By Alankrita Taneja, MBBS
In early April 2021, I was pulled in from an elective rotation to cover medical ICU due to a surge in the number of COVID-19 cases in Michigan. During one of those days on overnight call, I noticed a few missed phone calls from back home in India. I was able to text my family intermittently and was informed that my dear grandfather had developed high-grade fevers and cough. Chills ran down my spine as I thought of the worst-case scenario. He was almost 90 years old and had barely left his house in over a year since the pandemic hit.
There had been a long lull in COVID-19 cases in India at the start of this year, making epidemiologists question if the country had somehow escaped devastation from the pandemic. There were theories about people in India having a possible early herd immunity despite a low rate of vaccination. As a result, the country was opening up, especially New Delhi, the capital city and one of the most populous cities in the country—and my hometown.
My grandfather had got the first dose of Covaxin, which is India's indigenous COVID-19 vaccine. He had recently resumed his pre-pandemic morning walks at the park and was very happy to finally get to enjoy his favorite activity again. Unfortunately, it was also the decision he was starting to regret the most.
Within the next couple of days, his condition deteriorated. My parents and uncle stepped in to help him with household chores, medical tests, and medicines, doing so with full precautions including wearing PPE. When my grandfather got tested for COVID-19, he was found to be negative by PCR. He then underwent high-resolution CT imaging of his chest due to a high false negative rate of COVID-19 PCR in New Delhi. Based on a score called CORADS, he was found to have very high suspicion for COVID-19. He also got some blood tests which revealed evidence of liver and kidney injury. We decided to get him admitted for fluids and monitoring. Due to a negative COVID-19 PCR test, he was able to get an ICU bed at a non-COVID-19 designated hospital in his neighborhood. However, he was tested again while inpatient and happened to be positive this time around.
I curiously googled the number of COVID-19 cases in India and was shocked to see an almost perfect vertical straight line representing India's second wave of the pandemic. I was shocked because this was nothing like what I had seen with the pandemic all year long. I was also shocked to see that not many people were frightened by this—not the physicians I work with, not MedTwitter at the time, not even the media.
After my grandfather’s positive test result, he was asked to find a bed in a designated COVID-19 hospital. That is when I started to witness how the health care system was starting to collapse in New Delhi. Days went by and we could not find a hospital bed for him. Doctors prescribed him remdesivir, stressing that it might save his life. Unfortunately, it was out of stock in New Delhi. My cousin, who is not a medical professional, got a vial from the black market for 20,000 Indian Rupees, which had some major grammatical errors in the package insert that made us realize it was a counterfeit version. I kept asking my family to take my grandfather's cellphone into his room so that he would not be so alone in this critical time. Sadly, his belongings were not allowed to be taken in as per the hospital staff. Soon after his admission, he got intubated and was put on a ventilator. I was upset that no one even took the time to enquire about his code status. Moreover, since he was a COVID-positive patient on airborne and contact precautions in a non-COVID hospital, he was inevitably isolated and ignored by the staff.
When he got intubated, my heart sank. I had a terrible feeling in my gut that I would possibly never be able to talk to him again. Within a few more days, he went into cardiopulmonary arrest and was given CPR for a few minutes before they pronounced him dead. I remember joining his final rites on Zoom that morning just before morning rounds. We usually round at 8:30 AM, but on that particular day our attending decided on 9 AM for other reasons. In that moment I wondered if this was divine intervention.
As we were mourning my grandfather’s death, both of my parents as well as my uncle and aunt—all vaccinated against COVID-19 with at least the first dose—started developing high-grade fevers. As suddenly as a wildfire, almost everyone I knew in New Delhi, friends and family alike, had started to get the infection. The curve continued to get steeper. Everyone was prescribed a cocktail of doxycycline, azithromycin, vitamin C, ivermectin, Fabiflu, etc. Steroids were given to all patients despite their oxygen saturation, disease severity, or comorbidities. Remdesivir and convalescent plasma were not easily available but considered magical lifesaving therapies, resulting in a big black market developing for the same.
I was sad and I was scared, all while also taking care of critically ill patients with COVID-19 here in the United States. I felt like I was simultaneously living in two worlds with such contrasting circumstances. Our MICU in Detroit was much better equipped to handle this wave of the pandemic this time. We had appropriate resources, support, and some medical evidence to guide our decisions. India, on the other hand, had none of that.
With time, people started noticing the gravity of the situation in India. MedTwitter and the media were now talking about this large-scale devastation happening in a country with a population of over a billion people and an extremely fragile health care system.
My parents started developing high fevers of up to 104 F. I tried to stay in regular touch with my friends in the medical field back in India, asking them if they could help my parents in case the need arises. They tried to offer support but told me about all the patients they had to turn away for the lack of beds. They told me of times when oxygen supplies to reputable hospitals in New Delhi ran out for hours, resulting in the death of several critically ill patients with COVID-19.
One day, I got a call at 4 AM from a close friend in India. His dad, who was diagnosed with COVID-19, was very lethargic and becoming more unresponsive. His oxygen saturation was around 75% and they were in an ambulance trying to find an ICU bed for him. My friends asked me if he could do anything in the meantime to save his dad. I was so numb that I could barely talk. They drove around for 3 hours, ultimately giving up on the pursuit of an ICU bed. He told me he would be able to get a BiPAP device and supplies if I could help him set it up and I said I would be able to walk him through it on video chat. He promised to call back as soon as he had the supplies, so I stayed up, preparing. He called me again at 7:30 AM, thanking me for my help but stating that he would not be needing it, as his dad had passed away in that short period between our calls.
I was both numb and in a state of panic. My brain was in hyperdrive, like it could not stop. I had to keep going, I had to do everything I could to take care of my friends and family, despite who I lose on the way.
Meanwhile, I was calling my parents every couple of hours asking them their oxygen saturation. On day 10, both of their oxygen saturations dropped to the early 80s. I made about 50 phone calls trying to arrange home oxygen for them, as they self-proned at home, did some breathing exercises they learnt from WhatsApp forwards, and mainly just prayed. I called my friends and professors from medical school to help them get a hospital bed. Despite staying wide awake making calls for 3 days straight, I could find neither oxygen nor a hospital bed for my parents. I have never felt so helpless, so mentally and physically exhausted in my entire life.
My father, being a diabetic and placed on dexamethasone, also started showing signs of hyperglycemia, but I was able to arrange some insulin for him. A few days later, a pulmonary and critical care fellow on MedTwitter tweeted about his aunt dying from DKA due to poor glycemic control while being on steroids for COVID-19 in India. Moreover, neurologists started sharing stories of the deadly mucormycosis (referred to as “black fungus” in many U.S. media reports) being seen in several patients in India, the diabetic capital of the world, who were incessantly being prescribed steroids for both prevention of COVID-19 and treatment of mild cases.
However, the worst for my family finally passed! After a total of 14 days of absolute uncertainty, my parents had finally started showing signs of recovery. That night, when I finally slept, I realized how much trauma I had endured in those days and, in a way, it humbled me. The countrywide curve is also trending down and India is finally healing.
After all, as the saying goes, "If winter comes, can spring be far behind?"
I spoke about the crisis to a few friends, but I do not think many truly understand the magnitude of suffering that the people of India have endured in this second wave. While the country does, undoubtedly, have poor health care resources, death and suffering at such a large scale due to the lack of oxygen and hospital beds is unimaginable in this time and era. It is truly a humanitarian crisis and we are grateful that many from all over the world came forward to help in different ways.
Dr. Taneja is a resident physician in the Department of Internal Medicine at Detroit Medical Center/Wayne State University. She will start her hematology-oncology fellowship at Roswell Park Comprehensive Cancer Center in July. Follow her on Twitter @TanejaMD. Disclosure.