite the Covid-wrought work freeze, Vinay hopes to earn enough over the week for the bus fare. He knows it will be hell out there at the interstate bus stand, but he’ll take that chance. “Scores of people from our colony have alre­ady returned or sent back their families. Nob­ody wants to fall sick and be without help.”

Dinesh Shah, of Khagaria Zila in Bihar, is among those who have sent back their ­families in the past few weeks. He has been working as a mason in Delhi for 18 years—­falling in the exact category, like Vinay, that feels the pandemic as an economic pestilence. Each one of them is choking—and it’s not Covid. It is too, in a sense, for the virus ­paralyses their universe. There’s simply no work. And Shah is in a double dilemma: his family has no landholding back in the village. He had spent Rs 3,000 last year to return to his village. Penniless, Shah returned to Delhi with his family—wife and four children—only in January, and only to run smack into a new ­crisis. Many like Shah do not possess a labour card giving proof of residence, and that ­becomes an additional point of instability in uncertain times. He has now booked a train ticket for April 27—if it doesn’t get cancelled, he’ll be on it to join his family. Will they return? Perhaps. This double movement is the basic pattern for migrant workers, those caught on a highway with hell at both ends.

–Lola Nayar

Raman Singha 41

Apple farmer, Kotgarh, HP

The Singhas live in their orchard house, set quite apart from the nearby village clusters in this picturesque apple belt, just down the road from Narkanda and about 75 km from Shimla. They are the kind of family that’s easy to like—gentle of demeanour, prospering but modest. Raman’s father: Nand Kishore Singha, a 74-year-old retired school teacher, one of most respected social figures in the area. A strict disciplinarian, fit and healthy, he abided by the Covid protocol and confined himself to orchard work all through last year’s lockdown. So did Raman’s mother, Kanta Singha, 71. Looking at them, you don’t want anything to disturb the picture-perfect frame. But grief hangs over this Kotgarh ­orchard house now, in the form of an eerie sil­ence. The lamps had flickered out around last Diwali. A whole proud generation got wiped out in front of Raman’s eyes, as he watched in helpless horror. November 2020 it was, when the talons of an invisible sprite dug into their collective jugular. The entire family of six—the two parents, Raman and his wife Shilpa, and the two kids, Shreshth and Saharsh, aged 8 and 4—came down with the dreaded coronavirus. And soon, hell was breathing over them.

It was Kanta Singha, the elderly mother, who first got the symptoms—on November 8. Everyone was stunned. How would she, a homemaker, catch the infection out of nowh­ere in this isolated orchard home? Tracing back the arc of pain, Raman recalls he and parents had gone to attend a funeral in a nearby village, a close relative who had died of cancer. A woman with perhaps some travel history had also dropped in to pay condolences, as medical officials informed him later.

Now, Raman too got fever and other flu symptoms. The mother’s condition, meanwhile, showed no signs of recovery after routine home medication. Suddenly, her oxygen level started falling too. Something had to be done. Raman lost no time. He drove her down to Shimla’s Indira Gandhi Medical College Hospital—Himachal’s premium health institution. Not unexpectedly, the report was posit­ive for both. What followed next was a night­mare—mental, emotional, and in terms of the sheer horror of coping with hospital. “The Covid ward was packed to capacity with no oxygenated bed available. I struggled to get a bed for my mother…her condition started det­eriorating faster each day. We finally got adm­ission to the ward and mother was put on oxygen, and soon the ventilator,” he recalls, plotting a graph by now familiar to lakhs in India. There was no improvement in her ­condition, but he hoped for the best still.

But the best had forsaken the Singhas. It was around this time that news came from back home: his father, wife and both kids had also tested positive. Father was a diabetic too, despite his otherwise robust health. He was rushed to Shimla’s Deen Dayal Upadhaya (Rippen) hospital, but didn’t get medical atte­ntion for three days. His health worsened. Raman was finding it hard to cope. “Six family members—all Covid positive, split at three places, I was feeling so helpless,” he says. His sister then explored options at some reputed private hospitals in Chandigarh, a three-and-half-hour drive away. But it looked gloomier and gloomier: no oxygenated beds with ventilators anywhere. Finally, all three—Raman and his parents—were shifted to a private hospital at Zirakpur, near Chandigarh, on Diwali day, November 14. Here, Raman was cured after four days, but his parents never recouped. Even plasma therapy didn’t work for the mother. Interventions to improve his father’s falling platelet count also failed. Nand Kishore Singha breathed his last on November 24. His wife, Kanta, followed in less than 24 hours.

“The last conversation I had with my father, he asked about the kids and Shilpa. I told him they had all tested negative and are fine back in the orchard. He took a long breath with hands folded towards God,” says Raman, wiping his tears. “Diwali is supposed to be a festival of lights. For me it was the darkest turn…. This virus is very deadly. It can ruin anyone’s family. Please avoid going to crowded places or gatherings. Sometimes, even the mask doesn’t protect you.”

—Ashwani Sharma

Dinesh Parab 47

Photojournalist, Mumbai

Press photographers. From royal weddings and celluloid red carpets to wars and pestilence, they bring you images of the most ravishing and the humdrum, the most intimate and the most soul-crushing moments of people’s lives. They get you that moment no matter how unaccommodating the situation is for visual journalists—in rain, flood and summer sun, often themselves seen as a pestilence, refused access and harassed. But nothing had tested their mettle more than the shells bursting near the foxhole of wars they chronicled…until the coronavirus blew up on humanity. Dinesh Parab, Outlook’s Mumbai photographer, waltzed into it with the chutzpah typical of his breed, like a soldier going to war ­whistling—the outward demeanour betraying nothing of the ­sensitive, all-seeing eye. Till the images come out. Images that ­document Covid’s staggering human toll—obliterated lives, lost basic freedoms, and day-to-day fears and tribulations. Over the past year, these reflections also tell a deeper story, guiding the viewer to see and understand a once-in-a-century pandemic through the eyes of people who had the privilege and horror of witnessing it first-hand. The sheer surreal sense of seeing life slipping away, and being snatched back from death.

He was in a hospital room with the doctor’s ­consent, allowed to document “for the first time in my career and in my life” the vicious power of this “unforgiving coronavirus”. He wore a full white ­hazmat suit, the camera dangling from his neck. Inside the rubber overalls, he couldn’t breathe—it was as if he was paralysed. For a while, he couldn’t even pick up his camera to shoot. “I was in the suit for half an hour, yet it felt like forever. The goggles…I couldn’t see through them to focus through the viewfinder. It’s an experience that transformed me. I salute our doctors, nurses and ward boys, ambulance drivers. Don’t know how they have done their work wearing that stifling protective gear for more than a year, day in and day out.” He honours the courage of doctors, nurses and funeral workers who risked their own health to do their jobs. And just like his subjects, he is terrified he might get infected and bring the virus home. Just like his subjects, he remains haunted by what he saw. Just like his subjects, he finds moments of hope.

—Rituparna Kakoty

Dr Sanjeev Manglik 57

Gautam Buddh Nagar

Everyone these days thinks of India’s public healthcare with more than a touch of anger, and understandably so. Mostly because there simply isn’t enough of it. But spare a thought for the ­little that is there—the parts that do work—and the people manning the trenches on the frontline, amidst volumes of artillery fire never witnessed before. Government doctors working on the ground to track and trace Covid patients can be seen trapped in an endless blur of action, trying to keep up with the exponential curve brought on by the second wave. The number of containment zones has increased, you have to be in many places at once. Dr Sanjeev Manglik, a nodal officer for logistics, sampling and testing in UP’s Gautam Buddh Nagar, says he has to coordinate continuously with six teams of lab technicians on a daily basis just to cope with the work pressure.

“We have been conducting over 6,000 tests, both antigen and RT-PCR—that’s above the government’s daily target of 5,500,” says Dr Manglik, a veteran surgeon. His day begins early: he and his nodal sampling officer, Dr Tikam Singh, take stock of the availability of lab technicians, drivers and testing kits. They have plotted out the deployment the previous evening, but imp­lementation always brings its own set of troubles. “Many of our technicians and drivers are down with Covid. Our available manpower is shrinking, yet we have to maintain the momentum,” he says. He and his team undertake also field visits to see if lab technicians are working to plan. Once all the six teams return from the field, the next job is to prepare consignments of the collected RT-PCR samples and send them to the Government Institute of Medical Sciences for analysis. “It’s a tedious job. If things get messed up while tabulating, everything will go haywire,” he says. “For those who test positive in the antigen test, we provide them the result immediately and forward their details to the Rapid Response Team for action.” The RRT takes a call on whether the person is to be admitted to a hospital or left in home isolation.

Dr Manglik also handles the supply of ess­ential medicines to government hospitals—that’s enough to keep him and his team on their toes morning to evening, sometimes late into the night. “We need to keep a watch on the available stock, replenish them before they get exhausted, and attend calls from various government hospitals.” He says his department deals with only logistics and testing, yet in practical terms he’s the nodal point for all things essential to serve a Covid patient. The pressure is killing, and there’s no time for exhaustion. But they are as vulnerable as the population they tend to. “Two weeks after the second dose of Covishield, I developed Covid,” says Dr Manglik. Sure enough, there wasn’t a lot of time to sit back and ponder the future. There was work to be done out in the fields.

—Jeevan Prakash Sharma

Anil Pal 28

Car dealer, Varanasi

Not everyone gets to be the subject of research—especially one that tells you surprising things about your own body. Anil Pal, tall and robust, got that chance—and yet he is as befuddled now as he was in December, when he first submitted himself as part of a cohort to be studied by researchers from the BHU’s zoology department. Not that he can be blamed, the twists in the coronavirus story are leaving even scientists rev­ising their opinion at every step. The BHU team, headed by Prof Gyaneswar Chaubey, had initiated a seroprevalence survey in December 2020 to develop a reasonable estimate of the percentage of individuals in UP who have already developed antibodies against Covid. It was a largish cohort: 2,301 individuals from 14 districts across UP, Varanasi one of them.

The survey, published in the journal Science as an e-letter, suggested 40 per cent of people had already developed antibodies. Pal was one of them. He was surprised: this meant he had at some point contracted Sars-Cov-2. It was obvious that had been one of the many asymptomatic cases. “My whole family took the test. Neither my wife nor my one-year-old daughter had any antibodies,” says Pal.

Three months later, Chaubey’s team repea­ted the test on 100 of the total 2,301 participants. “We didn’t have the resources to visit all 14 districts,” explains Prof Chaubey. “So we chose 100, out of whom only seven had antibodies, the rest are as vulnerable to infection as anybody else.” Pal was one of those whose antibodies had waned. “The natural protection my body had developed has faded away within just three months,” he rues.

After the December serosurvey, Prof Chaubey had concluded that India might not see a second wave. “When the second wave peaked, I revisited my study. A substantial number might have been reinfected,” says Prof Chaubey.

—Jeevan Prakash Sharma

Amit Kumar Jha 43

Central govt employee, Ghaziabad

Twenty years ago, a landscape where people are begging for oxygen on the streets—and dying for want of it—would have seemed like ­something out of a bad sci-fi horror script. Yet, such is the evil sorcery our ­hypermodern world has wrought on us that it has come to be a reality across Indian cities. Amit Kumar Jha is an officer with the Comptroller Auditor General of India (CAG), and ­presumably used to the ­relative ­security that public offici­als enjoy in India when it comes to things like healthcare. And yet there he was, running from ­hospital to hospital, four in all, begging for a bed and an oxygen cylinder. He managed one finally in the emergency ward at Fortis Hospital, Noida, where he is battling for life as we go to print, already a broken man.

A resident of Crossing Republic in Ghaziabad, Amit developed Covid symptoms around April 15. Before he could be sure what it was, his mother too was infected. Her ­oxygen level deteriorated so fast that she collapsed and died even before they could move on an emergency plan. Soon after, Amit’s oxygen level too started worsening. Panic of this kind usually ends in the calm, white corridors of a hospital, the wise words of a doctor, the ministrations of a nurse. Here, even that solace was denied—one after the other, they refused to promise a bed. Finally, Amit’s brother Mukesh, who lives in Mumbai and had come down, decided to rush him to Fortis at Noida. They’d already bought a BiPAP machine and an oxygen cylinder by then. “He spent the whole night in the emergency ward…there was no bed in the ICU. The next morning, some CAG officials came to see him and advised that we move him to the Rajiv Gandhi Super Speciality Hospital (RGSSH), Dilshad Garden, as CAG has an official tie-up with it,” says Ashish Kumar Jha, a close ­relative and Amit’s constant companion. “We hired an ambulance and left for RGSSH. When we reached, the doctor informed us that there was no oxygen in the hospital so no new patient could be admitted.” The relatives of other patients waiting there were so ­aggressive that the hospital staff closed the reception and disappeared.

A doctor they were in touch with suggested Guru Teg Bahadur Hospital.  “As the ­ambulance rushed towards GTB, his oxygen level reached a critical stage. We somehow reached the hospital and rushed him to the emergency ward,” says Ashish. He was shocked to see patients carrying their own cylinders—this hospital too didn’t have ­adequate oxygen. They refused Amit oxygen support. “I lay down on the ground and started shouting and pleading with them to save my brother,” says Ashish. “I literally begged. The hospital staff were unmoved, but another patient’s relatives came to me and said I could share oxygen from their ­cylinder.” It was a reprieve, but a temporary one. They had to do something. In absolute desperation, Mukesh ran to buy two more cylinders, then they somehow hired another ambulance, shifted Amit into it, and started searching for a bed in other hospitals. “We had only enough oxygen for five hours. I called every person I know. No one could ­assure me of a bed. Finally, I told the ­ambulance to take us back to Fortis Noida, though I didn’t know whether we would get readmission.” On the way, they tried two more small hospitals, but they refused to admit a Covid patient.

At Fortis, they had to wait outside in the ambulance for five hours—by now even emergency was overflowing with patients. “When his oxygen cylinder was almost used up and he started gasping for life, I and the ambulance driver dragged his stretcher to the emergency ward. The doctor was kind enough to admit him immediately and put him on oxygen support,” says Ashish. Amit’s condition was very critical till we last heard. Whichever way his story turns, its moral should be stark and clear for the mandarins of India’s healthcare.

—Jeevan Prakash Sharma

Dr A. Velumani

MD, Thyrocare Technologies, Mumbai

As a pioneering figure in India’s ­diagnostics landscape, Dr A. Velumani knows the complexities that Covid poses for a country like ours. The big ­challenge at present, amidst an alarming second wave, is for testing labs to scale up fast enough to stay abreast of the ­accelerated rate of infections, he says. Besides, there are additional logistical ­issues: last year, the pressure was relatively less because of a complete lockdown. This time, the requirement for Covid-negative test reports for travel and work has pushed volumes up. “We had all felt in September that we should invest more because we didn’t know when it would peak. But then it peaked,” Dr Velumani tells Outlook. “In fact, our capacities came down to as low as 20 per cent utilisation in January. The Covid-related business ebbed and we felt the ­non-Covid diagnostic tests would pick up again.” At that time, the Mumbai-headquartered Thyrocare was testing about 2,000 samples a day for Covid, out of a daily capacity for 10,000 samples. The scenario changed from February on. By March, it was clear the rising case load wasn’t a blip. “We went from 10,000 samples a day to 20,000 within a matter of 50 days,” he says.

Thyrocare currently has a daily capacity of 20,000 swabs in Mumbai and 5,000 each in Delhi and Bangalore. Back in September, the firm had identified new premises for ­expansion and had given purchase orders. When the curve started dipping, these were put on hold. “So we only had to ask them to execute the purchase orders. We saved a good one month there. Fortunately, there’s no paucity of raw material now,” he explains. “With Covid, everybody has been wrong. We don’t know how long the pandemic will ­remain.” The apparent first peak, he reckons, gave a sense of false security.

For laboratories to ramp up, they also ­require trained personnel. “When the pandemic hit us in March 2020, there were no swab collection technicians at all. Suddenly, we had to generate swab collection technicians,” he says. Last year, Mumbai city was testing upwards of 50,000 swabs a day, which roughly translates into 5,000 technicians a day. “We were picking up very well. But now, Mumbai needs 2 lakh swabs a day. Where do we have technicians? That’s why I say everybody is caught unawares.”

Earlier this month, labs in Mumbai were swamped with demand for testing when the state government mandated RT-PCR tests every 15 days for the workforce. “We just could not take the phone calls,” he says. The order was eventually modified, making the test mandatory only for those with ­symptoms. “Things are a bit better now.”

In terms of testing, that is. A diagnostician also has other observations. In January, about 5 per cent of the 2,000 daily samples Thyrocare was testing in Mumbai turned out positive, says Velumani. “Today, when we are testing 20,000, the positives come to 35 per cent. In Delhi, it’s 50 per cent. This means it’s coming to a peak.”

—Ajay Sukumaran

Dr Sachin Jain 43

Gurgaon

Sometimes science says ­something, but events turn out otherwise. The iffy status of ­scientific conclusions only increases when you are trying to pin down a ­mutating reality. And nothing in the ­recent past has been so form-shifting as the coronavirus. A vaccine is said to offer a full protective shield against Covid two weeks after the second dose—that’s the time it takes to prompt an adequate immune ­response in an individual, for his or her body to develop antibodies. So one fortnight after the second dose, and you are safe from Sars-Cov-2. At least that’s what the science says, based on exacting clinical trials, or whatever was possible in an emergency. Unfortunately, it didn’t pan out like that for Dr Sachin Jain, additional director & HOD, Hematopathology, Fortis Memorial Research Institute, Gurgaon.

Dr Jain took his first dose of Covishield in the last week of January and the second dose after a gap of 28 days, in early March. He also maintained strict Covid protocol—mask, hand hygiene et al. Yet, by the end of March, he developed fever, cough and cold. The RT-PCR confirmed his worst fears. “First it was my father who developed Covid symptoms, and tested positive. A day later, my mother. Sequentially, my two kids aged 14 and 9,” says Dr Jain. His wife, fortunately, stayed Covid-negative throughout. The mother went on to develop severe complications and they took recourse to plasma therapy.

Dr Jain’s parents had taken the first dose when they contracted the virus, but that of course is no shield by itself. But how did he himself stay vulnerable to infection after two doses? Didn’t the vaccine prompt the production of antibodies as it promises to? Dr Jain simply doesn’t know: there’s no official protocol to check the status of antibodies in a person a fortnight after the second dose. Did he contract the ­infection despite having antibodies? Again, we are in the dark. Dr Jain feels he was fortunate: he developed only mild symptoms. Except for his ­mother’s case, which was more ­prolonged, the rest of the family fully recovered in 15 days. The questions linger, with both yes and no as potential ­answers. Should you get vaccinated? Dr Jain is quite clear on that one, though. “I believe it’s the vaccine that protected me from ­severe infection.” But it remains the job of science to always refine its judgements—and there’s a lot of that left here yet.

—Jeevan Prakash Sharma

Kishor Sendh 65

Baripada

Chronic bronchitis is what made Kishor keen, even eager, to get himself the jab. But when he reached the local ­vaccination centre just over a week ago, he was told it had run out of stock. “The man only said ‘how do I know?’ when I asked when it would arrive,” he says. Undeterred, Kishor checked every day with those in the know whether the Covishield ­vaccine had arrived. Good news ­finally came on April 19, Monday morning. Kishor and his wife duly reached the vaccination centre and got themselves their first jab. But now he’s worried. In weeks, it will be time for the second shot, and what he has seen has made him sceptical about supplies. “If I don’t take the second shot in time, the first will be rendered useless,” he says.

Across Odisha, thousands like Kishor are plagued by doubt and ­uncertainty. The state has been ­facing an acute shortage of vaccine supplies for over a week now. Once, they even had to shut down 900+ vaccine centres out of the 1,500-odd that were set up. The shortage has led to a political war of words, with the ruling BJD accusing the Centre of discriminating against non-BJP states. The BJP, in turn, ­accuses the state government of ‘mismanagement’. That doesn’t alter the ground realities in any way for Odisha’s people.

—Sandeep Sahu

Raakesh Maini 54

Parent of thalassemic kids, Delhi

Covid-19 is itself such an all-consuming spectre that people rarely think of the collateral damage it is leaving in its wake. Ask Raakesh Maini, a resident of Mukherjee Nagar in north Delhi. He has two kids—an 18-year-old son and a 20-year-old daughter. Both are thalassemic, and need a blood transfusion every fortnight. Bimonthly trips to St Stephen’s Hospital were, ­therefore, a routine part of life. But that was before the second wave hit the national capital, and caused unforeseen problems to even those yet outside its range. Thalassemia patients are a pathos-inducing example. “Due to the spread of infection, blood donors are not coming forward. When my kids went for blood transfusion, the hospital asked them to arrange blood on their own. Where will they bring blood from?” asks Maini, an advocate in the Delhi High Court.

Also, after the new surge, several hospitals in Delhi have been converted to Covid ­hospitals. Blood transfusion services are the last thing on their minds right now. Nor have they suggested alternative options, says Maini. There are also cases where ­thalassemia patients are themselves ­contracting the infection. That poses an acute, double-edged danger. Such patients need regular blood transfusion too, but there’s a catch. “Before every normal blood transfusion, a process of blood matching is done so it doesn’t cause any adverse reaction and suits the body,” says Maini. “Now hospitals who have admitted Covid-thalassemic patients are refusing the blood matching facility. They fear that will spread the infection. Where will these patients go?”

Maini wants the government to issue an order asking hospitals to provide these basic facilities to thalassemic patients. He also ­requests people to come forward and ­donate blood. “Offices, schools, colleges and many commercial establishments are closed. Blood collection vans won’t go ­because of low turnout,” he says. The ­answer, for him, lies in both a caring citizenry and a responsive government—both entities a tad scarce in such dire times.

—Jeevan Prakash Sharma

Fameer C.K. 36

Covid ICU nurse, AIIMS, Delhi

When he was posted at the Covid special ICU ward last June, like the rest of humanity he too had only a vague idea about this new enemy at the gates—the world was still grappling with the first wave of the pandemic then. After nearly a year of incessant labour in the deepest shafts, the wisdom he has gained is permeated by gloom. Being surrounded by morbidity is part of the job description, but the sheer volumes of it that’s coming the way of frontline health workers like Fameer is almost beyond the human capacity for ­tolerance. An exponential increase in ‘workload’ can mean a lot more, physically and psychologically, if handling life and death is what you do. Right now, as the second wave of Covid wreaks death and ­devastation all around, hospitals are bursting at the seams, and those like Fameer are the ones who do all the heavy lifting. In such close ­proximity with death that they fear it might consume them too.

“The situation is much scarier now. A lot more workload, but it’s also the anxiety. Even close friends and ­colleagues are contracting the virus. It has reached our doorstep,” says Fameer, who has been working at AIIMS since 2012. The high ­dependency unit (HDU), where Fameer is on duty, has 16 beds that take in mostly the critically ill. And these days, they mostly carry the highly infectious new strains. “I don’t even get a minute to sit. This time, the medicinal requirements of the patient are much higher. That’s the reason for the increased ­workload. We don’t let the patient’s oxygen saturation level dip,” he says. From constantly monitoring oxygen levels and vital parameters to administering medicines, his ­six-hour shift sometimes stretches up to seven. Fameer has no ­complaints on that front, though. He finds solace in the fact that fatality rates are not as high compared to the first wave. What’s most worrying is the increasing ­number of positive cases among colleagues, especially nursing staff. The effects of that are both personal and systemic, he says. “During the first wave, I didn’t see health workers turning positive on this scale. Now it’s a daily affair. The staff crunch puts an ­additional burden on us.”

The work itself is an unreal grind. Fameer is by now used to living in and out of a PPE suit, working for six hours at a stretch ­without food and water. “Most of the time, sweating inside the PPE suit turns our light green scrub into dark green after a six-hour shift. I drink lots of water before the shift so that we don’t get dehydrated. Most of us use diapers during duty. It gets very difficult after four hours,” he says.

New working hours for nursing staff has added to the burden. “We now have 18 days of work and 12 days off. Earlier, we used to get enough rest. Now that the pattern has changed, the infection rate among nurses is also going up,” he says.

Since the pandemic hit, Fameer hasn’t been able to visit his hometown, Thrissur in Kerala, even once. But he has no regrets. “These are sacrifices one has to make looking at the severity of the situation,” he says. The past year has taught him to approach crises with equanimity. “At the beginning of the pandemic, I used to get emotional. Then I ­realised I wouldn’t be able to work like that. Now I try to be positive and optimistic,” he says. However, he admits that stress and exhaustion take a toll on the mental health of many nurses. Like every frontline health worker, Fameer also fears for the safety of his family, which ­includes two young children. “There’s no end to such worries. There are no adequate quarantine facilities for health workers. It’s a major concern when there are small kids in the family,” he says. But his work ethic is clean and honourable; he is undeterred. “Everyone is vulnerable to this deadly virus. Today or tomorrow I may also get it. There’s no point living in fear,” he smiles.

—Preetha Nair