India’s COVID-19 afflicted left ‘to fend for themselves,’ overwhelmed families say

KOLHAPUR, India – Aishwarya Tandon knew that her grandmother, feverish and breathless, had COVID-19.

But no hospital would admit her without already having a positive coronavirus test, which was hard to come by.

"We were basically just going to hospitals door-to-door, and nobody was helping us," said Tandon, 28. "There were literally no leads. You really had to plead (with) people."

As India reels from a new variant and a second wave of COVID-19, its health care system is overwhelmed. And so are its citizens, grappling with the physical, mental and emotional onslaught of caretaking and loss.

The nation of nearly 1.4 billion reported more than 400,000 daily new cases several times over the course of the month, shattering global records. Public health professionals estimate the true infection numbers could be 10 times higher than the official reports.

A health worker takes a water break at the BKC jumbo field hospital, one of the largest COVID-19 facilities in Mumbai, India, May 7, 2021.
A health worker takes a water break at the BKC jumbo field hospital, one of the largest COVID-19 facilities in Mumbai, India, May 7, 2021.

Tandon ultimately "had to bribe" someone for a COVID-19 test for her 69-year-old grandmother, Usha.

Two days later, it came back positive, and Tandon again reached out to hospitals to try to find an available bed.

"I must have called at least 20 hospitals," she said. "One of them confirmed a bed. When I reached there, they turned it down because they said the patient doesn’t appear to be very, very sick." Her grandmother, meanwhile, was "gasping," she said.

The next day, they confirmed another bed.

"We arrived early. By the time we actually got the bed, there was some 25 people waiting," Tandon said.

When her grandmother finally reached the bed, the patient next to her died.

"Nobody came to claim that body," so her grandmother spent 12 hours less than a foot away from a corpse, Tandon said. "There was no shield that they could put in the middle of the two beds because the space was at capacity. There was more beds than the space (allowed)."

Tandon, who was not allowed inside the hospital, said her grandmother was in a "very traumatic state."

"The mental state of my grandmother went haywire," she said.

She ultimately decided to take her chances at home.

Skyrocketing prices for lifesaving –and life-ending – needs

Before making the 12-hour drive to Dehradun, the capital of the northern state of Uttarakhand, to help her sick grandmother and aunt, Tandon purchased medical equipment in New Delhi.

"It was impossible to get anything in Dehradun," she said.

"It’s quite sad that the government has just left if to the citizens to fend for themselves. The doctors are getting by saying OK, she is positive, so go get plasma or go get a (oxygen) cylinder. It’s not our job to do that, you know? Our job is to get the patient to the hospital, and the hospital is supposed to take over. Every step, everything you have to do on your own."

As it was, Tandon said she paid 10 times the typical price for an oximeter, five times the usual for an oxygen cylinder and 50 times the price for a flowmeter, which is necessary to operate an oxygen cylinder.

"There are people using this as a cash opportunity," Tandon said.

In Jharkhand, a primarily rural state in eastern India, a woman said a black market has emerged for medicine and medical supplies, and many people are turning to home remedies. She said oxygen cylinders now cost at least seven times what they cost her last year, when she borrowed one for her grandmother.

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Showkat Ahmed War carries an empty oxygen cylinder to get it refilled at a gas supplier facility in Srinagar, Kashmir, which is controlled by India, on May 11, 2021. War traveled about 40 miles to refill the cylinder needed for his ailing father due to the huge demand for oxygen after the surge in COVID-19 cases.
Showkat Ahmed War carries an empty oxygen cylinder to get it refilled at a gas supplier facility in Srinagar, Kashmir, which is controlled by India, on May 11, 2021. War traveled about 40 miles to refill the cylinder needed for his ailing father due to the huge demand for oxygen after the surge in COVID-19 cases.

The 37-year-old, who requested that USA TODAY not share her identity because she works for the government and feared retaliation, said she lost three close family members and two distant family members in the span of a week.

"This particular surge has actually shook us completely," she said on the phone from the state's capital, Ranchi. "I in my lifetime never thought of losing three people at a stretch. People are dying struggling for healthcare. Even families are struggling to provide support."

Her family even struggled getting last rites.

"As a Hindu, there’s a lot of work once a person passes away," she said. "The last rites continue for 14 days. So those 14 days were very, very difficult because we couldn’t find a priest who could actually chant mantras or do the work."

At the crematorium, there were no pyres available when the family arrived with her grandfather's body, the woman said. About a dozen bodies were being burned, and a queue had already formed. The woman said her family waited in line all day at the crematorium.

"They had to. They had no option," she said.

Her grandfather was finally cremated after 9 that night, she said.

"Every particular service that is available at the cremation ground has doubled," she said. "The pyre’s prices were three times the charge."

Her uncle also died, but the family doesn't know whether last rites were administered because the hospital wouldn't release the bodies of people who died of COVID-19. Her uncle and her grandfather had both called for ambulances. Her grandfather died waiting for one. Her uncle waited, then walked to a health facility, then another, and died the next day. He was 45.

'They can't afford' isolation

In Western India’s Maharashtra state, Dr. Nilesh Thackeray has been working at two village health sub-centers a dozen miles apart in Kolhapur district, where the fatality rate is 2.7% – the highest in the state. For 400 days now, he’s been tasked with detecting cases at the initial stage in the villages of Tardal and Alte.

"In rural areas, the biggest problem comes at the detection stage," he said. "Even if the person has tested positive, they aren’t reporting it to us."

Thackeray shared the story of a man who tested positive but didn't contact him until eight days later, once his oxygen levels had dropped.

"He was roaming in the village and didn’t isolate despite testing positive," Thackeray said. "Because of such cases, contact tracing isn’t working as efficiently as it was working in the first wave."

Nigave Dumala, another village in Maharashtra state, still has no testing facility a year into the pandemic, said health care worker Deepali Rawal. Residents must travel more than 9 miles to get a COVID-19 test, Rawal said, and with no public transport, patients often have to spend money on private vehicles they can't afford.

And if the tests come back positive, some people with COVID-19 still go outside – many have lost income and are looking for jobs, Rawal said.

"They can’t afford 14 days of isolation," she said. "Often, villagers tell me that they will either die of hunger or corona."

They can't afford treatment in a private hospital but don't trust local government hospitals, which have a much higher fatality rate, Rawal said.

'People still make them a pariah'

Another disincentive for testing: Thackeray said COVID-19 patients have been "stigmatized" by villagers, and some have lost their jobs as a result of infection.

"Even if someone has recovered from COVID, people still make them a pariah and don’t allow them to step outside the house for several weeks," Thackeray said. "In such a fearful atmosphere, no one wants to get tested. The patients who are showing up in the villages are the ones who ignored the symptoms at earlier stages."

May 5, 2021: A woman pulls away her crying relative as she reacts to the burning funeral pyre of their family member who died of COVID-19, at an open crematorium set up at a granite quarry on the outskirts of Bengaluru, India.
May 5, 2021: A woman pulls away her crying relative as she reacts to the burning funeral pyre of their family member who died of COVID-19, at an open crematorium set up at a granite quarry on the outskirts of Bengaluru, India.

The woman who lost numerous family members said she has been on the receiving end of that stigma.

"The moment there’s a death in the family due to COVID, you’re already sidelined from the society. People wouldn’t visit you at any cost," she said. "They are afraid of getting infected, and there is also a stigma associated. People sideline you. They do not want to help you."

No vaccines, no PPE on $54 a month

Families are not alone in their frustration and exhaustion. In the past 400 days, Rawal doesn’t remember taking a leave.

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Rawal works as one of hundreds of thousands of Accredited Social Health Activists who serve as the backbone of rural India’s health care system, tasked with containing local transmission of COVID-19.

ASHA workers like her receive an average stipend of $54 monthly for completing more than 50 tasks, including community surveys, vaccinations and maintaining health records.

Rawal said she's been doing the work for over a year now without the proper PPE.

"What if we die of COVID tomorrow? Who will be responsible?" she said.

Thackeray, for his part, said many of his team members, who are community health workers, haven’t been vaccinated yet.

"If the frontline health care workers aren’t vaccinated, there’s a major risk to the entire community," Thackeray said.

'Everyone wants to know when they will get the vaccine'

In the village of Tardal, in Maharashtra state, community health officer Seema Koli gets over 100 calls daily.

"Everyone wants to know when they will get the vaccine," she said.

Community health officer Seema Koli, left, addresses a villager's question about the COVID-19 vaccine near the health center in Tardal, India.
Community health officer Seema Koli, left, addresses a villager's question about the COVID-19 vaccine near the health center in Tardal, India.

Since late last month, more than 300 people have been gathering outside the health center each day, clamoring for a shot.

"I kept informing every single person that the sub-center received only 50 doses," she said. "I make calls in the nearby villages and ask if vaccines are available. Unfortunately, in most cases, I have to turn down the people’s requests."

India is home to the world's largest vaccine manufacturer, but the country has restricted COVID-19 vaccine exports amid its domestic surge. Government data shows India has administered about 167 million doses total, with around 34 million people receiving both doses. That's just a little over 2% of the country's population.

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Jaidee Meshram, an auxiliary nurse midwife, vaccinates a man against COVID-19 in Tardal village in Maharashtra, India.
Jaidee Meshram, an auxiliary nurse midwife, vaccinates a man against COVID-19 in Tardal village in Maharashtra, India.

Jaidee Meshram, a nurse who administers vaccines, said the center receives an inconsistent number of doses each day – sometimes 300 doses, and sometimes none at all.

"It has led to overcrowding at the subcenter with no physical distancing," Meshram said. "Imagine getting infected when you have come for vaccination. This is how bad it is in the villages."

The woman who lost multiple family members said she registered to get vaccinated but has not been given the opportunity to make an appointment yet. She said she fears getting sick if she arrives at a hospital crowded with people waiting in line.

"It’s difficult because we don’t know what’s going to happen. We don’t have any definitive answer for what we’re facing right now," she said. "There is a lot of panic around."

Tandon, whose grandmother and aunt recovered at home, said she received the Covishield vaccine, a version of the Oxford-AstraZeneca vaccine that manufacturers produce in India.

But as Tandon spoke to USA TODAY by phone during her drive back toward New Delhi, she revealed she wasn't feeling well.

"I started to feel the symptoms myself," she said. "And I don’t want to expose somebody else."

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This article originally appeared on USA TODAY: India COVID cases push health care workers, families to breaking point