Patna (Bihar): Contrary to the state government's claim that there were no deaths due to lack of oxygen in Bihar during the second wave of COVID-19, a detailed survey report prepared by the Communist Party of India (Marxist–Leninist) Liberation [CPI-ML(L)] indicates there were at least half-a-dozen such incidents.

The Union government had in July told the Rajya Sabha that health is a state subject and no deaths due to lack of oxygen were "specifically reported" by states and UTs. While this was not a denial, it represented the Union government's disinterest in maintaining data.

Later, some state governments went a step further and claimed that no deaths occurred due to lack of oxygen. Bihar was one of those states, with health minister Mangal Pandey saying, “No patient had died in Bihar due to lack of oxygen. Though there was a little bit of scarcity of oxygen at the beginning of the second wave. But enough oxygen was arranged on time, so no one died due to the lack of oxygen in Bihar.”

The CPI-ML(L)'s detailed survey report indicates that more than half a dozen COVID-19 deaths were caused by the lack of oxygen in April and May 2021. The report, published as a booklet, is titled 'Covid Ki Doosri Lahar Ka Sach (Truth Of Second Wave of COVID)'. The survey only covers 1,904 villages from 13 districts of Bihar, which represent just 4% of the total villages in the state.

From these villages alone, the survey identified around 7,200 persons who had died and had symptoms of COVID-19 like cough, fever, breathing problems, chest pain but were not tested for the viral infection. The booklet also has testimonies of family members of the deceased persons. Some families have reported multiple deaths which are not part of official records.

The team members who had conducted the verbal autopsy told The Wire that these deaths could not find a place in government records as many did not turn to government hospitals and were not tested for COVID-19.

Among the 7,200 deaths, in at least six cases, family members said they could not access medical oxygen.

While the CPI-ML(L) survey claims that there were 7,200 deaths during the second wave alone, the official government COVID-19 death toll in Bihar stands at 9,649 as of August 18.

Motilal Manjhi of Jaijor village in Siwan died on May 30. He had COVID-19 symptoms. His daughter-in-law Kavita Devi says, “He had a cough and fever. He was also suffering from breathing problems. We took him to a government hospital in Raghunathpur, but there was no oxygen available. Due to lack of oxygen, his conditions deteriorated further so we brought him back to our house. He died two days later.”

Shamim Ansari of Chitakhal village in Siwan also died with symptoms that are consistent with COVID-19 symptoms. His wife Laila Khatoon says, "He had a cough and fever. He also had breathing problems. We admitted him to a government hospital in Guthani, around four kilometres from Chitakhal. There was no oxygen at the hospital. He died in the hospital during treatment."

Other families also shared similar experiences.

Dr Ajay Kumar, the senior vice-president of the Indian Medical Association (IMA)'s Bihar chapter, told The Wire, “Whatever the government may say, the fact is that there was a shortage of oxygen across hospitals in Bihar. I personally know someone who was critical and needed oxygen, but the hospital discharged him forcefully as it did not have oxygen. The person didn’t get admitted to another hospital and died.”

During the second wave of COVID-19, the demand for oxygen spiralled out of control. As hospitals began running out of stock and supply was not forthcoming, courts heard many urgent hearings. It emerged that states did not maintain buffer stocks, despite the pandemic having begun more than a year ago.

Bihar produces 103.46 metric tons of medical oxygen, but state health secretary Pratyam Amrit had said on April 22 that given the oxygen demands of COVID-19 patients, oxygen consumption was expected to go up to 300 metric tons.

The Bihar government had to depend on the Union government for additional oxygen. In government hospitals, the shortage of oxygen was so steep that the superintendents had to write letters to the health department to relieve them from the duty.

The superintendents of the Nalanda Medical College and Hospital (NMCH) and the Darbhanga Medical College and Hospital (DMCH) had offered to resign as they feared that due to delay in oxygen supply, patients would die and the blame would fall on their shoulders.

The survey found that many patients had to resort to 'treatment' from quacks, so there is a possibility that many more had needed oxygen but the quacks could not figure this out and the patients died. As the country reported upwards of 4 lakh cases per day at the peak of the second wave, the health system collapsed and hospitals could not admit patients.

More than 7,000 unreported COVID-19 deaths

The CPI-ML(L)'s report has interviewed families of 7,984 persons who had died during the peak of the second wave of COVID-19 in 1,902 villages. The report says that 784 deaths may not have been caused by COVID-19 as the symptoms their family members described did not match the viral infection. The remaining 7,200 deaths, the survey claims, were due to COVID-19.

According to party workers, surveys were mainly conducted in those areas where it has a strong cadre base since the extensive exercise needed huge manpower.

Kunal, the state secretary of the CPI-ML(L), who was actively involved with the survey, told The Wire that the survey covers deaths that occurred between April 1 to May 31, at the peak of the second wave.

The questions asked for the survey included if the deceased person had COVID-19 symptoms or not, if they were tested for COVID-19, where they were treated and if they received any compensation.

“There are around 50,000 villages in Bihar. We found 7,200 unreported COVID-19 deaths in just 4% of villages. So, we can say that if all the villages are surveyed, the death toll may rise to around 2 lakh," he told The Wire.

Harihar Bhagat, 35, a resident of Damodara village in Arwal, had COVID-19 symptoms when he died. His name is not included in the official list of COVID-19 fatalities. His wife Kaushalya Devi says, “He suddenly developed breathing problems. He also had chest pain. Locals suggested that we arrange oxygen, but I had no money. I managed to arrange a vehicle to take him to a hospital, but he died in transit.”

The fourth round of the National Sero-Prevalence Survey also indicated a high positivity rate in Bihar. Of the 2,461 persons from Bihar who were tested for the survey, 1,867 persons or 75.9% had antibodies. If this data is extrapolated, it would mean that across the state, most people who had COVID-19 were not confirmed by laboratory tests. If these results are to be believed, one must also accept that the official COVID-19 death has missed several deaths due to the pandemic.

Experts believe that the findings of the CPI-ML(L) cannot be ignored and the government should take them seriously.

Dr K.R. Antony, a paediatrician and an independent monitor for the National Health Mission, told The Wire that underreporting of COVID-19 deaths is a pan India phenomenon and only the degree differs. He cited media reports which indicated that in many states, the undercount was as high as 27 times (in Gujarat) and 2.5 times (in Kerala).

He said, "So the findings of this study cannot be ignored".

“Many persons had died with symptoms that are suggestive of COVID-19, but they were not tested. Even doctors had symptoms but they were not tested and died. I operate my clinics in villages. I have come across many patients who had COVID-19 symptoms but they died before they got tested. The government must audit every village to identify those who died with symptoms of COVID-19," said Dr Ajay Kumar.

CPI-ML(L) to make health a public movement 

The team had surveyed the health infrastructure of 11 districts – Bhojpur, Patna (Rural), Rohtas, Siwan, Darbhanga, Arwal, Kaimur, Aurangabad, Jehanabad, Gaya and Buxar – and found it inadequate. According to the booklet, there is a huge manpower crunch in health centres.

The party has planned to make health issues a public movement. It workers are organising an 'Apno Ki Yaad (Remembering our loved ones)' programme every Sunday in several villages where people had died of COVID-19.

Dipankar Bhattacharya, the party's general secretary, said, “During the assembly election, we had made employment a big issue. Similarly, we will have to make health a public movement by making people aware of the importance of health infrastructure. I am sure we can make it possible. Things will certainly change if we do so.”

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