COVID Oxygen Shortage

My wife and I have just got our second dose of Covid vaccine. It was a triumphant moment, because there seemed to be an acute vaccine shortage in the country causing fears of its non- availability, coupled with new mutants of Covid spreading the virus like never before. The fear of those who got the first dose not being able to get the second one caused all round anxiety, because for old people like us, it is after all a life-and-death situation these days.

Before we rushed to the vaccination centre on the 22nd of April, I tried fixing a prior appointment through the much touted CoWIN portal but it proved to be a frustrating exercise, as the centres where every time I scheduled an appointment had no vaccine stock. Therefore, I decided to go through the age-old system of telephoning the municipality and finding out which primary urban health centre I should go. That is how we landed finally at a nearby municipal health centre.

We arrived at the vaccination centre one hour in advance hoping that we would be the early birds but, to our disappointment, there were already hundred people ahead in the queue. Since there was no other alternative, we joined the queue anyway, prepared for a long wait. It turned out to be long indeed, as it took more than four hours to get the “holy grail” of the vaccine shot. To get the second dose, after standing for so long, that too for frail senior citizens like us, was a moment of extraordinary effort and achievement. Just after we took the dose, one of the over-worked health workers administering the vaccine shot fainted, causing delays down the line after us. We were fortunate to have got the jab without any such hitch but we felt bad that the medical and the para- medical personnel in the front line were working under such stress, exposed to the virus more than anyone else.

When I downloaded the certificate for the first dose, I felt truly gratified that it carried the smiling, reassuring picture of no less than the all powerful Prime Minister, telling me in no uncertain terms that I should remain ever so grateful for such a noble gesture of the rulers’ charity for a lowly subject like me. As expected, the second vaccination certificate too carried the leader’s picture.

When I proudly announced this to a friend, he did not resonate with the same expression of excitement. In fact, he went to the extent of even questioning as to why a public document generated out of public funds and through public effort should carry anyone’s picture at all. He certainly had a point.

When my wife and I stood in the queue, waiting for our turn, the discussion naturally centred around the travails that the elderly people were being subject to like this, the possible reasons for such an acute scarcity of the vaccine and whether anyone in particular should take the blame. As usual, there was a perceptible hesitation among many to attribute the crisis to the senior political leadership in Delhi. Discretion is always the better part of valour, especially these days, when the Article 19 freedom bestowed upon us by our elders is occasionally denied! There are others who were certain that this was a man-made crisis resulting from a failure on the part of those in charge to balance the domestic vaccine supplies and exports, at a time when as many Indian citizens as possible would need to be shielded against the virus. Generally, there was a sense of helplessness among all. The consensus was that no government could be expected to deal with such an unprecedented calamity. It was after all an act of God! These differing perceptions about the vaccine shortage that seemed to cut across different States made me ponder over it again and again.

While the worldwide spread of Covid could certainly be attributed to the failure of the country of its origin to nip it in the bud, what happened thereafter represented a collective failure of the governments and the people of different countries.

As far as India is concerned, the first wave of Covid was certainly an externally imposed calamity on which we had no control. As and when it started declining last year, we seemed to have become somewhat complacent, unduly lowered our guard, failed to anticipate the second wave as we ought to have and added momentum to it by our own irresponsible acts of omission and commission.

Though India has been at the forefront of vaccine production, instead of quickly taking advantage of it and launching a nationwide vaccination drive at full steam, we seemed to have dithered, dividing our attention between an all out domestic vaccination effort and exporting the vaccine to the rest of the world. Meanwhile, elections arrived. Political parties of all hues and their star campaigners threw caution to the wind and competed with one another in holding huge election rallies that violated every Covid-appropriate norm, in order to gain as much of electoral mileage as possible, at the expense of the health of the people. They created opportunities for the virus to spread like wild fire and spiral into a debilitating second wave. The Kumbh Mela held in Uttarakhand added further fuel to it. There were protest rallies in different parts of the country which also could have contributed to the rapid transmission of the virus far and wide. Liquor being an important commodity that yielded the much needed revenue for the fiscally imprudent governments, people were allowed to line up in large numbers in front of liquor shops. Incidentally, liquor has also become an important input for the political leaders to benumb the masses into casting votes for them. Now, liquor queues also contributed to spreading the virus further.

The fury of the second wave has been such that it put every item of hospital infrastructure to test. Had the government foreseen the second wave and held back on election rallies and religious congregations, the havoc caused by it would have been far less. Unfortunately, the government failed to size up the imminent crisis properly and committed lapses in ramping up the medical infrastructure to the levels needed. Had a proper assessment been made of the intensity of the second wave, perhaps the government would not have resorted to export of essential items like oxygen, ventilators etc. As a result of our failure to foresee the crisis, many lives are being wantonly lost today, either due to non-availability of hospital care or due to inability of the hospitals to supply oxygen to their patients. The tragedy of the present crisis is such that those who have lost their kith and kin are finding it difficult even to secure space for cremating/burying the dead!

Does it not suggest a governance lapse on multiple fronts? Let us consider the related issues in some detail.

1.  Could we have foreseen that a second wave of Covid would arrive and cause so much havoc?

Anyone with a rudimentary knowledge of the way the Spanish Flue of 1918 progressed and, more recently, how both Europe and USA are experiencing wave after wave of Covid, causing immense devastation, could not have failed to foresee a second wave of Covid coming in India.

The Spanish Flue lasted from March 2018 till it fully subsided in the summer of 2019. The pandemic peaked during the highly fatal second wave, in the fall of 1918. A third wave occurred during the winter and the spring of 1919. The havoc wreaked by Covid again and again on Europe, the USA and several South American countries is known to all of us. To assume therefore that India had “conquered” Covid when the first wave was abating was clearly uncalled for. The political leadership should have listened to its expert advisers, instead of prematurely loosening the controls and displaying fool hardiness in taking undue credit for containing the virus. The respite that was available after the first wave should have been taken advantage of by the government to prepare adequately for the second and perhaps the subsequent waves. Too much of optimism, when it influences the planners, could prove expensive, as it seems to have happened in our case.

What really fuelled the second wave into becoming so virulent as it is today is the reckless manner in which the political parties and their leaders rushed into holding massive election rallies in the five poll-bound States and the callous manner in which the Uttarakhand government has gone ahead

with the Kumbh Mela, where several lakhs of pilgrims gathered to take a daily dip in the river for several days. These rallies and the Kumbh have apparently become super-spreaders that accelerated the spread of the virus not only in those States but also in the other States. The political leaders squarely responsible for this seem to be far more interested in winning elections or gaining indirect electoral advantage, than valuing human life. One is reminded of the age old legend in which Faust makes a deal with Mephistopheles, the Devil’s agent for worldly knowledge and pleasure, in exchange for his soul. Many political leaders display no hesitation whatsoever in selling their souls, if it can assure them of a win in elections!

The leaders who also occupy responsible positions in the government are expected to do what they say; they are expected to set an example to the people. However, they are good at delivering homilies to the people on how they should conduct themselves to combat the Covid virus but what they do is at variance with what they preach. In the election rallies, starting with the Prime Minister and the Home Minister, the star campaigners of almost all political parties, have remained mute spectators and often facilitators of crowds flouting the Covid norms. We seem to have a strange Dr Jekyll-Mr. Hyde situation in which political leaders in the “Dr Jekyll” avatar behave as though they are the people’s benefactors but in the “Mr Hyde” avatar, they do everything contrary to it.

Considering that the election rallies and the Kumbh Mela have become super-spreaders of the virus, should they not own responsibility for the present crisis and subject themselves to the rule of law, like any other ordinary mortal?

2.  Election Commission of India (ECI):

Following the direction issued by the Union Home Ministry in pursuance of the Disaster Management Act (DMA), the ECI also issued specific guidelines to the political parties to comply with “Covid-appropriate” norms of behaviour during electioneering. ECI’s guidelines sounded more like a polite appeal than a firm direction issued in exercise of its authority. The guidelines conclude by saying, “it is clarified that the Commission, in case of breach, will not hesitate in banning public meetings, rallies etc., of the defaulting candidates/ star campaigners, political leaders without any further reference”. The political parties including their star campaigners, some of whom are very senior public functionaries, blatantly defied those guidelines and did everything that was Covid- inappropriate. The ECI could have invoked its inherent authority and taken action to ban the rallies as soon as the Model Code of Conduct came into force and direct the local police to file cases against the violators of the Covid norms under both the DMA and Sections 269 and 279 of the Indian Penal Code (IPC) [“spreading an infection endangering human lives”]. The Commission could have directed the political parties to use the virtual platform only for electioneering. For reasons best known to it, the Commission failed to enforce its own directions. In a Writ Petition on elections, the Calcutta High Court is reported to have reminded the Commission of how the former election commissioner, T N Seshan had asserted the Commission’s authority in such matters. While all other political parties prudently announced cancellation of their rallies, though quite belatedly, the BJP chose to continue with its rallies, gloating over the large numbers of the people in attendance. Following the court’s intervention and only after the BJP also announced cancellation of rallies subject to a maximum of 500 participants, the Commission issued an embargo on rallies. It is like closing the stable door after the horse has bolted. Had the ECI exercised its authority and banned the election rallies right from the beginning of electioneering, many precious lives could have been saved!

3.  How quick had been the government’s response in terms of R&D effort to combat Covid?

New mutants of Covid are rapidly evolving in India like everywhere else. The available vaccines may not effectively counter some new mutants, unless the characteristics of the new mutants are identified early through genome sequencing and built into the vaccine development process on a continuing basis. This calls for continuing R&D effort based on genome sequencing for each new mutant. For this, the Indian scientists, who compare with the best anywhere else, need funds and other facilities. Investigation reports (

https://indianexpress.com/article/india/covid-virus-strain-india-gene-study-7280783/) indicate that the government’s complacency after the first wave led to its dithering on providing adequate funding for the concerned laboratories, resulting in a slow down in the genome sequencing effort between November 2020 and January 2021. One should not be surprised if this has held back our efforts to fine tune the indigenously developed vaccines to counter the new mutants.

It is not as though providing adequate funding for vaccine-related R&D effort is difficult. The funding required is minuscule compared to what the government has spent on erecting statues and will be spending on the Central Vista building complex in Delhi or what the political parties squander on election rallies.

Incidentally, had PMCARES Fund, the Society headed by no less than the Prime Minister himself allotted adequate funds for R&D effort, it could have helped our laboratories a great deal in their R&D effort. Unfortunately, the functioning of PMCARES has remained opaque, without sufficient accountability to the public. Should not the office bearers of the Fund make an accurate and comprehensive disclosure to the public about the details of the donors and the purposes for which the fund has been utilised?

4.  How is it that India, a large producer and exporter of vaccines, including the Covid vaccines, is struggling to find enough vaccine to vaccinate its own people?

Largely as a result of the scientific muscle built over the last several decades, India could set up sufficient Covid vaccine manufacturing capacity of its own within a record time. In the normal course, had the government taken full advantage of this and launched an all-out vaccination drive in right earnest, it could have covered a significant proportion of the 90 million 18+ population by now. Our vaccine industry is also working simultaneously on vaccines for children. However, Vaccine Maitri, a diplomatic initiative of the government appears to have taken precedence over domestic vaccination drive. Under this scheme, 66 million vaccine vials have been exported to 94 countries, out of which 35.8 million were given in grant to 48 countries. Today, even for the second dose in India, those in dire need are scrambling.

To get vaccinated is a fundamental right flowing directly from Article 21 of the Constitution. However, that right stands compromised, degenerating into charity meted out to the citizens.

5.  Why is there such an acute shortage of hospital infrastructure facilities, Oxygen and other medical inputs?

Almost six months ago, the Parliamentary Standing Committee on Health and Family Welfare, in their 123rd report (November, 2020) made the following observation.

The Committee observes that the total number of Government hospital beds in the country was grossly inadequate keeping in view the rising incidence of Covid-19 cases. Attention of the Committee has also been brought to Media Reports which highlighted the abysmally low number of beds in Government hospitals in the country especially at the peak of the pandemic. Data from National Health Profile–2019 states that there are total 7,13,986 Government hospital beds available in India which amounts to 0.55 beds per 1,000 population. As per Reports, 12 States stand below the national level figure. The Committee notes that lack of hospital beds and the inadequate ventilators further complicated the efficacy of the containment plan against the pandemic. As the numbers of cases were on the rise, a frantic search for vacant hospital beds became quite harrowing. Instances of patients being turned away from overburdened hospitals due to lack of vacant beds became the new normal. The scenario of patients holding oxygen cylinder rushing from pillar to post in search of bed in AIIMS Patna is a testimony to fact that tear apart humanity. The Committee is aggrieved at the poor state of healthcare system and therefore, recommends the Government to increase the investment in public health and take appropriate steps to decentralise the healthcare services/facilities in the country

Had the Centre heeded to these sane words, it could have ramped up the infrastructure to match the emerging need. No wonder when Covid came in its second wave, that too, in such an intense form, the gaping holes in infrastructure got fully exposed. News reports suggest that India sold twice as much oxygen to the world during the first ten months of fiscal 2020-21 as compared to exports during the previous financial year. (https://www.businesstoday.in/current/economy-politics/india- doubled-o…orts-to-930). The government has tried to explain this away by saying that it was industrial oxygen that was exported, not medical oxygen!. Today, it is industrial oxygen that is being converted into medical oxygen and rushed to States like Maharashtra and Delhi. As I write this article, one special train carrying medical oxygen provided by the Visakhapatnam Steel Plant is on its way to other States. Had the government exercised due diligence by anticipating the peak demand for oxygen during the second wave on a pessimistic basis and planned the supply chain, the unseemly crisis that is witnessed to day could have been preempted.

The same is the case with oxygen therapy equipment, ventilators etc. which were similarly permitted to be feely exported last year, leading to shortages at the present moment. Those in charge ought to have planned not only oxygen availability but also the logistics involved, especially since oxygen transport requires cryogenic facilities. From TV reports, it appeared that India would be airlifting cryogenic tankers from Singapore, which suggests that we are forced to fire fight. There is a high-level Task Force of officials set up by the Central government and a Group of Ministers on Covid but it is doubtful that they had met frequently to monitor the supplies, till the crisis overtook the country.

It is not just supplies of oxygen and ventilators that need to be carefully monitored and planned but also various other crucial items that go into the manufacture of the vaccines. For example, vaccine manufacture requires timely availability of syringes, which are also made in India. Other inputs are to be procured from the USA and other countries. It appears that bottlenecks have arisen in the case of several imported items. Unless the hurdles are removed, even domestic manufacture of the vaccines could face problems. An important precaution to be taken is to insulate the domestic manufacturing units from Covid, as we can ill afford to allow those facilities to come to a grinding halt as a result of the workers getting infected! Already, many medical and para-medical personnel have got affected and hospital healthcare systems have come under pressure.

6.  Governance failures on multiple fronts:

The Covid emergency that has arisen in the country is the cumulative outcome of misgovernance on multiple fronts. One cannot afford to take the prevailing Covid crisis lightly, as it has caused human misery and trauma on a very large scale. Ambulances for taking patients to the hospitals are not easy to get these days. There are patients waiting in long queues for admission to hospitals and in that process, losing lives. In hospitals, many patients are literally gasping for breath due to dwindling oxygen availability and inadequate ICU facilities. The kith and kin of those who have lost their near relatives are forced to wait for hours at the over burdened cremation grounds. While Covid is singeing the nation, like Neros, many political leaders are making merry at election rallies, insensitive to these harsh realities. Had those in authority stayed back at their posts and devoted 100% of their attention to dealing with the virus, instead of spending their time addressing election rallies and gloating over the presence of large crowds, India’s response to the crisis would have been different and more effective.

The daily count of deaths due to Covid has broken a mind-boggling figure of 2,000 and no one knows where it is going. As one report suggests, as on date, the mortality per million in India is worse than in the neighbouring Pakistan, Nepal, Bangladesh and Sri Lanka. With all the healthcare facilities at our command and the industrial muscle we have built over the years, should this not make us feel ashamed of ourselves? Those who thought they had “conquered” Covid should feel a sense of shame and repentance.

Every life lost due to Covid was a valuable one for which those directly/ indirectly responsible should be held accountable. When an ordinary defenceless citizen can be summarily penalised for not wearing a mask, why should those leaders who have played a crucial part in escalating the Covid crisis be left unpunished? In fact, the doctrine of proportionality calls for larger penalties on them, as the offences committed by them are far more serious in nature and far more devastating. There cannot be one set of rules for the ordinary citizens and another for the influential. This is unacceptable.

7.  Conclusion:

The concerns expressed above need to be discussed and debated widely. The welfare of the citizens should have overarching precedence over petty politicking in the name of winning elections at any cost. As a society, we are committed to promoting human welfare. Anything that runs counter to that has no place in a democracy. An ethical, participative democracy is what we need, not an “elected” autocracy that has no sensitivity to the well being of the people at large.

E A S Sarma, Former Secretary to GOI, Visakhapatnam


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