On the evening of April 23, Dhanraj Singh, a 40-year blind man, arrived at the Sikanderpur community health centre in eastern Uttar Pradesh’s Ballia district, complaining of breathlessness. Singh, a resident of the nearby Bansi Bazar village, was running a temperature too. According to the doctor who attended to him, Singh collapsed within “hardly five-seven minutes”. The body was handed over to the family.

In any case, the doctor said he would not have been able to help – the centre has no oxygen supplies, not even for emergencies.

Singh looked like a “suspected Covid case”, but the doctor said he had no way to be sure. The centre has inexplicably stopped testing since a month.

“What can we say, we want to test but we can’t, it is an administrative decision,” said the doctor, who did not want to be identified. “We send people to the block primary health centre where testing is still happening, that is around 5 km-6 km away. It is a tragedy that we are such a big centre and yet we do not test in these times.

The Sikanderpur community health centre caters to almost 200 villages in the area.

Despite the lack of testing, it seems fairly clear that Covid-19 is sweeping through the towns and villages of Ballia, a district bordering Bihar. Even Ballia’s chief medical officer Rajendra Prasad admitted as much. “The spread is a little too much this time,” he said. “The rural areas are not spared.”

Uttar Pradesh started experiencing a surge in the first week of April with the number of cases exploding beginning the second week. On April 8, the state reported 8,490 new cases, crossing the previous peak of 7,016 cases registered in September 2020. However, half of these 8,490 confirmed cases were limited to the four districts of Lucknow, Prayagraj, Kanpur and Varanasi.

But things have grown worse from there. On April 25, the state reported nearly 38,000 cases. As of April 27 morning, the state has over 3 lakh active cases. Experts say the true numbers are likely to be much higher given the state’s lackadaisical testing.

More ominously, the virus is no longer restricted to urban centres. The beleaguered health infrastructure of rural Uttar Pradesh, which recently saw migrants return home from city hotspots to vote in the panchayat elections, is already overwhelmed, conversations with people, doctors and administrators in multiple districts suggest.

‘Gasping for breath’

“People are dropping dead like flies,” said Imran Ahmed.

A local activist from Ballia’s Sikanderpur, he has been helping people get access to oxygen, but rarely with any success. “All their family members have the same story to share: they develop a fever and then all of a sudden they are gasping for breath, but there is no oxygen anywhere.”

The doctor at the Sikanderpur community health centre confirmed as much. “Our daily patient load is 200-250 patients per day and 90% of the cases come with problems of cough, fever and breathlessness,” he said. “The more severe cases who need oxygen, there are eight-ten everyday, we refer to the district hospital.”

But there is no guarantee of oxygen in Uttar Pradesh’s district hospitals either, as Shivakant Pal of Sitapur’s Babupurwa village found out on April 24.

Pal’s mother Ramdevi Pal, 42, had been running a fever since April 20, but that morning she was struggling to breathe.

The family hired an autorickshaw and took her to a nearby private hospital where the doctor asked them to rush to the district hospital located some 30 km away. Ramdevi Pal’s oxygen saturation level had dropped to 35%, the ideal level being above 95%.

There, Shivakant Pal counted 72 beds – and one oxygen cylinder. His mother did not get any oxygen from it. She died gasping for breath at around 6.30 pm. “During the time we were there, at least five people died apart from my mother in the hospital, all of whom had come looking for oxygen. I saw with my own eyes,” said 20-year-old Pal. Officially, Sitapur did not report a single Covid-19 death that day.

That’s because, like Dhanraj Singh of Balia, Ramdevi Pal had never been tested for Covid-19.

Sitapur’s chief medical officer was not available for comment. A person in her office said she was in a meeting and there was “no problem” as such in the district.

Ramdevi Pal died gasping for breath in the Sitapur district hospital. She was never tested for Covid-19.

Desperate for oxygen

Uttar Pradesh’s Chief Minister Adityanath has repeatedly claimed that there was no shortage of oxygen in the state and even threatened to seize the property of those spreading “rumours” and trying to “spoil the atmosphere”.

Yet, accounts from across the state suggest it is facing a severe oxygen crisis.

For instance, when Sanjay Kushwaha, a resident of a village near the Indo-Nepal border, took his 35-year-old breathless elder brother Manoj Kushwaha to the Kushinagar district hospital on April 18, the doctors administered an injection, but no oxygen. Nor was a Covid-19 test done, Sanjay Kushwaha said, as it was a Sunday. “His condition was not improving so we moved him to a private hospital,” he added.

His brother was immediately put on oxygen at the private hospital, but a Covid-test was not done there either, according to Sanjay Kushwaha.

Manoj Kushwaha stayed on oxygen support for four days at the private hospital — but after that it too ran out of oxygen. “We were told to arrange our own cylinder because the hospital’s stocks had run out,” said Sanjay Kushwaha.

On April 24, the private hospital asked the family to transfer Manoj Kushwaha to the tertiary-care BRD Medical College in Gorakhpur, which according to Sanjay Khushawa refused to admit him. “They told us they are not taking in patients from private [hospitals],” he said.

Manoj Kushwaha was brought back to the Kushinagar district hospital, where died on April 25, bereft of any oxygen support.

Kushinagar’s chief medical officer did not respond to repeated calls seeking comment.

Sanjay Kushwaha, struggling to breathe, died without oxygen support at the Kushanagar district hospital

‘Arrange your own cylinder’

It is the same story across districts: hospitals are asking relatives to get their own oxygen cylinders.

In Bahraich, when Akshay Srivastava’s mother’s oxygen levels dropped, the family managed to get a cylinder, but under tragic circumstances. An acquaintance, whom the cylinder was meant for, died the previous night. “Well, I don’t know whether there is an oxygen shortage or not, but I can tell you that we entered the district hospital with our own cylinder,” said Srivastava.

On Sunday evening, the family was struggling to get a refill – the district hospital authorities had told them they could not help since all the oxygen was earmarked for the Covid ward and Srivastava’s mother’s Covid test was still pending.

Srivastava’s mother has since been shifted to a Covid ward where family members said the hospital was administering her oxygen.

Bahracih’s chief medical officer Rajesh Mohan Srivastava said there were ample critical care beds in the district. “Our positivity rate is 1.5%,” he said. “People are getting whatever they want.”

But few other officials and doctors in the state seem to share that optimism. A senior official in the state’s health department based in one of the eastern districts, currently down with Covid-19 along with the rest of his family, said he was thanking his stars no one in the family needed oxygen yet.

“It is all about chance, in all probability I could not have managed too,” he said.

Deaths in the villages

Professor Gopal Nath heads the Virus Research and Diagnostic Lab at the Institute of Medical Sciences, Banaras Hindu University, expressed a grim view of the situation. ““The community spread is so bad in the villages that people don’t know what to do or where to go,” he said. “Also, testing such huge numbers is difficult because where is the health staff to collect so many samples. To meet the current demand, we need ten times more staff.”

Nath who hails from a village on the Jaunpur-Varanasi border said he shuddered at the prospect of going there anytime soon. “We have done massive blunders,” he said. “The gram panchayat elections should have been postponed because not only did it see big gatherings, the elections have so much prestige attached to them that people from cities came home to vote carrying the virus with them.”

A four-phase panchayat election that began on April 15 is currently underway in Uttar Pradesh. The Allahabad High Court refused to postpone it, despite an unprecedented Covid-19 surge in the state.

Nath’s fears about a surge in the wake of the elections seem to be well-founded. Situated on the outskirts of Varanasi town, Ramna was of late seeing four-five deaths each day, of people showing Covid-like symptoms, said Amit Patel whose wife is the elected head of the village

“Last night three people died in my village,” Patel told Scroll.in on Monday. “None of them were tested.”

The primary health centre at Ramna is neither testing people for the virus nor treating people with symptoms. Currently, it is only administering Covid-19 vaccines.

Varanasi’s chief medical officer was not available for comment. A representative from his office said he was attending the funeral of his father who died late Monday evening. The representative, however, did say that the “situation was extremely bad in the district”. “Probably the worst in the whole of Uttar Pradesh,” he said.

In adjoining Chandauli, the District Combined Hospital at Chakia, which serves a largely rural population, is predictably getting overwhelmed. The hospital has 50 critical care beds reserved for Covid patients. “Last year, at any point of time, a maximum of 13-14 beds were occupied,” said Usha Yadav who till recently headed the facility. “Now my staff tells me there are 100 patients with makeshift beds everywhere. So you can imagine what the situation is.”

The burst of cases in the mofussil districts has meant additional pressure on already overburdened health facilities in urban centres like Lucknow. “It is not like we are dealing with patients just from Lucknow – people from the villages are now flooding our hospital,” said Madhulika Singh, who owns a private hospital and a medical college in the city “From Faizabad, Gonda, Raebareli, Basti, Ambedkar Nagar, everyone is coming to Lucknow. There just aren’t enough hospitals there.”