THE FIRST WAVE VIRUS
A worker arranges medical oxygen cylinders at a facility near Hyderabad
SARS-CoV2 virus enters the respiratory tract and attacks the lung cells
Cells start dying to protect themselves and break the infection chain
Blood supply to oxygen is disrupted
Virus attaches to the lung cells and starts replicating
Large number of dying cells lead to tissue damage. Air sacs lining the lungs start leaking and fill up with fluid, triggering pneumonia
The slow-moving government bureaucracy woke up only when the crisis exploded in their faces, and realised it would be days before additional supplies from the industrial centres in eastern India could reach. In an affidavit before the Supreme Court on April 27, the Union government projected shortfalls in supply in six Covid-affected states (see graphic Oxygen Alarm) by April 30. UP, with a demand-supply gap of 400 tonnes, was likely to be the worst-hit. To speed up the movement of oxygen trucks, the Hindon-based C-17 Globemasters, from the IAF’s strategic airlift squadron, flew empty trucks to oxygen factories in eastern India. The foreign ministry sent out SOS-es to other countries for medical aid such as cryogenic oxygen tanks, cylinders and oxygen concentrators. But, for the grieving relatives, it was too late. “My sister-in-law could have been saved,” says an anguished Varma, “they killed her.”
LULL BEFORE THE STORM
On March 1, 2021, India recorded 12,286 new cases. It was a dip in the Covid-19 graph that had been flatlining since the beginning of the year. The pandemic, it seemed, was receding. India was getting back to normal. The surge of medical facilities that had been set up across the country during the first wave had begun to be dismantled. In February 2021, for instance, the Union home ministry had closed down a 10,000bed Covid care facility, the world’s largest, at the Radha Soami Satsang Beas in South Delhi’s Chhatarpur last June. By March 26, the Election Commission had announced the election schedules for the five states going to polls.
Then, on April 6, India crossed 115,000 infections in just 24 hours, its single-largest daily case load since the start of the pandemic. The wall of the Covid tsunami had begun to loom over the horizon.
It was what Uddhav Thackeray, the chief minister of India’s worst affected state, Maharashtra, had warned somewhat presciently in his Facebook address last November. “This second and third wave are strong like a tsunami. If you don’t follow safety protocols, it will hit us.”
As the second wave crashed into 12 states across the country, medical health experts began tracking an aggressive new strain of virus that hit the lungs, almost immediately, on the first day of the infection. Shortness of breath was the defining medical symptom of the second wave.
“The new mutant strains are so aggressive that if you don’t give medicines on the first or second day, the patient is already in a serious condition,” says Dr Sandeep Datta, pulmonologist and secretary of the Indian Medical Association, West Delhi.
The body’s immune system triggers cytokines which attack the body’s own cells and tissues and not the virus. This ‘cytokine storm’ leads to lung inflammation and severe damage, breaking down the lung’s ability to process oxygen, leading to hypoxia. Medical oxygen required to assist
breathing in severely ill patients thus becomes vital. In the first wave, the number of hospitalised patients short of breath was 41.7 per cent. It is 47.5 per cent in the second wave. With the virus spreading faster in the second than in the first wave, patients requiring oxygen also increased. A critically ill Covid patient could require anything from 2 to 8 litres of oxygen per minute. A five feet tall oxygen cylinder with 7,800 litres capacity would, therefore, last six hours.
That medical oxygen more than ventilators was going to be vital in the fight against a virus that paralysed the human body’s breathing apparatus was something the government knew well by last year. It was among the points of agenda before the 11 inter-ministerial Empowered Groups set up by the central government in March 2020.
Medical oxygen makes up only a small fraction of the 7,500 tonnes of industrial oxygen India produces each day. Specialised air separation units suck in atmospheric air and break it down into its basic elements—nitrogen and oxygen. The oxygen is liquefied and shipped in specialised tankers in cryogenic containers in which it is stored at minus 183 degrees. Each tanker carries 17,000 litres of liquid oxygen. Since the Indian steel industry uses what is
WE HAVE BEEN RUNNING THE FACTORY DAY AND NIGHT TO PRODUCE 800 CYLINDERS A DAY, BUT CANNOT MEET DEMAND” SUSHIL SINGH Plant manager, Murari Gases, Lucknow