A severe shortage of medical oxygen in India has left people gasping for their final breaths in their hospital beds, a sign of government futility in its fight against a crushing wave of coronavirus infections.
The latest tragic consequence came on Sunday night, when at least 12 people hospitalized with Covid-19 died in Chamarajanagar, southwestern India, because of a lack of oxygen, according to the regional authorities. Hospital officials were left desperately dialing senior government functionaries and made calls to neighboring officials for help. Videos from the hospital showed relatives of sick patients using towels to fan their loved ones in an attempt to save them.
Many countries, including Mexico, Nigeria, Egypt and Jordan, have faced oxygen shortages that have led to deadly accidents and driven up virus deaths. The World Health Organization estimated earlier this year that 500,000 people were in need of oxygen supply every day, but that number is likely to be much higher with the outbreak in India.
The Indian authorities have said that the country has enough liquid oxygen to meet medical needs and that it is rapidly expanding its supply. But production facilities are concentrated in eastern India, far from the worst outbreaks in New Delhi and in western areas of the country, requiring several days of travel by road.
Ritu Priya, a professor at the Center of Social Medicine and Community Health at Jawaharlal Nehru University in New Delhi, called the oxygen shortage a failure of governance. “We were not able to channelize oxygen distribution over the past year when that is what we should have been doing,” Dr. Priya said.
“We are living from oxygen cylinder to oxygen cylinder,” she said.
On Sunday, the New Delhi High Court said that it would start punishing government officials for failing to deliver oxygen after hospitals in the capital successfully sought an injunction, The Associated Press reported.
It was the latest verdict against Indian leaders: Voters in crucial state elections dealt Prime Minister Narendra Modi’s party a blow by electing an opposition party in West Bengal, one of India’s most populous states and a stronghold of opposition to Mr. Modi, India’s most powerful prime minister in decades.
The Supreme Court also weighed in on Sunday, urging the central and state governments to consider another lockdown to gain control of the virus and to create an emergency stockpile of oxygen, according to the Indian news media.
Critics have blasted Mr. Modi’s handling of the crisis. A sudden, harsh lockdown imposed early in the pandemic sent millions of laborers scrambling back to their home villages and disrupted the economy. When cases dropped, Mr. Modi’s government failed to heed warnings of a potential resurgence from scientists, and its Covid-19 task force did not meet for months. Mr. Modi declared a premature victory over Covid in late January during what proved to be a mere lull in infections.
Now, cremation grounds are working day and night, burning thousands of bodies. The country is rife with the more lethal and transmissible B.1.1.7 variant of the coronavirus, first found in Britain, as well as a local variant, B.1.617. Experts are worried that the unchecked outbreak will spawn more dangerous variants of the coronavirus.
On Saturday, India reported nearly 3,700 deaths, its highest daily toll, with 3,417 deaths on Sunday, according to a New York Times database. It also logged 392,488 new cases Saturday and 368,060 on Sunday. These are tallies that no other country has ever seen, and experts say the real toll is far higher.
Indian officials announced over the weekend that the army had opened its hospitals to civilians and that the first batch of the Russian vaccine, Sputnik V, had arrived, a boost to India’s flagging inoculation campaign.
Over the weekend, aid from a half-dozen countries arrived at airports across India; it included 157 ventilators from the United Arab Emirates, 500 oxygen cylinders from Taiwan and 1,000 vials of the medicine Remdesivir from Belgium.
On Sunday, the United States delivered the third of six aid shipments to New Delhi, including 1,000 oxygen cylinders. Britain donated more than 400 oxygen concentrators, and France sent eight oxygen generators, each of which can serve 250 hospitalized patients.
Britain and France announced plans to donate more, and the United States has pledged $100 million worth of supplies, which will include 15 million N95 masks and one million rapid diagnostic tests. Ron Klain, the White House chief of staff, said on Sunday that the Biden administration had sent the raw materials to produce 20 million vaccine doses, and he said the United States might lift patents on vaccines to boost global production.
Vaccines are badly needed in India, where shortages forced several states on Saturday to delay expanding access to everyone aged 18 and over. While it is a global power in vaccine production, India didn’t purchase enough doses to protect itself: Less than 2 percent of its 940 million adults have been fully vaccinated.
To prevent a new wave of infections in Australia, about 8,000 Australia citizens and residents are banned from returning home from India as of Monday.
The travel ban is believed to represent the first time Australia has made it a criminal offense for its own citizens and permanent residents to enter the country.
“I never expected this to happen,” said Drisya Dilin, an Australian hospital administrator whose 5-year-old daughter has been in India for over a year because of strict border policies, despite many attempts to bring her home.
Much of the world has decided to cut off travel to and from India as it grapples with an uncontrolled outbreak that is killing thousands of people every day. But Australia, a continent with a strong preference for hard borders, has pushed isolation to a new extreme. No other democratic nation has issued a similar ban on all arrivals. Britain, Germany and the United States, for example, have restricted travel from India, but have exempted citizens and permanent residents, many of whom are rushing home.
Australia’s decision — announced quietly late Friday night by officials who said it was necessary to keep the country safe — has built into a medical and moral crisis.
Indian-Australians are outraged. Human rights groups have condemned the move as unnecessarily harsh and a violation of citizenship principles. Other critics have suggested that the policy was motivated by racism or, at the very least, a cultural double standard.
“It’s criminalizing the situation when intense empathy is required,” said Sheba Nandkeolyar, a marketing executive and national chair of Women in Business for Australia India Business Council. “It’s a very tough situation.”
Australia’s latest move fits a pattern. The island has maintained some of the strictest border measures in the world since the pandemic began. No one can leave the country without official government permission. Coming home, even from a country with declining infection rates, often seems to require government connections, celebrity status or luck, along with $30,000 for a one-way plane ticket.
There are about 35,000 Australians overseas who have been unable to make the journey either because they have been unable to obtain seats on repatriation flights or because they have been unable to afford the tickets.
In the case of India, Australia’s already opaque, unequal and selective policy — based in part on how many people can be moved through for 14-day hotel quarantine — has become absolute. It means keeping thousands of Australians in a place where coronavirus case numbers have skyrocketed; where hospitals have run out of beds, ventilators and medical oxygen; and where crematories are burning day and night amid a deluge of bodies.
Australian officials said the new restrictions, with penalties of up to five years in prison and nearly 60,000 Australian dollars ($46,300) in fines, would keep its hotel quarantine system from being overwhelmed.
The European Union will recommend that its member states open borders to travelers who have been fully vaccinated, it said on Monday, clearing the way for the countries to welcome more visitors.
Member states are set later this week to debate the proposal, which was issued by the European Commission, the bloc’s executive arm. Visitors who have received a vaccine approved by the European Union’s drug agency would be allowed to travel freely, and individual countries could still impose tougher requirements on visitors, the proposal said.
The Commission said that if certain member states were prepared to let in visitors who had tested negative, they should do the same for vaccinated ones. Unvaccinated travelers could still be permitted, but countries could require tests or quarantines.
Yet the return of tourism, which the European Commission’s president, Ursula von der Leyen, spoke about last Sunday, would be a much-needed boon for countries, particularly those in southern Europe whose economies rely heavily on tourism but have been crippled by shutdowns.
The announcement comes more than a year after the first bans on nonessential travel from most countries to the bloc came into effect.
A handful of countries with low virus caseloads, including Australia, New Zealand and South Korea, have been exempt from the ban. The Commission said on Monday that it would expand that list by allowing in visitors — regardless of vaccination status — from countries with virus rates higher than the current limit (though still lower than the European Union average).
If member states accept the proposal, they would also be able activate an “emergency brake” mechanism to suspend all travel from outside of the bloc, the Commission said, to avoid the spread of coronavirus variants.
Countries including Greece, Spain and France have already said they will open for visitors who can show proof of a vaccination or a negative test.
Under the new proposal, visitors would be able to enter the European Union if they received the last recommended dose of an authorized vaccine at least 14 days before arrival.
Travelers would have to prove their status under a vaccination certificate program issued by the national authorities of the country they wished to travel to, according to the Commission. But until that program was in place, governments could also accept certificates from countries outside the bloc, impose quarantines or require a proof of a negative test.
Early in the pandemic, when vaccines were still just a glimmer on the horizon, the term “herd immunity” came to signify the endgame: the point when enough Americans would be protected from the virus that we could be rid of it.
Now, more than half of adults in the United States have been vaccinated with at least one dose. But rates are slipping, and there is widespread consensus among public health experts that herd immunity is not attainable — not in the foreseeable future, perhaps not ever.
Instead, they are coming to the conclusion that the virus will most likely become a manageable threat that will continue to circulate in the United States for years, still causing hospitalizations and deaths but in much smaller numbers.
How much smaller depends in part on how much of the nation, and the world, becomes vaccinated and how the coronavirus evolves.
global roundup
The American drugmaker Moderna announced on Monday that it would supply up to 500 million doses of its coronavirus vaccine to Covax, the international vaccine-sharing initiative that aims to distribute vaccines to poor and middle-income countries that have been unable to secure deals on their own.
Under the agreement, which was negotiated by Gavi, the Vaccine Alliance, the first 34 million doses will be delivered by the end of the year, and the rest through 2022.
The deal covers 92 middle- and low-income countries, Moderna said. It added that the doses would be offered at the company’s “lowest-tiered price” but did not say what that was.
The deal comes as countries in Europe have pledged donations to Covax to address urgent supply shortages, in particular with AstraZeneca vaccines manufactured in India, which has curtailed exports as it faces an unprecedented surge of infections.
Tedros Adhanom Ghebreyesus, the director of the World Health Organization, which backs Covax, said on Monday that the initiative urgently needed 20 million doses for the second quarter of 2021.
Sweden announced that it would donate a million AstraZeneca doses to Covax to address shortages, and France made an initial pledge of 500,000 last month.
Although Covax was created to resolve the inequities created by a free market where the richest can buy the most, it has delivered only 49 million doses to dozens of countries, according to Gavi’s website. Health advocates have questioned its transparency and accountability, and developed countries have been accused of cutting lines and monopolizing vaccine doses.
In other news from around the world:
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In Britain, a group of cross-party lawmakers urged the government on Monday to discourage all leisure travel abroad to prevent the importation of new variants into Britain and to reduce the risk of a new wave of infections. The warning comes as Prime Minister Boris Johnson plans to reopen international travel this month, with many in Britain hoping that they can travel across Europe and beyond for summer vacation.
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In the Philippines, President Rodrigo Duterte appeared to receive his first dose of the Sinopharm coronavirus vaccine on Monday, according to a livestream shared on Facebook by a Filipino lawmaker and Filipino news outlets. “I feel good,” Mr. Duterte said in the video, adding that he had been expecting to receive the China-backed vaccine for a long time. The vaccine has not been approved by the World Health Organization for emergency use yet, and Sinopharm has not applied for approval by the Philippine drug regulator. But Mr. Duterte received it under a permit that granted access to 10,000 doses for his security group, according to Rappler, a Manila-based news website.
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In Greece, outdoor restaurant service resumed on Monday after a six-month hiatus, a much-anticipated reopening after people began filling city squares and beaches as temperatures rose. Greece has gradually lifted restrictions in recent weeks, including ending quarantine requirements for visitors from dozens of countries. The authorities plan to reopen the tourism sector on May 15, when domestic travel restrictions are also set to lift.
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France began easing lockdown restrictions on Monday, reopening middle and high schools and lifting a ban on domestic travel. Outdoor dining at cafes and restaurants is scheduled to reopen later this month, and a 7 p.m. nightly curfew is expected to be pushed back to 9 p.m.
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The European Union’s drug regulator announced that it had begun evaluating clinical-trial data to extend the authorization of the Pfizer-BioNTech coronavirus vaccine to children ages 12 to 15, the first vaccine to be assessed for pediatric use in the bloc. The European Medicines Agency said the review would be accelerated, and it expects a decision in June.
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In Germany, the Munich Oktoberfest will be canceled for a second year in a row, the authorities in the Bavaria region said on Monday. The lawmakers cited difficulties in enforcing mask or distance rules. The last time the event ran, in September and October 2019, it attracted 6.3 million people.
The coronavirus surge that is lashing India, where countless funeral pyres cloud the night skies, is more than just a humanitarian disaster: Experts say uncontrolled outbreaks like India’s also threaten to prolong the pandemic by allowing more dangerous virus variants to mutate, spread and possibly evade vaccines.
The United States will begin restricting travel from India later this week, but similar limitations on air travel from China that President Trump imposed in the early days of the pandemic proved to be ineffectual.
“We can ban all the flights we want but there is literally zero way we can keep these highly contagious variants out of our country,” said Dr. Ashish Jha, the dean of the Brown University School of Public Health.
What are variants, and why should we care?
As the coronavirus spreads among human hosts, it invariably mutates, creating opportunities for new variants that can be more transmissible or even more deadly. One highly contagious variant, known as B.1.1.7, crushed Britain earlier this year and is already well entrenched in the United States and Europe.
Recent estimates suggest that B.1.1.7 is about 60 percent more contagious and 67 percent more deadly than the original form of the virus. Another worrisome variant, P.1, is wreaking havoc across South America.
On Friday, India recorded 401,993 new cases in a single day, a world record, though experts say its true numbers are far higher than what’s being reported. Peru, Brazil and other countries across South America are also experiencing devastating waves.
Virologists are unsure what is driving India’s second wave. Some have pointed to a homegrown variant called B.1.617, but researchers outside of India say the limited data suggests that B.1.1.7 may be to blame.
I’m already vaccinated. Should I be worried?
With 44 percent of adults having received at least one dose, the United States has made great strides vaccinating its citizens, though experts say the country is far from reaching so-called herd immunity, when the virus can’t spread easily because it can’t find enough hosts. Vaccine hesitancy remains a formidable threat to reaching that threshold.
In much of the world, however, vaccines are still hard to come by, especially in poorer countries. In India, less than 2 percent of the population has been fully vaccinated. “If we want to put this pandemic behind us, we can’t let the virus run wild in other parts of the world,” Dr. Jha said.
Preliminary evidence suggests that the vaccines are effective against the variants, although slightly less so against some.
“For now, the vaccines remain effective, but there is a trend toward less effectiveness,” said Dr. Céline Gounder, an infectious disease physician and epidemiologist at Bellevue Hospital in New York.
Vaccine makers say they are poised to develop booster shots that would tackle especially troublesome variants, but such a fix would be of little help to poorer nations already struggling to obtain the existing vaccines. Experts say the best way to head off the emergence of dangerous variants is to tamp down new infections and immunize most of humanity as quickly as possible.
Dr. Michael Diamond, a viral immunologist at Washington University in St. Louis, said that the longer the coronavirus circulates, the more time it has to mutate, which could eventually threaten vaccinated people; the only way to break the cycle is to ensure countries like India get enough vaccines.
“In order to stop this pandemic, we have to vaccinate the whole world,” Dr. Diamond said. “There will be new waves of infection over and over again unless we vaccinate at a global scale.”
Public fury over Nepal’s growing wave of coronavirus infections has been rising in the country, with many people blaming travelers from India and several other virus-stricken countries as well as government ineptitude in handling the pandemic and large political rallies.
In response, Nepal halted all domestic flights on Sunday and announced that it would suspend international flights starting Wednesday.
As India’s crisis has worsened over recent weeks, people from several Indian states thronged to Nepal via land and air routes. Some were Nepali migrant workers returning home; others aimed to travel onward to third countries.
Last week, Nepal responded by banning third-country travel via Nepal and imposing two-week lockdowns in several cities, closing schools, colleges, factories, nightclubs and theaters. Public gatherings are also banned.
But those moves have so far done little to quell infections, which are spiking in Nepal’s densely populated cities, including Kathmandu, the capital, and metropolitan areas bordering India to the southwest.
The number of infections reported in Nepal has escalated rapidly since mid-April, from a seven-day average of new daily cases of less than 100 to more than 4,500 as of Saturday. On Sunday, Nepal reported 7,211 new cases.
Three cabinet members have been hospitalized with the virus, and the government is scrambling to arrange for oxygen imports and hospital beds.
Health experts have attributed the country’s second wave in part to the unchecked flow of Nepali migrant workers from India and in part to large political rallies organized by the ruling Communist Party of Nepal (Unified Marxist and Leninist) and other opposition parties that aimed to show strength during the pandemic.
This is the second time Nepal has suspended international flights in response to the pandemic. In April 2020, it halted international flights for more than five months.
According to accounts in Nepali news outlets, chartered cargo flights will continue to fly.
Naomi Harris plans to drive to Buffalo next week from her home in Toronto to get the second dose of the Pfizer coronavirus vaccine. At home, her second appointment was set for July 1, but she thought that as a caregiver for someone with cancer, that was too long to wait.
Canada’s slow vaccine rollout has left some people waiting four months between doses. While at least 33 percent of Canadians have received one shot, just three percent are fully vaccinated.
New daily cases reached a seven-day average over 8,700 in mid-April, according to a New York Times database, levels not seen since a winter surge. Ontario has been among the hardest hit, reporting 3,700 new cases on Sunday.
Ms. Harris, 47, said she had to be “very pushy” for her mother to get vaccinated in a shorter time than expected. After her mother received a first dose in early March, her second dose was scheduled for June 30, according to Ms. Harris, “which was insane because my mom has cancer and is over 80,” she said.
Eventually, their province of Ontario changed the rules for people with certain types of cancer and Ms. Harris’s mother received her second dose in early April. Ms. Harris is eligible for her shot in Buffalo as a dual Canadian and American citizen who is enrolled in a graduate program in Buffalo remotely. “I can’t take the risk of getting my mom sick,” Ms. Harris said.
As supply increases, officials have said, the wait between two inoculations is expected to shorten, and some initiatives are trying to shrink the gap.
Zain Manji, who runs the company Lazer from Toronto, created a text system with a friend that allows people to find vaccination sites near them. Since its start on April 30, at least 50,000 people have used it.
“I think there’s been a lot of confusion around who is eligible, which locations are vaccinating people, what vaccines that they’re offering,” Mr. Manji said. “People are eager to get it and want to get it as fast as they can,” he added about the vaccine.
The vaccines are coming at a crucial time: Amid a third wave, the worst-affected provinces are reporting case numbers per capita that rival those of India — although figures in India are likely to be underestimated.
In Quebec, a curfew, limits on gatherings, and takeout-only dining have helped to quell cases. Jean-Sébastien Guay, 27, of Montreal had his first shot on Sunday. “It hasn’t been perfect,” he said, but officials communicated consistently. “They all work pretty hard to make it work.”
Peter Hotez, a vaccine expert at Baylor College of Medicine, has been pushing for the Biden administration to offer help to Canada. “This is not a time to hold back,” Dr. Hotez said in a telephone interview. After writing on Twitter that the government should ship more Pfizer doses to Canada, he was met with emotional stories from Canadians.
Adding insult to injury for some Canadians is the possibility of their country opening travel to vaccinated American tourists. “It’s frustrating for me to sit here and watch my friends in the United States going to restaurants, carrying on as if life is normal,” said Ms. Harris, who said she had been in a quasi-lockdown since November.
“In the rest of the world, life is not normal.”
With India’s health care system overwhelmed by the country’s unprecedented Covid-19 surge, desperate relatives and friends of the infected have resorted to sending S.O.S. messages on social media.
Many of those calls are being answered.
More than 400,000 new coronavirus cases and thousands of deaths are being reported each day. Some people need medical oxygen, which is nearly impossible to find in Delhi, the capital. Others are hunting for medicine that is expensive on the black market, or for rare ventilators.
The pleas are reaching tech-savvy engineers, lawyers, employees of nongovernmental organizations, politicians, doctors and even tuk-tuk drivers, who have mobilized online to help the sick, some of them hundreds of miles away. They have formed grass-roots networks that are stepping in where state and national governments have failed.
India’s loose online aid networks rely on tools and techniques commonly used in marketing and other forms of messaging on social media. Families tag people with large followings or specialized skills who might be able to amplify their messages, while volunteer organizers use keywords to filter the flood of requests.
About 3,000 clubgoers were rammed up against each other inside a warehouse in Liverpool, England, on Friday night, waving their hands to techno music.
It was an attempt to see how reopening might work. Other trial events in Liverpool have included a concert for 5,000 fans in a circus tent and a business conference.
People had to show a proof of a negative test before they could enter the club on Friday. “This is the first dance,” Nick Evans, a 28-year-old legal adviser, shouted above the music. “And it could be the last dance, so I’m going to enjoy it,” he added.
In February, Prime Minister Boris Johnson announced that because of high vaccinations, he hoped to remove all restrictions on social life in England on June 21.
Some academics criticized the nights as “human guinea-pig experiments,” but Iain Buchan of the University of Liverpool, the scientist leading the trials, insisted Covid-19 rates in Britain were so low that the chances of an outbreak were slim.
In a bid to improve their customer service at vaccination centers, officials in Mexico City have cued up entertainment performances for those waiting for their shots.
Now people can watch operatic performances; large, bare-chested Lucha Libre wrestlers doing the limbo; and men performing tricks with a surprising number of soccer balls. They can join a yoga session, with women in white shirts leading the crowd.
The goal is to make the process as appealing as possible, a woman leading a song and dance performance said on a recent Wednesday.
“Put those little hands in the air!” she shouted to the older people in her care.
The effort is important given the alarming resurgence of the virus in Latin America and the sputtering vaccination efforts in many of its countries. Concerns have been compounded by the rapid spread of a virus variant first discovered in Brazil.
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