SharecloseShare pageCopy linkAbout sharingimage copyrightGetty ImagesIndia’s deadly Covid-19 second wave has devastated big cities like Delhi, Mumbai, Lucknow and Pune. Hospitals and crematoriums have run out of space, and funerals are taking place in car parks. But the pandemic has now firmly gripped many smaller cities, towns and villages where the devastation is largely under-reported.Rajesh Soni spent eight hours taking his father from one hospital to another in a tuk-tuk in Kota district in the northern state of Rajasthan on Tuesday. He couldn’t get an ambulance and the rickety vehicle was his only option. At 5pm, he decide to end his search for a hospital bed as his father’s condition was deteriorating. He then “left everything to fate” and came home.”I am giving him medicines at home, but I am not sure that he will survive. We have been left to die on the streets,” Rajesh said. He says several private hospitals even “conned” him and took money to do tests, only to tell him later to take his father away as there were no beds.”I am not a wealthy person. I spent whatever I had to pay the tuk-tuk driver and to hospitals. Now I am going to borrow some money to get an oxygen cylinder at home.”Why second Covid wave is devastating IndiaWhy India’s Covid crisis matters to the whole worldSuch stories have become common in Delhi, the worst affected city in India, but similar accounts are now coming in from smaller cities and towns across the country.The BBC looks at what’s happening in five different states to see how fast the virus is spreading there. Kota, Rajasthan stateThe city and surrounding district has reported more than 6,000 cases in the past week, and 264 deaths since the pandemic began – but 35% of those happened in April alone. Up to 7 April, it was taking 72 days for the number of cases to double, but now it’s 27 days.All oxygen beds were occupied, and only two out of the district’s 329 ICU units were free on 27 April. A senior journalist in the city told the BBC that hospitals were overrun and “this suggests that the actual numbers are much higher”.There is an acute shortage of oxygen and drugs like remdesivir and tocilizumab. The district is home to many coaching centres for students from all over the country taking exams to get into prestigious medical and engineering colleges. But the students have left and the district is now in turmoil and largely away from the radar of national and international media. The journalist said the city’s hospitals were not ready for what he described as a Covid tsunami. He said there was an urgent need to add “more oxygen and ICU beds before more people start dying on the streets”.Allahabad, Uttar Pradesh stateThe city, also known as Prayagraj, had recorded 54,339 cases up to 20 April, but it has registered a 21% increase since then, adding 11,318 cases in the past week. About 32% of the reported 614 deaths in the city happened in April alone. There is no official data on healthcare facilities in the city, but several people the BBC spoke to said they had been unable to find a bed for their loved ones.Several calls and written questions to the city’s chief medical officer about the shortage of beds went unanswered. A senior journalist in the city said the actual death toll was much higher as cremation and burial grounds were functioning day and night. Yogi Adityanath, the state’s chief minister, recently said there was no shortage of drugs, hospital beds or oxygen, but experts say the reality on the ground is vastly different.image copyrightGetty ImagesSocial media is awash with posts from people from the state pleading for beds, oxygen and drugs like remdesivir. The chief minister has also warned that action will be taken against any private hospital that “falsely reports” an oxygen shortage.An employee of one small private hospital told the BBC that arranging oxygen had become difficult, but he would not complain because he feared retribution. “But I fail to understand why would any hospital falsely report a shortage. It makes no sense,” he said. There have also been reports about deaths due to oxygen shortages in the state. Several other districts and villages in Uttar Pradesh are also reporting that hospitals have run out of beds.Man charged over oxygen SOS for dying grandfatherIndia’s round-the-clock mass cremationsAshish Yadav’s father is in a critical condition in Kanpur district but he is unable to get him a bed and he doesn’t even have access to a doctor. “I have begged and pleaded everywhere, but nobody helped. Nobody is picking the helpline numbers that have been advertised,” he told the BBC.Kabirdham, Chhattisgarh stateThe central Indian district did not have any active cases of Covid-19 on 1 March. But it has added almost 3,000 cases in the past seven days. Kabirdham district hospital has seven ventilators but there are no trained doctors to operate the life-support machines. According to government data, the district hospital should have 49 specialist doctors, but it has only seven. There is also an acute shortage of nurses and lab technicians. Local journalists say that the district is not able to handle really sick patients as it did not prepare to manage the sharp uptick in cases. Several people have died without getting proper treatment in the district.Bhagalpur and AurangabadBhagalpur district in the eastern state of Bihar is also badly hit. It has recorded a 26% increase in its caseload since 20 April, and the number of deaths increased by 33% in the same period.Only Jawaharlal Nehru Medical College (JNMC) has ICU beds in the district, and all of its 36 units were occupied on 28 April. More than 270 out of 350 oxygen beds in the hospital were occupied. image copyrightGetty ImagesA senior official from the hospital told the BBC that out of its 220 doctors, 40 had tested positive in the past 10 days and four of them died. This has added to the pressure on the hospital. Aurangabad district in the west of the state is also badly hit. It has recorded more than 5,000 cases since 5 April, and six people died in the same period, according to official data. But senior journalists in the state say the actual numbers are higher as testing is a major problem in smaller towns and cities. Many people become critical and die without ever being able to get tested for Covid-19. Such deaths don’t go into official data. Sumitra Devi struggled to get a test done in Aurangabad. She couldn’t get an RT-PCR test done for days as her condition continued to worsen. Hospitals refused to admit her without a positive test result. So her family took her to a small private hospital in a nearby district where she tested positive, but the hospital said she was critical and they didn’t have facilities to treat her. The family then took her to a big hospital in the state’s capital Patna where she was made to wait for several hours before she could be admitted. She died two hours after finding a bed.Nainital, Uttarakhand stateThe tourist district in the Himalayas is struggling to cope with the rising number of cases. At least 131 out of its 142 ICU beds were occupied on 27 April and only 10 out of its 771 oxygen beds were free.image copyrightGetty ImagesIt has reported more than 4,000 cases and 82 deaths in the past week. The district is particularly finding it difficult to handle the rise because it also receives patients from remote towns and villages where healthcare facilities are negligible. A local doctor, who did not wish to be identified, said “the situation was dire and he was terrified”. “We are in this situation because the government didn’t plan to augment facilities in remote areas. I am worried that many people in remote Himalayan areas will die and we will never hear about them. They will never show up in statistics.”

SharecloseShare pageCopy linkAbout sharingimage copyrightSumit KumarRajeshwari Devi, 58, died on Sunday after waiting for two days to get uninterrupted oxygen, an ambulance and a bed in a Covid-19 hospital.She kept waiting and gasping but it was too late by the time help arrived. She was taken to a hospital emergency room on 16 April after her oxygen saturation level dropped. Her CT scan showed that she had developed chronic pneumonia.But without her Covid report the hospital refused to admit her. She spent around 36 hours in the emergency room on oxygen support in the northern Indian district of Robertsganj. The staff there told her family they were running out of oxygen and she needed to be moved to a bigger hospital but there was no ambulance or any promise of a bed. The desperate family took her in their car to a hospital where a bed had become available after the intervention of a politician. She had no oxygen support in the car – she died minutes before she could be admitted to hospital. Ashish Agrahari, her son, says his mother “would have had a chance at survival if treatment was given in time”.Heartbreaking stories such as this are coming in from across India as a second Covid wave wreaks havoc. Data suggests that this wave is proving to be more infectious and deadlier in some states, although India’s death rate from the virus is still relatively low. But the county’s healthcare system is crumbling amid the surge in cases – doctors say it’s hard for them to “see the light at the end of the tunnel this time”. Sharp rise in casesThe rise in case numbers has been exponential in the second wave. On 18 June last year, India recorded 11,000 cases and in the next 60 days, it added 35,000 new cases on average every day. On 10 February, at the start of the second wave, India confirmed 11,000 cases – and in the next 50 days, the daily average was around 22,000 cases. But in the following 10 days, cases rose sharply with the daily average reaching 89,800.Experts say this rapid increase shows that the second wave is spreading much faster across the country. Dr A Fathahudeen, who is part of Kerala state’s Covid taskforce, said the rise was not entirely unexpected given that India let its guard down when daily infections in January fell to fewer than 20,000 from a peak of over 90,000 in September.Big religious gatherings, the reopening of most public places and crowded election rallies are being blamed for the uptick. Dr Fathahudeen said there were warning signs in February but “we did not get our act together”.”I said in February that Covid had not gone anywhere and a tsunami would hit us if urgent actions were not taken. Sadly, a tsunami has indeed hit us now,” he added.”A false sense of normalcy crept in and everybody, including people and officials, did not take measures to stop the second wave.”Shortage of bedsMany Indian cities are reporting a chronic shortage of hospital beds. It’s also evident in the desperate cries for help on social media platforms. Disturbing reports of people dying without getting timely treatment are coming from all over the country.Several state governments say they are creating new facilities but experts say it’s going to be hard to keep up with the pace of the rising number of infections.India has been consistently reporting more than 150,000 cases for days now. It reported 273,810 cases on Monday – the biggest daily spike since the pandemic began.Badly-affected cities like Delhi, Mumbai and Ahmedabad have almost run out of hospital beds. The situation is not very different in other cities, such as Lucknow, Bhopal, Kolkata, Allahabad and Surat. Public health expert Anant Bhan says officials did not use the lean period to boost facilities.”We didn’t learn any lesson from the first wave. We had reports of some cities running out of beds even in the first wave and that should have been a good enough reason to be prepared for the second wave,” he said.He adds that there appears to be a lack of co-ordination between states and the federal government over the supply of oxygen and essential drugs. “We need a consolidated response and resources should be shared between states.” The situation is much more dire when it comes to ICU beds. Several cities have just a few dozen ICU beds left and they are now frantically trying to build extra capacity in hotels and stadiums.But getting ICU beds up and running quickly is not easy. Dr Fathahudeen says adding beds alone is not enough. “We need to ensure that most of these beds have oxygen facility. We need more doctors and nurses to manage extra ICU beds,” he adds.He says it’s going to be a “daunting task” for the government to get such facilities up and running and ensure good quality of care in a short span of time.Unreported deathsThe number of daily deaths has risen sharply in the second wave. India reported 1,761 deaths on Monday, taking the toll to over 180,000 since the pandemic began.Crematoriums have been running day and night in several cities, and people have to wait for hours to get the deceased cremated or buried.Experts say this shows that the actual number of deaths could be much higher. Sanjeev Gupta, a photojournalist based in the central Indian city of Bhopal, reached one of the city’s crematoriums for what he thought was a usual assignment last week. Bhopal had reported only four Covid-related deaths on that day. But Mr Gupta was surprised to see dozens of funeral pyres burning. Additionally, several bodies were lined up to be cremated in the electric furnace. Mr Gupta says he was moved when a young man asked him to photograph the smoke coming out from the chimney of the electric crematorium. “He said the smoke represented his mother. It’s the most heartbreaking thing I have ever heard.”Another photojournalist in Lucknow, which is the capital of Uttar Pradesh state, told the BBC that he counted nearly 100 funeral pyres burning at one of the city’s crematoriums in the city on 14 April. The official death data for the whole state on that day was 85.”The sky had turned orange near the crematorium. I still get chills thinking about it. We are definitely not getting the right death data from the government,” he said.image copyrightEPAAnother photojournalist the BBC spoke to in Varanasi city in Uttar Pradesh state also talked about similar discrepancies in how deaths were being reported. Experts say there are several reasons for this. One of them is that many people are dying at home because they are not getting hospital beds or they are not being able to get tested for Covid. So, they don’t find a place as a Covid patient in the database managed by different states. Mr Bhan says testing facilities are still poor in smaller towns and even in some cities and “it’s possible we are missing many Covid-related deaths in these areas”.He adds that there seems to be an issue with recording Covid deaths in some states. There have been reports about administrative oversight as well but officials deny the allegation. “We need more transparency in numbers as it helps in managing the situation and also clearly tells you how severe the situation is,” Mr Bhan adds. Variants in playIndia on 25 March announced that a new “double mutant” variant of the coronavirus had been detected from samples collected from different states.Virologist Shahid Jameel explained that a “double mutation in key areas of the virus’s spike protein may make the virus more infectious and allow it to escape the immune system”.He says the change in the virus is the only “logical explanation” behind the surge. Health officials in the UK are now investigating whether a double mutant spreads more easily and evades vaccines.image copyrightSumit KumarDr Jameel adds that India started looking at mutations “fairly late”. “By December, India had done genome sequencing of only 5,000 samples. It wasn’t a concentrated effort.”In January, India put together a group of labs to speed up sequencing and these labs started functioning in February. “But unfortunately, the second wave started and the vision of sequencing roughly 5% of the total samples did not come through.”Sequencing becomes important in a pandemic as it allows scientists to monitor changes in the virus. “If you can catch a more infectious variant early on in a region, you can quickly put in public health measures to stop it from spreading wider in the community,” he explains.But it’s “never too late” to take measures. “We need to strengthen safety protocols and rapidly vaccinate people, and also keep an eye on mutations. If we do all this, we could reduce numbers significantly.”Read more stories by Vikas PandeyIndia’s Covid-19 patients turn to black market’Think about ICU workers before you party”I have cancer in my 30s, but can’t get a Covid jab’India in ‘delicate phase’ as Covid cases surgeThe vaccine pioneer the world forgot