Breathless patients queue outside hospitals as a second wave of Covid infections crashes over India
When Arun Gangrade was told his father was struggling to recover from Covid-19, he didn’t hesitate to fly home to Nagpur, in the state of Maharashtra.
The 28-year-old chemical engineer spent the next week caring for his father before developing unusual headaches and subsequently testing positive for the virus himself.
Under the rules set by the authorities in Nagpur Mr Gangrade required immediate hospitalisation.
But, to his shock, both the first and second hospitals he called had no more space for Covid-19 patients. Social media is awash with pleas from Nagpur’s 2.4 million residents desperately searching for beds for their ailing loved ones.
India recorded over 68,000 new infections on Sunday – a rapid, six-fold escalation in cases since mid-February and the country is now fighting to contain a resurgent outbreak that is increasingly thought to be driven by new, more transmissible variants.
Nagpur, and the western Indian state of Maharashtra, is experiencing the worst of the surge, reporting more cases than at any other point during the pandemic. On Friday, more than 4,000 people tested positive for Covid-19 in the city.
Nagpur has become the first major Indian city to return to a lockdown since June and an eerie silence has descended over its usually bustling streets.
“The last three weeks have been unprecedented, with more patients than during the first surge and we are seeing a shortage of beds,” said Dr Prashant Rahate, the chairman of Nagpur’s SevenStar Hospital, “Both the government and private hospitals in Nagpur are flooded.”
A reluctance to adhere to social distancing rules is the official reason for the resurgence, as well as Indians delaying getting tested until their symptoms become severe.
While both factors have certainly contributed to the surge, there is mounting evidence that more transmissible variants could instead be behind the country’s sudden “second wave”.
On Tuesday, the Indian government announced it had detected 795 positive cases of the UK, South African and Brazillian variants, with around half of these infections occurring since March 18.
India is only genetically sequencing 0.1 per cent of its positive cases, far below the UK’s five per cent, so it is believed that these figures are an underestimate.
In India’s northern state of Punjab, also badly affected by the resurgence, the UK variant – which is up to 70 per cent more contagious – was found in 81 per cent of 401 samples collected between January 1 and March 10.
There is also concern about a more transmissible domestic strain, after the Indian Government said it had found 771 variants of concern, including one “double mutant” strain which has infected over 200 people in Maharashtra.
The “double mutant” strain contains two key variations: one identical to a variant identified in California, which studies show is more contagious, and another similar to the South African strain, which can re-infect patients.
“Mutant viruses have been discovered in India and the variants of concern that are circulating everywhere else have also been seen here. For example, the UK variant, which really spread very fast and there is evidence that it is putting more people in hospital in the UK, and it is now circulating in the community in some parts of India,” said Dr Shahid Jameel, one of India’s leading virologists.
The Indian government has been slow to sequence positive Covid-19 cases, despite warnings from public health experts that this could result in new strains circulating unknowingly in India’s densely-populated megacities.
“We are always going to be playing a cat and mouse game, the virus is going to adapt and evolve. The priority for the Indian Government should now be identifying which of these strains are more contagious and deadlier,” said Dr Ramanan Laxminarayan, the director at the Center for Disease Dynamics, Economics and Policy.
In Nagpur, doctors are increasingly convinced that these new variants are behind the resurgence. They are also seeing an increase in younger patients and patients being admitted for longer.
“What we are generally noticing is that people are getting infected much faster. Earlier we were seeing one member of a family getting infected and isolating successfully but now we are seeing whole families coming in,” said Dr George Fernandes, the CEO at Viveka Hospital, the biggest private Covid-19 centre in central India.
“It’s too early to comment conclusively but the disease is now manifesting itself over a longer period of time. People are being hospitalised for 10 days, rather than five to seven days, as during the first wave. We are definite that the mutation is around, but it is too early to say what the exact effects are.”
Around 25 per cent of the 160 Covid-19 patients recently admitted to Kingsway Hospital, the largest private tertiary care hospital in Nagpur, are under the age of 40. During the first wave, the number of patients below 40 was very low.
An increase in the number of younger patients has also been noted over recent weeks by staff at SevenStar Hospital.
“If clinicians are saying they are experiencing different behaviour of the virus, we should really be paying attention to that and can say it is possibly because of a mutant,” said Dr Jameel.
Mr Gangrade counts himself as one of the lucky ones, as he was eventually admitted to SevenStar hospital.
Many are not so fortunate, says Dr Mohan Nerkar, chief physician at SevenStar: “One month back, we had 20 patients in total and now we are getting 50-60 people arriving in our triage department per day.”
The state-of-the-art hospital is already at capacity – as soon as one patient is discharged another is admitted from an endless waiting list.
According to official figures there were 494 vacant beds for Covid-19 patients in the city’s hospitals on Friday but the reality for Nagpur’s citizens appears very different.
When the Telegraph contacted four major private hospitals in Nagpur on March 25 – Care Hospital, Viveka Hospital, Kingsway Hospital and the Aureus Institute of Medical Sciences – they were all full.
Local healthcare activists claim public hospitals are unable to admit patients without a high-profile referral and there are reports in the local media of Covid-19 patients sharing beds, although the Telegraph could not verify these claims.
Last week, the Government Medical College Hospital in Nagpur hurriedly reopened a flooded basement after approximately 60 “breathless” patients were queuing outside for beds.
“The lack of hospital beds is going to impact the recovery of patients, some may lose their life while on their way to a hospital,” said Dr Nerkar, who describes the situation in the city as “very critical”.
Facing growing domestic pressure to take firm action against India’s second wave and amidst sluggish take-up of immunisations among frontline workers, Prime Minister Narendra Modi announced a temporary halt on the export of the AstraZeneca vaccine which is being manufactured in the country.
New Delhi will now stockpile doses ahead of accelerated plans to immunise all of its citizens over the age of 45 from April 1, despite facing criticism from countries awaiting exports.
The UK said this will reduce availability in April, while many lower and middle-income countries expecting doses from India through the World Health Organization’s Covax scheme will also be impacted.
In India, the move has been lauded.
“The whole year I have watched many people succumb to Covid-19 despite all the available facilities due to rapid progression of the illness,” said Dr Nerkar, who believes he has treated over 5,000 Covid-19 positive patients at SevenStar Hospital.
“I think we should be vaccinating everyone over the age of 18, particularly in areas like Nagpur where we are seeing a surge. It is the time to be putting India first.”