'So many bodies,' says ambulance driver as India struggles to stem COVID-19 death toll
Businesses are reopening, hospitals are full and doctors see no end in sight.
With the windows of his ambulance rolled down and the siren blaring, Mohsin Khan, 41, told his attendant why he drives ambulances.
"I lost my mother because no ambulance came on time to attend to her," he said. "The helplessness I felt, I don't wish that on my worst enemy."
On COVID-19 duty since the beginning of the pandemic in India, Khan has seen and done it all: from rushing patients to hospitals across Delhi to being the sole witness to last rites being performed. But this particular trip to the cremation ground brought him a sense of complete helplessness, as it involved him shifting the body of a 3-year-old COVID-19 victim, the youngest he has ever carried.
"She just reminds me of my daughter, she is somebody's child," he said tearfully.
"Sometimes I end up spending my entire day in cremation grounds and cemeteries. There are just too many bodies," he said as he waited to hand over the stretcher at the crematorium.
Since April 17, when Khan picked up his first COVID-19 patient, he has seen the numbers in cases and deaths rise consistently.
"My ambulance was the only one in the fleet until then," he said. "But with an increase in the number of cases and deaths, we now have 17 ambulances."
Some days, death is the only thing he sees.
"There are so many bodies and so many patients," he said. "On some days, we don't even have time to eat. There have been times when I have had to take six patients at once."
India this month surpassed Brazil as the country with the world's second-highest number of recorded infections. According to the Johns Hopkins Coronavirus Resource Centre, the country has 5.6 million total cases, putting it not far behind the United States, which has 6.8 million.
The country is seeing between 70,000 and 90,000 new cases daily. The virus has killed more than 80,000 people and infection rates are surging across the country with no sign of stopping.
"The number of cases per day is a matter of concern. And everybody from governments, union governments, state governments, medical professionals, everybody is concerned," Dr. Arvind Kumar, a lung specialist at New Delhi's Gangaram Hospital, told ABC News. "And are we constantly having discussion, dialog, on what to do to contain this number?"
Experts also worry that the infection rate in India could be higher than what it is currently being reported.
In the past few months, the Indian government has been doing more testing -- up to 1 million tests are being carried out each day, according to authorities -- but per capita testing rates remain low.
"If you compare with other countries which have a comparable number of cases, the Indian test per million population is 47,000. Brazil is one-and-a-half times that, and Russia and the U.S. are six times that," said Dr. Rajib Dasgupta, a professor of community medicine at Delhi's Jawaharlal Nehru University. "And that's a far more sensitive indicator than saying we've gone up so many tests. So in that sphere, there's a lot more that needs to be done."
Testing in India also includes the rapid antigen tests, which result in a higher portion of false negatives, Dasgupta told ABC News.
"Antigen tests have been there for quite some months now and were meant for special situations like containment zones and people with high probability of illness," Dasgupta said. "But it's being done more generally now. On the plus side, this has pushed up testing numbers, but on the minus side you're picking up less than you would from such a high number of tests."
In March, India instituted a stringent lockdown to curb the crisis and give India's overburdened health care system a shot at dealing with the pandemic. But the lockdown plan did not account for the millions of internal migrants working in cities. Most of them were daily wage laborers who, overnight, found themselves without work and shelter.
They were left with no choice but to undertake arduous journeys, often on foot, to go back to their villages located thousands of miles away. And that contributed to the spread of the virus.
"We did have the unfortunate incidents of millions of laborers crisscrossing the country, which unfortunately carried this virus from cities to our rural areas, which were previously untouched," Kumar said.
The lockdown hit the economy hard. India's GDP went down 23.9% between April and June, and 121 million people lost their jobs between April and August.
By May, Prime Minister Narendra Modi's government had begun easing the lockdown, just as cases were going up.
Authorities decided they couldn't afford a further slowing down of the economy, and they have since continued to ease restrictions despite the surge in cases.
Workplaces and businesses have reopened, construction has restarted, markets are bustling and restaurants have opened their doors. Metro rail services in different cities have resumed as well.
The iconic Taj Mahal, India's biggest tourist attraction, also welcomed back tourists on Sept. 21, though in much smaller numbers, after closing its doors for an unprecedented six months.
But, as cases increase each day, India's health care system has been put to the test.
"Yes, it's a fact that in most of the big cities we are reaching a saturation point where most of the hospitals are choked to capacity. There is a scarcity of ventilators," said Kumar.
Precious oxygen has also been in short supply.
Dasgupta believes so far the health services have broadly managed to deal with the pandemic.
"If cases stabilize at this point we can assume that services can cope. If they continue to increase, it will become difficult," he said. "The other issue is that other services are affected, for example, routine services such as ante natal care, like immunization, post-natal care, treatment for those with chronic diseases. All of those have been affected to a varying extent, and that's often not part of the story."
It's those on the front lines of the battle who are most at risk. The Indian Medical Association claimed that at least 382 doctors have lost their lives fighting COVID-19 after the Indian government said they had no data on the deaths of health care personnel.
For Mohsin Khan, the ambulance driver, the danger of infection is ever-present. But he soldiers on.
"There was an ambulance driver in Chennai who got coronavirus and died. People have told me about this incident and asked me what I would do. I told them that I wouldn't leave this job. If God gives us courage, then we will continue," Khan said.
At 1.6%, officially India's mortality rate remains low. This means that of all the people with a positive COVID-19 test, only about 1.6% die of the disease. In comparison, the U.S. has a mortality rate of 2.9 % and in the United Kingdom, that rate is 10.4%.
But in India, the death rate is likely a massive undercount. It has been reported that people suffering from comorbidities, who die after contracting coronavirus, may not always be considered COVID-19 fatalities.
"This is quite contrary to the guidance of the World Health Organization," Dasgupta said. "While a state has full authority to review deaths, and indeed should do rigorous mortality analysis, it should be guided by the WHO's position on this matter."
In parliament, health minister Harsh Vardhan blamed "irresponsible societal behavior" for contributing to the spike in cases. He urged all Indians to follow proper hygiene, wear masks and practice social distancing.
"I think people are now getting restless and probably becoming less compliant with social distancing norms, masks and hygiene, than at the beginning of the lockdown," said Arvind Kumar. "I have been repeatedly requesting people that no matter how many months have passed, we have no choice but to continue to abide by social distancing norms."
It's not just COVID-19 fatigue. In a country like India that is densely populated, with crowded public areas, and cramped housing solutions, most people don't have the luxury of space.
In the narrow, crowded lanes of Old Delhi, the Mughal era walled city, social distancing is next to impossible.
Piyush Dixit, who runs an eatery in one of the narrow lanes, has seen his benches fill up since restaurants started opening up.
"Earlier, people were scared, they weren't coming out, they were trying to maintain distance from each other. But it's human nature, how long can you confine someone to one space?" Dixit told ABC News. "Cases are only going to rise. But people aren't going to wait inside anymore. Be it for work or for just going out, they will come out."
Dasgupta believes that people will have to learn to live with the virus for the foreseeable future.
"There's no end in sight as we speak since there are at this point a million active cases and current reproduction rate is 1, which is not bad but it means that a million cases will be transmitted to another million," said Dasgupta. "The most optimistic scenario is plateauing, but it's not going to end soon."
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