Mourning Becomes India

AT THE PEAK of the pandemic are the orphan corpses waiting for their turn. A line of shrouds at cremation grounds like the mythical magical cup that never fills. Or, piled in a corner of the hospital because the queues are too long at graveyards. Society’s nuts and bolts are for the expected load and this is not that moment. The bodies are not unclaimed but they are alone. What can be more intimate and necessary than the touch of a loved one before fire consumes flesh, the ground swallows or the vultures feed? The last touch is the one to enshrine grief, to appreciate absolute loss and thereby let it away. This too has been snatched. The dead go without wailing, in the fatigued exasperation of attendants in personal protective equipment (PPE) suits. It is a story that can be told by collecting headlines now: ‘Cremation grounds bear the brunt as casualties rise’, ‘East MCD will run facility 24×7, North asks hospitals to stagger release of bodies’, ‘Cremation grounds in Lucknow: Shortage of wood making the dead wait longer’,

‘Record 132 Covid deaths in Chhattisgarh on Monday, new cremation grounds opened’, ‘Over 1,000 urns gather dust at Rajkot’s crematorium as fear of Covid keeps kin away’, ‘Karnataka: Families of victims wait for hours to say final goodbyes’, ‘MP: 40 pyres burnt simultaneously, baby girl said, “Mom is going take a photo”’.

Perhaps we should be grateful that the bodies don’t rack up on the streets. Go back far enough in time and the present, despite its scarred chaos, would even be an advance. Procopius writing about the Plague of Justinian in his History of the Wars draws a picture of the corpses of the time, 542CE. The place is Byzantium, one of the capitals of the world then. It lasted four months, three being its worst, the dead bodies unrelenting until even the rich found it hard to get a dignified send-off. He wrote: ‘Now in the beginning each man attended to the burial of the dead of his own house, and these they threw even into the tombs of others, either escaping detection or using violence; but afterwards confusion and disorder everywhere became complete. For slaves remained destitute of masters, and men who in former times were very prosperous were deprived of the service of their domestics who were either sick or dead, and many houses became completely destitute of human inhabitants. For this reason it came about that some of the notable men of the city because of the universal destitution remained unburied for many days.’ The emperor Theodosius did what the modern state does now: paid from his own pocket to bury the bodies that no one else would. But the numbers became overwhelming until, as now, niceties became irrelevant. ‘At that time all the customary rites of burial were overlooked. For the dead were not carried out escorted by a procession in the customary manner, nor were the usual chants sung over them, but it was sufficient if one carried on his shoulders the body of one of the dead to the parts of the city which bordered on the sea and flung him down; and there the corpses would be thrown upon skiffs in a heap, to be conveyed wherever it might chance.’

Without the shadow of death a pandemic is not a pandemic, otherwise every case of cold would be a decision about a lockdown. But the shadow is overarching even if, as some say, the virus is less lethal. It infects more than the first wave and so percentages are irrelevant. The count is the only one that matters. It overwhelms everything. The edifices humanity has built to perpetuate life, all its technologies, are impotent. The germ spreads like fire on a field of tinder. In the 1590s, John Davies would write a poem called ‘The Triumph of Death’ on the plague in London: ‘London now smokes with vapours that arise/ From his foule sweat, himselfe he so bestirres:/ ‘Cast out your dead!’ the carcase-carrier cries,/ Which he by heapes in groundlesse graves interres’. That is the first stanza. The next deals with people trying to flee but are not allowed to. ‘As if they were not men, nor Christians,/ But fiends or monsters, murdering as they go,’ he wrote. The website interestingliterature.com says about the poem that it ‘captures the lockdown that villages were put under’. The lockdown is as old as man’s first appreciation of what a pandemic is, its causes, his inabilities and the only way to meet the germ.

There are differences now. Even isolated, we reach out with virtual fingertips and touch the world. You can be in the doctor’s living room at the other end of India, tell him your symptoms. He can tell you what to do, write a prescription and message it. You can upload it on an app and the medicine can reach your home. A chain of virtual reality, but with a blank spot. The medicine must be available. And if it is, then a whole sequence of events is necessary to get to it. There must be hospital beds and there must be a test and the results of the test in your hands. There must be the state in the middle looking at that test result to permit you to get to that bed. None of these is a certainty now. People die waiting for test results that used to take 12 hours but now days and days until you either need no treatment or have died. Not all the leaps of connectivity can guarantee you treatment if you are in a city that the wave has engulfed. And people die giving updates about their impending death. The oximeter must be at least at 90 for the certainty of remaining alive. Vinay Srivastava put a photo of his oximeter in which it read 31 on April 17th. He was in his house in Lucknow tweeting in Hindi and asking simple questions which had no answer: ‘Yogi Adityanath, in your state doctors, hospitals and path labs have become dictators. I am 65 years old with spondylitis because of which my oxygen level has come down to 52. No hospital, lab or doctor is picking up my phone.’ Next day, he tweeted in broken English: ‘My oxygen is 31 when some will help me’. That day he went for a test but the results would come only the day after. No hospital would admit him without it. His son went to the chief medical officer’s (CMO) office for a letter to get a hospital bed. He returned to see his father die. Another man in Lucknow, whose mother was not being hospitalised, had better luck. He waylaid the car in which the CMO was travelling. He screamed in agony, lay down prone, inviting the car to run him over. In the video, you can see the CMO trying his best to ignore him. Luckily, there is a media gaggle to force him out. The letter is issued later. One patient gets a bed by the desperate cunning of a frantic son.

If the story of crematoriums can be told through newspaper headlines, there is an entire novel on remdesivir in WhatsApp forwards. It is a drug of limited help, only for those in a small window of disease progression, reducing hospitalisation by some days. But faced with the prospect of someone close dying, every relative of a patient wants it. Anything is better than nothing. It is a psychological salve, to feel that they are not allowing death victory without giving it battle. When the Spanish Flu struck a hundred years ago, there was nothing that medicine knew to deal with it. In fact, they didn’t even know it was a virus. And so people then too did what they could, hoping it might work. In Pale Rider: The Spanish Flu of 1918 and How It Changed the World (2017), Laura Spinney writes about how aspirin and quinine were prescribed in large doses. But there were all sorts of other experiments being done. ‘Arsenic preparations were popular, for their tonic, painkilling action, as was camphor oil for treating shortness of breath. Digitalis and strychnine were supposed to stimulate the circulation, Epsom salts and castor oil were prescribed as purgatives, and various drugs derived from iodine for ‘internal disinfection’. When none of these things worked, doctors fell back on older techniques. Having observed that some patients seemed to take a turn for the better following a gushing nosebleed, menstruation, even—traumatically—miscarriage, some revived the ancient practice of bloodletting, or medicinal bleeding,’ says the book. Note the line ‘camphor oil for treating shortness of breath’ in the extract above. Among the treatments doing the WhatsApp rounds now one had camphor in it, echoing the past again. It went viral. A Union minister put it up on Facebook leading to fact-checking websites investigating whether there was any truth in it. They found no evidence. It has been 100 years, camphor still doesn’t save lives.

Only one thing makes the difference between life and death—oxygen. That was the big lesson of the first wave. Get it to the lungs fast enough at critical junctures and most patients can survive. Yet, oxygen makes for the most heart-wrenching stories of this wave. The image of people who come to hospitals and are turned away is rife with tragic irony. The air all around them is full of oxygen. Just across the door of the hospital are the oxygen machines. The gas is everywhere and yet they die bereft of it.

Like Deepak Mhatre, a 57-year-old in Mumbai. Perhaps his family waited too long to decide that he needed hospitalisation but then they didn’t suspect Covid. He had just had malaria and the symptoms he exhibited were thought to be part of it. By the time they realised it was Covid, he was finding it difficult to breathe. The family called the municipal helpline from where beds are allotted but were asked to wait. Hours went by and as he showed signs of worsening, they put him on a wheelchair and headed to a hospital. Like Mhatre, the hospital too had run out of oxygen. They directed them to the helpline again. They remained outside the hospital with a pulse oximeter strapped onto Mhatre’s finger that now showed 55 per cent. There is a line in a report in the Times of India that crunched all the desperation of the family—‘In the meantime, as Deepak complained of his worsening breathlessness, they purchased a portable can that holds about 8 litre oxygen. “Soon as we gave that, his oxygen level showed some improvement, but the can lasted less than ten minutes,” Santosh (his son) said.’

It was during the Spanish Flu that the use medical oxygen as a life-saving tool in respiratory disease began to be explored. As a 2018 article titled ‘How the 1918 Flu Pandemic Helped Shape Respiratory Care’ in the American Association for Respiration Care website had said: ‘Many of those treatment modalities were driven by pulmonary pioneer Dr. Alvan Barach, whose interest in clinical oxygen therapy was sparked by experiences he had while witnessing the treatment of flu patients during his medical training in 1918-1919. As he told Dr. Tom Petty in a 1979 interview, when it appeared that patients were 10 or 15 minutes away from death, he saw physicians hold a funnel about an inch away from their faces into which oxygen was bubbled from a low-pressure tank. While the young physician noted no benefit from this last-ditch effort, it got him thinking about whether oxygen could be effective with higher concentrations.’

The technology has been fleshed out to perfection but what difference does it make to Mhatre? States are running out of oxygen, while fresh supplies will take time to come. Hospitals and chief ministers tweet their desperation and deadlines about when they will have no oxygen at all. The Centre tries to scramble fresh supplies and then do an intricate permutation and combination of how much should go where. People die till then in wheelchairs outside hospitals.

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