H5N1

Indonesia: Government orders more oxygen as Covid patients use up supplies

Via JakartaNews.Net: Government orders more oxygen as Covid patients use up supplies.

JAKARTA, Indonesia: Following the deaths of 60 people in hospitals needing oxygen, the Indonesian government has ordered manufacturers of oxygen and tanks to prioritize medical needs amid the growing demand from COVID-19 patients. 

Indonesia is suffering one of the worst outbreaks of the Covid virus, registering 27,913 new cases just on Saturday. 

The Sardjito hospital in Java issued a statement saying 63 patients died after it ran low of oxygen from Saturday until early on Sunday, when new oxygen supplies arrived. 

A hospital spokesman, however, did not know whether all of the fatalities had suffered from COVID-19. 

"We also hope people don't stock up on oxygen," health ministry official Siti Nadia Tarmizi said, fearing additional shortages. 

The hospital said it had sought additional supplies of oxygen, however, large numbers of patients arrived at the hospital on Friday in need of oxygen. 

The crisis only eased before dawn on Sunday when more oxygen was delivered to the hospital. 

The ministry supervising Indonesia's COVID-19 response has ordered the oxygen industry to fill the estimated demand of 800 tonnes of oxygen per day needed for the nation's ill population. 

Hospitals in Java are being left with no empty beds following the spread of the highly infectious Covid Delta variant. 

In the Indonesian capital of Jakarta, the government said there are now 392 burials per day, a ten-fold increase over earlier months. 

Beginning on July 6, Indonesia will not allow foreign visitors onto the island.

Oxygen shortages threaten ‘total collapse’ of dozens of health systems

Via The Guardian: Oxygen shortages threaten ‘total collapse’ of dozens of health systems. Excerpt:

Dozens of countries are facing severe oxygen shortages because of surging Covid-19 cases, threatening the “total collapse” of health systems. 

The Bureau of Investigative Journalism analysed data provided by the Every Breath Counts Coalition, the NGO Path and the Clinton Health Access Initiative (CHAI) to find the countries most at risk of running out of oxygen. It also studied data on global vaccination rates. 

Nineteen countries around the world – including India, Argentina, Iran, Nepal, the Philippines, Malaysia, Pakistan, Argentina, Costa Rica, Ecuador and South Africa – are deemed most at risk after recording huge increases in demand since March – at least a 20% rise – while having vaccinated less than 20% of their populations.

There are concerns that other Asian countries like Laos are at risk, and African countries including Nigeria, Ethiopia, Malawi and Zimbabwe, which have less mature oxygen delivery systems, meaning a small increase in need could create big problems. 

Many of these countries faced oxygen shortages before the pandemic, said Leith Greenslade, coordinator of the Every Breath Counts Coalition. The extra need is pushing health systems to the brink. 

“The situation last year, and again in January this year in Brazil and Peru, should have been the wake up call,” she said. “But the world did not wake up. We should have known India would happen after seeing what happened in Latin America. And now looking at Asia, we should know this will happen in some of the big cities in Africa.” 

 Robert Matiru, who chairs the Covid-19 Oxygen Emergency Taskforce, told the bureau: “We could see the total collapse of health systems, especially in countries with very fragile systems.” 

 Hospitals in India have reported significant shortages of oxygen as the country battles its second wave. By the middle of May, India needed an extra 15.5m cubic metres of oxygen a day just for Covid-19 patients, more than 14 times what it needed in March, according to the bureau’s analysis. 

In response, India has banned all exports of liquid and cylinder oxygen. 

But experts are worried about India’s neighbours – Pakistan, Nepal, Bangladesh, Sri Lanka and Myanmar – some of which rely on Indian-made oxygen and equipment. 

“You’d imagine if they start to see peaks of the same degree, then it could be even worse, because India needs all the supply,” said Zachary Katz, vice-president of essential medicines at CHAI. 

The bureau’s data shows that Nepal now needs more than 100 times as much oxygen as it did in March. 

Demand for oxygen in Sri Lanka has risen sevenfold since mid-March. In Pakistan, which is suffering its third wave of cases, almost 60% more patients are on oxygen in hospital than during the country’s previous peak last summer, according to a government minister, who warned in late April that pressure on the oxygen supply was reaching dangerous levels.

“The mood is extremely grim,” says Dr Fyezah Jehan, a doctor in Karachi. “I think we are very scared of an India-like situation. We’re hoping that some magic happens, and this [current] lockdown can prevent a new onslaught of cases.”

How India's Kerala has battled Covid-19

Via The New York Times: How India's Kerala Has Battled Covid-19. Excerpt:

When India’s second coronavirus wave slammed the country last month, leaving many cities without enough doctors, nurses, hospital beds or lifesaving oxygen to cope, Sajeev V.B. got the help he needed. 

Local health workers quarantined Mr. Sajeev, a 52-year-old mechanic, at home and connected him with a doctor over the phone. When he grew sicker, they mustered an ambulance that took him to a public hospital with an available bed. Oxygen was plentiful. He left 12 days later and was not billed for his treatment. 

“I have no clue how the system works,” Mr. Sajeev said. “All that I did was to inform my local health worker when I tested positive. They took over everything from that point.”

Mr. Sajeev’s experience had much to do with where he lives: a suburb of Kochi, a city in the southern Indian state of Kerala. Kerala officials have stepped in where India’s central government under Prime Minister Narendra Modi has failed, in many ways, to provide relief for victims of the world’s worst coronavirus outbreak.

Though supplies have tightened, Kerala’s hospitals enjoy access to oxygen, with officials having expanded production months ago. Coordination centers, called war rooms, direct patients and resources. Doctors there talk people at home through their illness. Kerala’s leaders work closely with on-the-ground health care workers to watch local cases and deliver medicine. 

“Kerala stands out as an exceptional case study when it comes to proactive pandemic response,” said Dr. Giridhar Babu, an epidemiologist at the Public Health Foundation of India, which is based in the northern city of Gurugram. He added that “their approach is very humane.”

Coronavirus live: A summary of today's developments

Via The Guardian: Coronavirus live: second pandemic year to be deadlier than first, warns WHO; Germany to mark UK as risk area.

A summary of today's developments 

• Brazil recorded 85,536 further confirmed cases of coronavirus in the past 24 hours along with 2,211 deaths, the country’s health ministry said. Brazil has registered more than 15.5 million cases since the pandemic began, while the official death toll has risen to 432,628, Reuters reports. 

• Mexico registered 2,880 new coronavirus cases and 258 additional fatalities on Friday, according to health ministry data, Reuters reports. It brings the overall tallies to 2,377,995 infections and 220,159 deaths. 

• France has added Bahrain, Colombia, Costa Rica and Uruguay to its list of countries deemed as high-risk zones. This will mean that people arriving from those countries will have to undergo quarantine measures on arrival. 

• The Lithuanian government to donate 200,000 Covid-19 vaccine shots to its eastern European neighbours, including 100,000 to Ukraine, 15,000 going to Georgia and 11,000 to Moldova. The remaining 74,000 shots will be decided later. 

• Stocks fall as Singapore announced on Friday its strict guidelines on gatherings and public activities, amid a rise in infections and new clusters forming in recent weeks. 

• Russia will restart regular air travel between Iceland, Malta, Mexico, Portugal and Saudi Arabia from May 25, the government’s coronavirus response headquarters said. 

• The Russian Direct Investment Fund (RDIF) said it expects the second batch of its Sputnik V Covid-19 vaccine will be delivered to India by the end of the week. 

• Since the coronavirus outbreak began, at least 3,346,813 people have died due to a tally combined from official sources by AFP. 

• British holidaymakers will be allowed to enter Portugal as of midnight on May 17th. Travellers will need a negative PCR test 72hrs before their flight to gain entry into the country. 

• India’s Prime Minister Narendra Modi said he feels the pain of all Indians battling the pandemic after weeks of mainly avoiding public comment on the country’s fatal coronavirus wave. 

• Canada is planning a gradual return to indoor sports and family gatherings as more people get vaccinated, Reuters reports. Canada has administered one dose of a Covid-19 vaccine to just over half its adult population, and the country may be over the worst of its current third wave of infections, chief public health officer Theresa Tam said. 

• The Japanese Prime Minister Yoshihide Suga has said that a state of emergency was being extended to a broader area due to a rapid rise of Covid-19 cases in those regions. 

• An international cybercrime gang has been announced as being behind a significant ransomware attack on Ireland’s health service operator that halted diagnostic services on Friday and led to the cancellation of appointments. 

• World Health Organisation (WHO) chief Tedros Adhanom Ghebreyesus said the second year of the pandemic was set to be more deadly than the first, with India a considerable concern. 

• Delta Air Lines will require all new hires in the United States to be vaccinated against Covid-19, becoming one of the first major companies to issue this requirement. 

• Italy has lifted quarantine rules for all travellers from the European Union, including the UK and Israel, upon their arrival, health authorities announced. 

• Slovakia ends its state of emergency as the coronavirus pandemic has receded. 

• Dutch tourists who visit Spain’s Balearic and the Canary Islands will no longer have to take a coronavirus test on their way home. 

• Germany plans to classify Britain as a coronavirus risk region due to the emergence of the highly infectious variant first detected in India, government sources said on Friday. 

• Turkey is to ease coronavirus restrictions, emerging out of a complete lockdown, President Erdogan has said today. The country has been in a lockdown for two weeks after daily new cases rocketed to above 60,000. 

• France will have administered at least one Covid-19 vaccine injection to 20 million people by Saturday, Health Minister Olivier Veran said on his Twitter feed. 

• The B.1.617.2 variant first found in India will, over time, surpass the variant first discovered in Kent and become dominant in the UK, Britain’s Chief Medical Officer, Prof Chris Whitty, said on Friday.

Inside India’s COVID-19 surge

Via The New Yorker, another excellent report by Dhruv Khullar: Inside India’s COVID-19 Surge. Excerpt:

The tale of the Indian pandemic is both mysterious and familiar. For much of the past year, the world’s largest democracy—with a population of some 1.4 billion living on a landmass a third the size of the U.S.—escaped the worst. 

Researchers have advanced all sorts of theories to explain this outcome. They point out that India is a young country, with a median age of twenty-eight; that it instituted an early and strict lockdown; that it has undercounted cases and deaths; and that Indians may have had some level of preëxisting immunity to the novel coronavirus, owing to exposure to similar viruses in the past. Studies have indicated, perplexingly, that more than half of the residents in some dense urban centers had previously been infected, even though their hospitals hadn't filled up. 

None of these explanations have been fully proved, and, separately or in combination, they may not account for why India was spared last year. That debate will likely continue for a long time to come.

The reasons for the country’s current surge, on the other hand, appear straightforward. Since the New Year, there’s been a substantial relaxing of public-health precautions. Mask-wearing declined; sporting events, political rallies, and religious festivals brought large numbers of people close together. Lacking a sense of urgency, the country’s vaccination campaign proceeded slowly: India is the world’s leading manufacturer of vaccines for a wide range of diseases, but has fully immunized roughly two per cent of its population against covid-19. 

Many assume that the rise of more contagious variants is accelerating the damage. Almost certainly, B.1.1.7—originally identified in the U.K. and now dominant in many countries, including the U.S.—is contributing to India’s viral spread. But a new variant, known as B.1.617, has also captured headlines and the attention of scientists and the general public. The predominant form of the variant, misleadingly referred to as the “double-mutant”—it has at least thirteen mutations—was first detected in December. B.1.617 has several mutations on its spike protein, including E484Q and L452R, which seem to increase the virus’s ability to bind to and enter human cells, and which may improve its capacity for evading the immune system. Some scientists have hypothesized that another mutation, P681R, could improve the variant’s ability to infect cells. 

Still, the role played by B.1.617 in India’s crisis is uncertain. India has sequenced only about one per cent of positive coronavirus tests, rendering claims about the relative contribution of variants hard to disentangle from other factors, such as a rise in unrestricted gatherings in a densely populated country with limited health-system capacity. In any case, Covaxin—India’s domestically developed covid-19 vaccine—appears to work against both B.1.1.7 and B.1.617. Arora told me that, although several fully vaccinated clinicians at his hospital have recently contracted the virus, none went on to develop severe disease—exactly the kind of protection the vaccines are designed to deliver. 

Last week, the Biden Administration announced that the U.S. would send a hundred-million-dollar aid package to India, including testing kits, ventilators, oxygen cylinders, and P.P.E. The U.S. has also removed restrictions on exporting raw materials for vaccines so that India can increase its production. Last weekend, syringes, oxygen generators, and ventilators poured in from across Europe, and a hundred and fifty thousand doses of Sputnik V, Russia’s vaccine, landed in Hyderabad. The Indian diaspora has committed tens of millions of dollars in aid. 

Whether these interventions will be enough remains to be seen. In a country as large, diverse, and bureaucratically complex as India, the logistical challenges of converting aid into impact cannot be overestimated. Meanwhile, the Indian experience holds a deeper lesson for the world—especially for wealthy countries that have hoarded vaccines and supplies. The constellation of forces that led to India’s crisis—pandemic fatigue, the premature relaxation of precautions, more transmissible variants, limited vaccine supplies, weak health-care infrastructure—is not unique; it’s the default in most of the world. Absent a paradigm shift in our approach, there’s no reason to believe that what’s happening in India today won’t happen somewhere else tomorrow.

While India is desperate for oxygen, its politicians deny there’s even a problem

Via The Guardian: While India is desperate for oxygen, its politicians deny there’s even a problem. Excerpt:

In India’s capital city, citizens are dying in their hospital beds because they can’t breathe. Their lungs, clotted with Covid-induced pneumonia, need oxygen to function. Overwhelmed by India’s tsunami-like second wave and undermined by the smug inertia of the state, hospitals run out of oxygen and patients choke to death in front of their horrified families. 

Sometimes hospitals will discharge patients on oxygen support, casually giving their relatives a day or two to find rare air. They set off on frantic odysseys around Delhi, looking for one of two sources of oxygen: a heavy cylinder that weighs 50kg or more and looks like a dented relic from the Industrial Revolution, or a concentrator which extracts oxygen from the air in the room and pipes it into the patient. Delhi is something of a seller’s market. Prices vary. The going rate for a concentrator this week is 160,000 rupees, or slightly more than £1,500. That is a month’s salary for a tenured professor in a public university. 

There is a harrowing video of a traumatised and angry young woman standing in the lobby of a hospital in Lucknow, the capital of India’s most populous state, Uttar Pradesh. She is looking into the camera and raging. Her father’s oxygen levels are dangerously low. The hospital, she says, has run out of oxygen twice. Her father is being given hand-pumped oxygen for which she’s paying 40,000 rupees a day. The chief minister of Uttar Pradesh has threatened legal action against anyone who complains of oxygen shortages because he insists there is no such shortage. She calls him out and dares him to come to the hospital to make good his threat. 

 Yogi Adityanath, the chief minister in question, is a Hindu monk with a vigilante past and a well-earned reputation for being a dangerous man to cross. He has recently threatened to seize the property of people complaining of the unavailability of oxygen because they are lying rumour-mongers, spreading panic. For a young woman to dare a politician of Adityanath’s ilk to do his worst in Lucknow is a measure of her – and the general public’s – desperation. 

A 26-year-old man in Amethi, a town in Uttar Pradesh, tweets out an appeal for an oxygen cylinder for his ailing grandfather. His grandfather then dies of a heart attack. The police press criminal charges against him because his “false tweet” has brought the government into disrepute. For the month of April, newspaper headlines in India read like stage directions for some black farce. 

The principal scientific adviser to the Indian government said in an interview that the government made great efforts to ramp up hospital and health care infrastructure in response to the first wave, “but as that wave declined, so perhaps did the sense of urgency to get this completed”. This distinguished scientist, a fellow of the Royal Society, clearly moonlights as one of the world’s great ironists. The declining sense of urgency he refers to must describe, in its understated way, the government’s concerted efforts to get massive crowds to gather and mingle in the middle of this pandemic.

India’s COVID-19 crisis is the world's crisis

Via The Atlantic: India’s COVID-19 Crisis Is the World's Crisis. Excerpt:

India considered itself to be “in the endgame” of the pandemic just a few weeks ago. Now it is the global epicenter. The country recently surpassed the devastating milestone of more than 345,000 new COVID-19 cases in a single day, the biggest total recorded globally since the pandemic began. 

What is taking place in India isn’t so much a wave as it is a wall: Charts showing the country’s infection rate and death toll, which has also reached record numbers in the country, depict curves that have shot up into vertical lines. Public-health experts aren’t optimistic that they will slope down anytime soon.

India’s outbreak is an enormous tragedy for its own people, but it’s also a catastrophe for the rest of the world. Ninety-two developing nations rely on India, home to the Serum Institute, the world’s largest vaccine maker, for the doses to protect their own populations, a supply now constrained by India’s domestic obligations. 

Meanwhile, the coronavirus is mutating. Reports of double- and even triple-mutant strains of the virus, which experts fear could be driving the country’s latest surge, have prompted concerns that what has started in India won’t end there. Despite efforts to restrict the spread of India’s new COVID-19 variant, called B.1.167, it has already been identified in at least 10 countries, including the United States and Britain.

If ever there were a time for intervention, it would be now. But world leaders, who have so far only paid lip service to the need for global cooperation, have mostly been preoccupied by their own internal situations. Although this approach may have served vaccine-rich countries such as the U.S. so far, India could prove its limits. 

How did India, which merely a month ago thought it had seen the worst of the pandemic, get to this point? Michael Kugelman, the deputy director of the Asia program at the Washington, D.C.–based Wilson Center, told me the answer comes down to a “perfect storm” of factors that includes new and existing variants (and a lack of robust genomic sequencing to track them), a continuous stream of widely attended political rallies and religious gatherings (with no social distancing or mask wearing), and a general complacency on the part of the Indian government, which was slow to respond to a crisis in which it had prematurely claimed victory. 

The result has been overwhelmed hospitals, depleted oxygen supplies, morgues that have run out of space, and crematoria that are melting from near-constant use. The country surpassed 2,000 deaths a day last week—and those are just the cases that have been recorded. This time next month, that figure could rise to as high as 4,500 daily deaths, Bhramar Mukherjee, a biostatician and epidemiologist at the University of Michigan who is tracking the situation in India, told me. Others warn that it could get as high as 5,500. Though the projections vary, the conclusions are largely the same. “All the arrows are pointing to real darkness,” Mukherjee said. 

The situation has become so dire that the Pune-based Serum Institute, the manufacturer of the AstraZeneca vaccine and a major contributor to the COVAX initiative to provide doses to low- and middle-income countries, said it will not be able to meet its international commitments amid India’s domestic shortage. Once considered the pharmacy of the world, India is now being forced to import doses.

Indian hospitals swamped by coronavirus as countries promise aid

Via Reuters: Indian hospitals swamped by coronavirus as countries promise aid. Excerpt:

India ordered its armed forces on Monday to help tackle surging new coronavirus infections that are overwhelming hospitals, as countries including Britain, Germany and the United States pledged to send urgent medical aid. In a meeting with Prime Minister Narendra Modi, the Chief of Defence Staff General Bipin Rawat said oxygen would be released to hospitals from armed forces reserves and retired medical military personnel would join COVID-19 health facilities. 

And where possible, military medical infrastructure will be made available to civilians, a government statement said, as new coronavirus infections hit a record peak for a fifth day. 

"Air, Rail, Road & Sea; Heaven & earth are being moved to overcome challenges thrown up by this wave of COVID19," Health Minister Harsh Vardhan said on Twitter. 

Modi on Sunday urged all citizens to get vaccinated and to exercise caution amid what he called a "storm" of infections, while hospitals and doctors in some northern states posted urgent notices saying they were unable to cope with the influx. 

In some of the worst-hit cities, bodies were being burnt in makeshift facilities offering mass cremations. 

 The southern state of Karnataka, home to the tech city of Bengaluru, ordered a 14-day lockdown from Tuesday, joining the western industrial state of Maharashtra, where lockdowns run until May 1, although some states were also set to lift lockdown measures this week. 

The patchy curbs, complicated by local elections and mass festival gatherings, could prompt breakouts elsewhere, as infections rose by 352,991 in the last 24 hours, with crowded hospitals running out of oxygen supplies and beds. 

"Currently the hospital is in beg-and-borrow mode and it is an extreme crisis situation," said a spokesman for the Sir Ganga Ram Hospital in the capital, New Delhi. 

FIRE 

Following a fire at a hospital in the western diamond industry hub of Surat, five COVID-19 patients died after being moved to other hospitals that lacked space in their intensive care units, a municipal official told Reuters. 

Television channel NDTV broadcast images of three health workers in the eastern state of Bihar pulling a body along the ground on its way to cremation, as stretchers ran short.

India’s daily Covid death toll hits new record amid oxygen shortages

Via The Guardian: India’s daily Covid death toll hits new record amid oxygen shortages. Excerpt:

India’s daily coronavirus death toll passed a new record Saturday as the government battled to get oxygen supplies to hospitals overwhelmed by the hundreds of thousands of new daily cases. 

Queues of Covid-19 patients and their fearful relatives are building up outside hospitals in major cities across India, the new world pandemic hotspot, which has reported nearly a million new cases in three days. 

Another 2,624 deaths, a new daily record, were reported in 24 hours, taking the official toll to nearly 190,000 since the pandemic started. 

More than 340,000 new cases were also reported, taking India’s total to 16.5 million, second only to the United States. 

But many experts are predicting the current wave will not peak for at least three weeks and that the real death and case numbers are much higher.

Indian hospitals turn away patients in COVID-19 ‘tsunami’

Via Reuters: Indian hospitals turn away patients in COVID-19 ‘tsunami’. Excerpt:

Overwhelmed hospitals in India begged for oxygen supplies on Saturday as the country’s coronavirus infections soared again overnight in a “tsunami” of disease, setting a new world record for cases for the third consecutive day. 

Max Healthcare, which runs a network of hospitals in north India, tweeted that it had less than two hours of oxygen left while Fortis Healthcare, another big chain, said it was suspending new admissions in Delhi. 

"We are running on backup, waiting for supplies since morning," Fortis said. 

India is in the grip of a rampaging second wave of the pandemic, hitting a rate of one COVID-19 death in just under every four minutes in Delhi as the capital's underfunded health system buckles. 

The government has deployed military planes and trains to get oxygen to Delhi from the far corners of the country and overseas including Singapore. 

The number of cases across the country of around 1.3 billion rose overnight by 346,786, the Health Ministry said, for a total of 16.6 million cases, including 189,544 deaths. 

COVID-19 deaths rose by 2,624 over the past 24 hours, the highest daily rate for the country so far. Crematoriums across Delhi said they were full up and asked grieving families to wait. 

 Hospitals in Delhi have gone to the city's high court this week seeking it to order the state and federal governments to make emergency arrangements for medical supplies, mainly oxygen. 

"It's a tsunami. How are we trying to build capacity?" the Delhi high court asked the state and federal governments in response to this plea. 

Television showed families tending to the sick in hospital corridors and streets as they waited for medical attention. 

One man identified as Amit who was grieving for his brother at Delhi's Jaipur Golden hospital said he had seen families running around with oxygen cylinders trying to get them refilled. 

"You can't leave me in the lurch," a lawyer appearing for the Jaipur Golden hospital told the high court on Saturday, seeking its intervention. 

The court asked the government to ensure supplies, as well to make security arrangements for medical centres amid people's desperation. "We know how people react, let's not have a law and order situation," the court said in its direction to the authorities.