For the past five days, Bijendra Singh has been haunted by the voice of his dead wife, Neelam. “Why could you not get me the treatment that I needed?” she asks. “Why could you not save me, save our baby?”
It was around 6am on 5 June when Neelam, more than eight months pregnant, began complaining of lower back pain and breathlessness. Presuming it was early contractions, Singh and his wife set off in his brother’s auto-rickshaw to a government hospital in the Uttar Pradesh city of Noida. Before leaving, they kissed their five year-old son goodbye and promised they would be returning with the birthday present he had requested: a baby sister.
However, because of her suspected Covid-19 symptoms, they were refused entry at eight hospitals. It was to be a 15-hour ordeal that would expose how the coronavirus pandemic has pushed India’s healthcare system to the brink of collapse, and would result in the needless death of 30-year-old Neelam.
“From the beginning of this pandemic, the government completely underestimated the virus,” said Dr Harjit Singh Bhatti, who works on the Covid-19 ward of Delhi’s Manipal hospital. “We had over two months of lockdown, but all that time was wasted. We have not seen any investment in healthcare, which will be the only way to get this under control.”
He added: “Every day I see the number of patients are rising, while hospital admission is becoming impossible and many are dying outside hospitals. Healthcare workers are all getting infected in droves and our healthcare system in Delhi is already exhausted. If strong steps are not taken now, I expect the healthcare system to collapse in a few weeks.”
On Monday, India began easing its coronavirus lockdown, one of the largest and strictest in the world, with shopping malls and places of worship opening their doors for the first time in more than two months. It joined countries such as neighbouring Pakistan as well as Mexico, Russia and Iran, who, despite escalating infection rates, have decided to ease restrictions.
Cleaning staff throw medical waste into a bin at Guru Nanak Dev hospital, Amritsar. Photograph: Narinder Nanu/AFP/Getty Images
Cases in India, currently at 298,000, are increasing by 10,000 a day and the country has overtaken the UK to become the fourth worst hit in the world. India’s biggest cities of Delhi, Mumbai and Chennai are running out of not only beds but also doctors and nurses to treat the unprecedented numbers of patients, and university medical professors have been seconded to work on Covid wards. Private hospitals have been charging upwards of 80,000 rupees (£840) per night for those who are admitted with Covid symptoms – unaffordable prices for even middle-class let alone poorer Indians.
Singh, a factory worker from Khora Colony in Ghaziabad, took his wife first to a government hospitalin the neighbouring city of Noida. But the doctor insisted they could not admit her. It was to become a familiar refrain. At another hospital nearby, an ambulance driver refused to go near Neelam because he suspected she had Covid-19, and she was refused admission. They then went to the private Shivalik hospital. “But again the doctor said there, sorry, this looks like a Covid case, we don’t have ventilators or beds,” said Singh.
They tried eight hospitals, each time being denied entry because medics suspected from Neelam’s breathing troubles that she had Covid-19, although she was never tested.
“At the fourth hospital, I broke down, pleading with them, telling them I had been going around hospitals all morning. They told me ‘we cannot treat her, she will die here’,” said Singh. “My wife was shouting out: ‘I need oxygen, I need painkillers, please help me,’ but no one listened to her.”
By the time the couple reached their next hope, Sharda hospital, they were so desperate that they paid for Neelam to be transferred to an ambulance so she could have access to an oxygen tank.
At the seventh hospital, Gims hospital in Noida, when it too refused to admit her, Singh called the police. “I could not bring myself to go back into the ambulance and face her. She kept telling me: ‘I won’t survive much longer, please get me help, you are not doing anything for me.’ At this point I lost all my strength.”
A colleague helps a nurse put on PPE in Max hospital, New Delhi. Photograph: Atish Patel/AFP/Getty Images
But even the two officers could not get her a bed. Singh and Neelam drove 30 miles to the Max hospital in Ghaziabad, where again doctors walked him into the ward to show him it was full, so they drove back to Gims. “But when we got there, I pulled the oxygen mask off my wife’s face and she was dead,” said Singh.
“Please know I did everything to save her and my baby. It is not my fault, the system is broken.”
The consequences of a pandemic in India, a poverty-stricken and densely populated country that spends just 1% of GDP on healthcare, are becoming more apparent by the day.
Hospital morgues are overflowing with bodies: Delhi’s LNJP hospital morgue, which has capacity for 45 bodies, last week had 108 piled up. Nigambodh Ghat, New Delhi’s biggest and oldest crematorium, has begun building traditional funeral pyres because their furnaces cannot keep up with the number of bodies, around 30 a day more than usual. They have performed more than 500 coronavirus-related funerals in the past two months.
Delhi’s deputy chief minister, Manish Sisodia, has said the capital will have more than 500,000 Covid-19 cases by July and will need to increase the number of beds from 9,000 to 80,000 to meet demand. “For Delhi, this is a big problem if cases continue to rise,” Sisodia said.
Balram Bhargava, the director general of the Indian Council of Medical Research, insisted India was still “definitely not” in a community transmission stage of the outbreak, even though officials in Delhi admitted they knew the source of only around 50% of infections. But this was rejected by Bhatti, the Covid-19 doctor. “The claims of no community transmission is rubbish, it is only to save the government from criticism and so they can avoid spending more money on hospitals and manpower,” he said.
Only 5m tests have been done in a country of 1.3 billion people. And while India’s official death toll of 8,102 is comparatively low, some analysts believe this may be due to rampant under-reporting and also the fact that 65% of India’s population is below the age of 35, compared with nations with more vulnerable, ageing populations.
Even the home minister, Amit Shah, admitted in a speech on Monday that the government, which last month announced a stimulus package billed as being worth $266bn, “may have made a mistake, we may have fallen short” in the fight against the virus.
The situation has become so bad that not even money and influence can pull the usual strings. Resident associations for affluent neighbourhoods have begun buying their own oxygen supplies. In Delhi’s Greater Kailash I (GK1), an upmarket area in south Delhi, the residents’ association has purchased two oxygen concentrator machines, while in the housing complex of Eldeco Utopia in Noida, residents have bought 20 oximeters and sequestered five rooms, equipping them with oxygen cylinders, a stretcher, a wheelchair and PPE kit.
“The bubble we lived in has burst,” said Rajiv Kakria, an adviser to the GK1 residents’ association. “You can have money. You can have connections and know influential people, but it doesn’t mean anything. You can still die waiting for a bed or oxygen.”