We thought that the worst was over. We thought that we had overcome this new disease and were going about our lives. But a more devastating crisis was about to unfold. The strain changed in the second wave. And the ability of the strain to impact or infect other people faster was much higher than the first wave. The virus does not want to kill its host. The virus wants to livein our genome forever, and multiply and replicate. A terrifying wave of COVID-19was about to grip our country. The minute you got up in the morning,you could smell smoke in the air. It was the bodies burning everywhere. The death rate had become very high. And we would need to do whatever it takesto battle this unseen enemy. The spring of 2021. It is business as usual in India. COVID-19 cases had peaked in September 2020. And by early February 2021, the national daily was around 10,000 cases. More than half of India's states weren't even reporting COVID-19 deaths. Life seemed to get back to how it was. But in a couple of days,things started to change. And I, just another ordinary Indian,would watch the devastation unfold. Signs of the second wavefirst show up in Maharashtra. The COVID-19 cases in Mumbai,the state's financial capital, begin to rise. Mumbai has reported more than 9,000 daily COVID-19 cases which is the Maharashtra state capital's highest ever single-day spike, according to Mumbai's municipal body,the BMC. We always knew that the second wave was coming because we were closely monitoring countries in Europe, such as Italy, Germany, France and the UK. The first wave was not very infectious. The second wave was highly infectious. We knew that it was the same virus. If the second and third waveswere happening in the UK, why wouldn't it happen in India? For the second wave, the virus had mutated,becoming more transmissible. And when there was the surge of cases, the country's oxygen supplywas quickly depleted because the demand for medical oxygenwent up ten-fold during that peak. Soon, infections begin to spreadacross the country. Daily deaths increasedby over 500% in just one month. Deaths have been rising at a scary rateof almost 10% a day in April. The national capital, Delhi,is hard hit. This time,young people were getting sick. There were 17-year-olds and 16-year-oldswho were getting sick. It did not happen last year. Last year, it was people above 65, and people above 55. And anyone younger than that would just get better. But this time, they were getting much sicker. Any amount of oxygen given to them was not enough. Any amount of medicinethat we could give was not enough. The treatment protocol was the same. The disease was the same. The way it looked on the CT scan was the same. But this time,the mortality was very high. Within two to three daysafter being hospitalised, some of them would die. And at the same time,the oxygen crisis started. The main thing people required was oxygen, which was suddenly not available any more. Last year, a regular COVID-19 patient would only require about four or five litres of oxygen per hour. This year, a regular COVID-19 patient who is admitted in the ward would require an average of about 10 litres of oxygen per hour. And when the patientis on the ventilator, the required oxygen is almost 45 litres per hour. So, we were scaredto put patients on ventilators or to keep patients on ventilators because one cylinder would only last for one patient. Over 24 hours, on one ventilator, I would need six such cylinders. The lack of oxygen cylinders was because the publicwas buying cylinders in bulk, filling it up and keeping it at home. And not understanding that if these cylinders were to go to the hospitals, and were filled by the hospitals, there would be more available bedsin the hospitals to treat patients. We had beds. We had a lot of beds,but we had no oxygen. We were running from one place to another. We ran between 300 and 700 miles, to a place where we could find oxygen. We were continuously on our phones, trying all the leadsthat can provide us oxygen. We have over 4,000 oxygen cylindersin distribution. And this facilitycan accommodate 500 people. The patients who come hereare the ones who can't find a bed. Some have been in their cars, finding a hospital bed for the past 30 hours. So, the patients who come here are in very critical conditions. I still remember the first day when we set up the facility. We had one patient coming inin an auto-rickshaw. They didn't have the moneyto even get the patient an ambulance. We have seen patients who were calling us and saying, "We are coming from 50 kilometres away. So, please keep something for us." We call them after some time, and we found out that they had passed away during transit. We prioritise people whose oxygen levels are below 80 because we know that the people who have an oxygen level of 90 and above will easily survive and be stable. But the one who might come in after 10 minutes may be a more severe case. So, this is how we plan. There is no solution to it. You need to draw a line at some point. But yes, saying no to someoneis the hardest thing you can ever do. Our focus now is, for each bed that we haveat our O2 centre facilities, we will always haveone concentrator for backup. It will help us to not rely onthe supply chain of oxygen cylinders, and on oxygen refilling stations. We just need the electricity connectionto run an oxygen concentrator. And our volunteers will be all setto keep this facility running 24/7. The journey doesn't just end today. I am fortunate enoughto be waking up tomorrow to serve more people. So, that in itself is an inspiration. We started Mission Oxygen with a group of friends, who are all entrepreneurs and founders of technology companies and other businesses in Delhi. Mission Oxygen is just an initiative that was started from a feeling of helplessness and a feeling of motivationthat we all had to do something. When Mission Oxygen came upon our WhatsApp group, I couldn't stop myself from saying, "Yes, I would like to be partof doing something good for my country, and for the frontline workers out there." When we started speaking to hospitals in Delhi NCR (National Capital Region), we realised that every hospital was asking for 10 to 100 pieces. And within a few hours, we all realised that this is not a problem that is going to be solved with 100, 200, 500 or even 1,000 pieces. We require thousands and thousands of them. We couldn't find anything in India. And that's why we started looking outside India, and how we can import these. And one of the reasons why we chose China was because one of the factories that we found was a WHO-approved supplier for oxygen concentrators. In fact, it was the only one in China. We had to book charter flights so that we could get these concentrators to India in time, because there were a lot of flights that were getting cancelled. So, all the airports in China were overloaded with cargo. There were about 700 to 1,000 tonnes of extra cargo. So, we had to make the decision that everything we were bringing in had to be brought in through charter flights. What we have been doing has been very difficult and taxing. We have all been working between 18 and 20 hours a day. And sleeping between three and four hours. The goal is to get these out within next two to three days so that it reaches the destination. The oxygen crisis escalatesin the last week of April, especially in Delhi. Today, desperate Indians around the country are begging, pleading and dying, waiting for beds,oxygen and medicines. There is a national oxygen emergency and it has to be called exactly that. And hospitals face a devastating truth. They may not have enough oxygen for their patients. That particular night was really like a horror movie. You didn't know what to do. People were gasping. The families were crying. They were desperate. And you know that these peopleare totally dependent on the oxygen. The minute the oxygen level dips, the saturation dips and they start becoming sick. The helplessness that was the reat that point in time was beyond imagination. There was no authoritythat I did not beg. Nothing could be done at that time. We contacted the ministry,we contacted the MLAs, we contacted peoplein the higher-up stations. But nobody could help us. People stopped answering the calls. I had this vision that the staff in our ICUwere standing. The oxygen was finished. One by one, the patients were dying. At that point in time,I took to social media. We don't have enough oxygento sustain our patients for the next two hours. We have been trying since 4.30am. Our vehicles have gone to Bawana. They have gone to Faridabad and Noida. We are not getting oxygen from anywhere. We have young patients who will die in a matter of two hours. I would like to request that you send oxygen to us, please. We need oxygen for our patients. Luckily, four to five hospitals came to our rescue. And some how, I managed to get enough oxygen for that night. But oxygen wasn't the only thing we are running out of. Hospital beds, medicines, ventilators, all critical tools to fight the pandemic,are in short supply. A lethal second waveof the COVID-19 virus engulfs India. And there is an acute shortageof oxygen and hospital beds. People were dying because of the fact thatthey couldn't get a bed in a hospital. They couldn't get an oxygen concentratorto save their lives. I think that these are really hard times, and all of us have come togetherto support this cause. It wasn't our responsibility to have to step up and do the work. But we did, because we couldn't let the lives of the people be another number on the screen. We also need to set upthe Facebook helpline because the Instagram helpline is kind of glitching and it got blocked. Let's have a meeting tomorrow at 12.30pm. I will send a text the group if you want to. Initially, when we started Uncut, we were two teenagers who thought thatwe should try and engage the youth more. A month and half ago, we had a little bit of extra timeon our hands. So, we decided to put that free timeinto doing COVID-19 resources work. We just compiled a couple of resourcesfor the region. We put them on our website, and we started circulating those linkson social media. Instead of having to frantically run around 10 hospitals and getting denied everywhere, we could direct them to the one place that they could getthe life-sustaining things they needed to save themselves and their families. As you can see,there are all the states below. And you have to work with the state that you are assigned to. We managed to make a database of all the resources, whether it was for beds, injectionsor anything that was available. And we managed to get it live on our website within 14 hours. I have some ambulances resources. I'll just send them to you. And can someone add those to the database as well? On the first day we did our database and had put it on social media, we received a text from someone asking,"Can you find me these resources?" And the entire team just worked on it, making phone calls and reaching out to personal contacts to try and find the resources. And two hours later,we got a call from that person saying, "The patient is stable now." And the doctors are very hopefulthat he'll make a recovery. I think that was the moment when we realisedthat we were doing a big thing. We have divided the entire teaminto fragments. We have a teamwhich is sending in resources to a group. We have a teamwhich is adding it to the database. And we have a separate teamwhich is verifying it side by side. So, the whole processbecomes a lot faster and smoother. Is there anything that went wrong? Is there anything that we can improve onas a team and can work on? Database-wise? Helpline-wise? Anything? I am going to forward the number to you. One of our volunteerswoke up in the morning for his first DM shift at around 8am. And the first thing he had to do was to look for a body bag for someone in Lucknow because the patient had passed away half an hour before and they needed a body bag. So, things like this just takes a huge toll on the team. (Foreign Language) Our next consignmentof oxygen concentrators has just come in from the airport. About 1,000 pieces or sohave come in this consignment, and they are just getting unloaded from the vehicles and being sent to the warehouse. If you think about it,in such a short span of time, we have gotten 6,000 pieces. We have paid $7 million to the vendors. We are flying charter flights into India. We have already sentmore than 2,000 concentrators to more than 13 states in India. I think it's just something that happened because the more we kept doing it,the more we felt that it was not enough. And that feeling of it not being enough is what led us to doingwhat we are doing right now. As the paperwork come, hopefully, it will leaveby tomorrow morning. And we will get it all out. The goal is to get themto the best place possible. And what is the best place? It is where the need is the most critical at this point in time. We have partnered with multiple NGOs and organisations on the ground that understand where the real need is in rural India today. Because the problem has extended down to the rural levels and to the smallest villages. Smaller towns like Dhampur in North India are not spared. Some even lack the basic infrastructure to deal with the crisis. Infection rates crossed 21 million by May 2021. There were 400,000 new cases every day,a world record. ...have been reported in the last 24 hours alone. This is the highest number of cases that have been reported in the country. Over 40 countries, including the US,UK, Russia and Singapore, rushed to our aid. The Indian Air Force does non-stop sorties. Warships bring oxygen plants from abroad and special oxygen trains are pushed into service. How did we get here? We had battled the first wave successfully, with nationwide lockdownfor over 70 days. The numbers had come down by early 2021. But did we let our guard down too soon? At the start of the year,large-scale celebratory events took place. The virus had mutated, and a highly infectiousvariant of the virus, the Delta variant,had begun to spread. Every virus has its genetic code. When we talk about its genetic code, this virus has an RNA,the Ribonucleic Acid, for its genetic code. I would describe it as a necklace made up of almost 30,000 beads. And the 30,000 beads comprise four main colours. And for its genetic code, the beads comein a pre-ordered sequence. And when it is multiplying very rapidly, sometimes, errors happen in the order of those beads. So, those changes are known as mutations. And these mutations are the variants of the virus. The whole genome sequencing is really lookingat that necklace of 30,000 beads. It is examined from one end to the other to see where the beads have changed. And sometimes,when these beads are changed, it confers different properties to the virus. The ability of a virusto be considered as a virulent strain is dictated by its genes. So, what contributes to virulence? One factor could be thatit becomes more infectious. It's able to quickly get into a cell and even jump from cell to cell. The other factor is its impact on the infected person's immune system. We have all heard of this so-called cytokine storm in people who have severe COVID-19. So, it can cause a hyperimmune or an exaggerated immune response. It could also spreadfrom one organ to another organ. In this case, the B.1.617,or the Delta variant, has been found to be highly transmissible. In the second wave, our daily oxygen requirements tripled from pre-pandemic times. What was the real problem with oxygen? Typically, hospitals don't generatetheir own oxygen, anywhere in the world. They are typically supplied with liquid oxygen which is then stored on-sitein cryogenic tanks. It is not that India doesn't makeenough medical oxygen. India makes a lot of oxygen,over 7,000 tonnes a day. And it happens to be in remote locations which are close to steel plants. When the government of India realised that there was a crisis all over, the question then was where they could get the oxygen. The answer is that it is available at the steel plants, because steel plants use oxygen and part of that,about 10% to 15% of the oxygen, is kept in storage as a reserve. Because whenever we havea power shutdown, a maintenance or a breakdown in our oxygen plant, we need at least 24 hours of buffer. So, this is a reserve quota that we always have. What is liquid oxygen? From the air,we separate nitrogen and oxygen. At a particular temperature of -180 degrees Celsius, we separate the nitrogen first and then, we separate the oxygen. And at that particular negative temperature, oxygen turns into liquid form. It looks like water. And then, we fill it up into the tanks. You can transport it as liquid from one location to another location. There are seven large steel plantsin the country. And every day, we can produce 2,000 tonnes of liquid oxygen. So, at its peak,the country's demand was at 2,200 tonnes. We had a capacityto produce more than 2,000 tonnes. But how do we transport it all the way from the central or eastern part of India, sending the oxygen to a particular city? That was a marathon of a task. We're experiencing an average of 2,000 deaths a day. But we are fighting to get things back under control. This is a nationwide effort. My father was an army officer who told me that wars are fought by systems,and not by individuals. And as a student of history,when I joined, I knew that the earlier pandemics, whether it was the Bubonic Plagueor the Spanish Flu, were around for years. So, I told my team that it was not an ad-hoc responsefor one to two months. This is a battle or a war,which is going to go on for years. So, we must build systems. It can be shifted here. For the first wave, we created 26 different systems, initiatives or models. And I would say that each of these models is unique. So, the second wave came,and the systems were on autopilot. Mumbai is also the only cityin the world today where the COVID-19 positive report does not flow directlyfrom the test lab to the patient. So, I said that these reports should come to me. This was a very risky decision that I took. It created panic in the market. They started running around and started to visualise death. And we created ward war rooms. Each ward gets about 40 names. Each dashboard would get four names, and each dashboard is manned by a professional doctor. And that doctor had to ring uponly four people, announce their positive results to them,send ambulances to their homes, and then we decide what category of bed they are entitled to. There is social equity. So, we call this system,"Chase The Patient". Right from his test reportto putting him on the bed. It worked greatly in our favour because we made the patient captive at his residence. Otherwise, if he had goneto a couple of hospitals seeking for a bed in taxis or private cars, by the evening, he would have infected dozens of people with COVID-19. We created these seven jumbo hospitals, with 9,200 beds, 612 ICU and 70% oxygenated beds. Not even one bed was shut down despite the fact thatin the whole of December and January, we had almost no cases. From the end of March, we were watching what was happening in Maharashtra and we were also kind of hopingthat it would not happen here. But at the same time,we were also planning. For Bangalore, cases peaked at around 4,000 last year. And we never expected that the number of cases would reach around 23,000. So, the surge in the number of cases has been quite unexpected for us. We have around 60 triage centres in operation. And the purpose of these triage centres is that if any patient tested positive, he has the option ofwalking into a triage centre. India is battlingits worst public health crisis. We have a huge populationof over 1.3 billion people. And one of the ways out of this crisis is to vaccinate everyone as quickly as possible. In early 2021, we had embarked on one of the largest vaccination drives in the world. The plan was to vaccinate 300 million people by August. But just as the second wave peaked, the vaccination drive stumbled. India's vaccination journey,with regard to COVID-19, has been mixed. India makes about 2.5 million doses a day. So, if you convert that into the number of people to be vaccinated, about 1.2 million people can be vaccinated a day based on the number of vaccines that are made in India. But considering that India has a population of about 900 million or 1 billion that need to be vaccinated, you are talking about over 900 days,or three years, to vaccinate at that rate. So, due to the size of the population, the production capacity hadto be ramped up by five to six times so that we could vaccinate peoplein six to eight months, instead of over a three-year period. Because that did not happen, we are now stuckwith having to import vaccines. Nandurbar is a district situatedin the northwest corner of Maharashtra, with a population of around 2 million. Around 70% of the population is tribal. And in terms of literacy and income,it's one of the lowest in the state. In many cities, there were long queues. People were waiting to get vaccinated. Here, despite active involvement, and actively persuading many local leaders and tribal people, they were apprehensive or fearful. And they were not believing us. Someone had said that this vaccine would make you impotent. Someone said, "They will kill you. Your kidney would be given to someone and sold to the market." Someone said thatafter taking the vaccine, you would die in four or five days. So, we deployed all our teachers,ASHA workers and Gram Sevaks. And we made it like a competition. If you vaccinate your village and your ward, make your village reach a vaccination rate of 100%, we will then give you a certificate. So, many people came upwith very innovative ideas. Someone dressed up as Mahadev (Great God). The second thing is the use of technology because this is based on the CoWIN app. You have to register to use the app. The availability of Internet is an issue. So, rather than having people come to our centres, we deployed the centres to the public. If the public is not coming to the centres,we should go to the public. Buses will go to the hamlets. They will pick up the peopleand bring them to the vaccination place, where the vaccination will be done. It's heartbreaking when you see someone die and you can do nothing about it. There are stories of people dying from the virus because they had to go out. They had no other choice. There are stories of people who tried to get a vaccine, and never got a vaccine. And in the end,they died because they got infected. These are extremely hard storiesbecause they didn't have to die. But they died because of the way we have created our systems and created this world. And they died simply because of inequalities, which are inherent in this world. Is it the first or the second doseof the vaccine? If it was the first,then you check when it was taken. It becomes critical to have those touchpoints. I am blind,and that's just a medical condition. But someone like meis not able to access the software because they have not designed itto be used by someone who is blind. Someone who is in a wheelchair can't access physical spaces because they are not designed for someone in a wheelchair. This has nothing to do with their disability. These are handicaps that have happened simply because of the way we have constructed the world. Our fundamental focusis to enable people to get vaccinated. So, starting from there, to helping them registeron the CoWIN app, understanding their needs of transport,or financial needs, such that every single person can have a dignified vaccination experience. It has been three and a half weeksof trying to procure the vaccine for someone with a disability,like myself. And through the helpof the ABBF foundation, we are on our wayto the SL Raheja Hospital where I have managed to secure a spotfor myself and my care giver to get a shot of the vaccine. And I am very excited to go and get it. No two persons with disabilities have the same needs. The needs of Rustom in a wheelchair are very different than those of someone else that he knows, or someone else in a wheelchair. There are certain pockets in every city where you have higher concentrationsof people with disabilities. So, our on-ground volunteersgo door to door. They know these people. They are part of the community. So, they are familiar with the people. They go speak to them, and stay in touch with them until they come to the vaccination centre. I really believe that all of usare inherently good human beings and want to do good. It's just that we all needsome opportunities. We all need to knowthat what we are doing does bring a difference to someone's life. Sudhir put it very beautifully once and he said, "If not now, then when?If not me, then who?" And I think that's what really drivesmost of the volunteers, and the people who are on the grounddoing such amazing work. And while the country grapples with the aftermath of the second wave, the battle with COVID-19is far from over. When I took over,I closed my eyes for five minutes. And I said, "Look, God has chosen me." And I promised in my heart and soul that I will do whatever possible,to the maximum. Our vaccination is ongoing. And you see in the United Kingdom and the United States of America that mortality has nosedivedafter vaccination. And we have floateda global expression of interest to acquire 10 million vaccines in one go. So, even if we get the next wave in one or two months' time, in five months' time, we would have reached that position where everybody in Mumbai is vaccinated. We are building 4 jumbos (field hospitals)with 6,500 beds. These jumbos can handle over 15,000 patients. This is the Paediatric ICU. We have oxygen, suction, lines air, as well as the ventilators ready. And we also have the medicines for these children ready in case of an emergency. And this is all ready for a third wave which will be coming. Even as cities begin to slowly unlock, and people returnto some sense of normalcy, the devastation brought by the second wave lingers. We had a lot of fear because we were surroundedby COVID-19 patients since we were a COVID-19 hospital. There was the fear of bringing it home. And there was a lot of fear of actually getting COVID-19 and dying. But after seeing so many deaths, personally, I am now not scared of death any more. For the first time, we were seeing so much more positive news as compared to negative news. For example,people are helping each other, irrespective of gender or caste. So, it just felt really good to see that as a country, we can be so united if we put in that effort. I've gotten COVID-19 twice. Even if I get it one more time, the worst case would bethat I lose my life. But with the number of people I've saved, I know I've made a difference which nobody can take away from me. I know that I've lived my lifeto the fullest. It's a complete journey. As we're survivingthe catastrophic second wave, we remember the lives lost, the lessons learnt, and hope that we never have to go through this devastating crisis again.
