Facing new COVID wave, Dutch delay care for cancer, heart patients

AMSTERDAM (Reuters) – Dutch healthcare officials said on Friday they have begun delaying operations for some cancer and heart patients to free up space in intensive care units during a record wave of COVID-19 infections.

“These are cancer patients that should actually be operated on within six weeks of diagnosis, and that won’t be met in all cases. It’s also heart patients,” said a spokesperson for LCPS, the national organization that allocates hospital resources.

“It’s horrible, of course, for the patients.”

The National Institute for Health (RIVM) reported a record of more than 23,000 new cases in the previous 24 hours on Thursday, compared with the previous daily high of around 13,000 reached in December 2020.

With 85% of the adult population vaccinated, both hospital and intensive care unit (ICU) admission rates have so far remained lower than they were at the height of the initial wave in April 2020, although there is a delay between the date of infection and the date of admission to hospital.

With fewer than 200 beds remaining in Dutch ICU as of Thursday, hospitals are scrambling to add more capacity.

The government at the start of November reintroduced mask-wearing in stores, and last weekend it reimposed a partial lockdown, including closing bars and restaurants after 8 p.m.

But the impact of those measures has yet to be seen in the daily case numbers.

Parliament is divided over a plan proposed by Prime Minister Mark Rutte’s government to limit access to indoor public venues to people who have a “corona pass,” which shows they have been vaccinated or already recovered from an infection. Critics say the move would be divisive and discriminatory.

Schools remain open, and virologists on Thursday proposed extending Christmas holidays to slow infections, which are rising most rapidly among children.

(Reporting by Toby Sterling; Editing by Mark Heinrich)

Without ICUs, doctor in Jakarta hospital battles to help COVID-19 patients

By Yuddy Cahya Budiman

JAKARTA (Reuters) – Indonesian doctor Cheras Sjarfi says the small public hospital where she works in south Jakarta was not ready for the influx of COVID-19 patients who arrived after a surge of new infections in the world’s fourth-most-populous country.

Only equipped for basic health care, her facility has had to treat COVID-19 patients even though it lacks the life-saving ventilators and intensive care units they sometimes require.

“We weren’t prepared for this situation,” she said, adding that the situation at smaller hospitals like hers showed how severe things had become.

The 28-year-old general practitioner said she knew it was getting bad when all the patients classified as suspected coronavirus cases tested positive within a week.

Grappling with the worst outbreak in Southeast Asia, Indonesia has reported record daily cases in seven of the past 11 days, including on Thursday, with 24,836 new infections and 504 deaths, both new highs.

The spike has made it harder to transfer severely ill patients, and city hospitals were at 93% capacity this week. Hospitals across Java are also nearly full.

“We… receive the incoming patients as best as we can. Give them oxygen, check their blood pressure, and observe them,” she said, adding that if a patient’s condition worsens it is unlikely that other hospitals can take them.

“The worst case is they die here. I definitely feel sad even if I have seen… people dying many times,” said Cheras.

She is working 12-hour shifts, double the normal length, after she said some of her colleagues were infected despite being fully vaccinated.

Indonesian authorities have announced new curbs starting Saturday, including tighter restrictions on movement and air travel, a ban on restaurant dining and closing non-essential offices.

Still, despite the huge strain and concerns she could be re-infected with COVID-19, Cheras tries to remains positive.

“Although we are exhausted and wonder when will this end… I think it still manageable,” she said.

(Writing by Ed Davies. Editing by Gerry Doyle)

U.S. CDC director urges teens to get vaccinated after hospitalizations rise

(Reuters) – The U.S. Centers for Disease Control and Prevention director urged teenagers to get vaccinated, as new data from the agency’s researchers showed one in three teenagers who were hospitalized due to COVID-19 early this year needed ICU admission.

“I am deeply concerned by the numbers of hospitalized adolescents and saddened to see the number of adolescents who required treatment in intensive care units or mechanical ventilation,” CDC Director Rochelle Walensky said in a statement on Friday.

The rate of hospitalization due to COVID-19 increased among adolescents aged 12 to 17 in April to 1.3 per 100,000 people from a lower rate in mid-March, the CDC said in its Morbidity and Mortality Weekly Report (MMWR).

Among 204 adolescents, who were hospitalized mainly for COVID-19 between Jan. 1 and March 31, 31.4% were admitted to an intensive care unit and about 5% required mechanical ventilation, the agency said.

“Much of this suffering can be prevented,” Walensky said.

The CDC’s latest data was based on a surveillance system of laboratory-confirmed COVID-19–associated hospitalizations in 99 counties across 14 states, covering approximately 10% of the U.S. population.

The data adds to previous information showing that hospitalizations due to severe COVID-19 occur in all age groups even though they occur more often in older adults. The CDC released the data as part of the United States’ push to vaccinate teenagers with Pfizer Inc and German partner BioNTech SE’s vaccine.

The shot was authorized for use in 12 to 15 year old’s in May. Nearly 50% of the U.S. population, 12 years and older, has been fully vaccinated, according to the agency’s data.

The increased hospital admission rates in teens may be related partly to the circulation of more infectious variants of the coronavirus and a large number of children returning to schools, the agency said.

(Reporting by Manojna Maddipatla in Bengaluru; editing by Caroline Humer and Amy Caren Daniel)

COVID and conflict: Gaza’s hospitals strained on two fronts

By Nidal al-Mughrabi

GAZA (Reuters) – Gaza’s hospitals were already struggling to cope with the COVID-19 pandemic before the conflict with Israel erupted last week. Now, medics say, they are being stretched further.

“The Ministry of Health is fighting on two fronts in the Gaza Strip – the coronavirus front and the other front, which is more difficult, is the injuries and the wounded,” said Marwan Abu Sada, the director of surgery in Gaza’s main Shifa hospital.

More than a week into fighting, with Palestinians pounded night and day by airstrikes and Israelis racing for refuge from rockets as sirens wail, Gaza’s doctors are battling to keep pace.

At Shifa, the biggest health facility among the 13 hospitals and 54 clinics serving the crowded enclave’s 2 million people, the number of intensive care beds has been doubled to 32 as the toll of those wounded from the conflict mounts.

Like the rest of the system, the 750-bed hospital faced shortages of medicines and equipment before fighting erupted on May 10 – blamed by medics on a blockade led by Israel and backed by Egypt, which shares a border with Gaza. Israel says its measures aim to stop arms reaching militants. “The list of essential medications and medical disposables suffered an acute shortage,” Abu Sada said.

It’s not just medicines in short supply. Fuel for generators that power Gaza’s hospitals – with main’s power too intermittent to be relied on – is also running out.

Israel says its blockade does not aim to stop medicines or other humanitarian supplies, and any shortages are the result of actions by Hamas, the Islamist group that has run Gaza since 2007, when the blockade was imposed.

“Hamas constructed a network of underground terror tunnels in Gaza underneath the homes of Palestinians, using funds meant for their health & welfare to expand Hamas’ terror machine instead,” Israel’s Foreign Ministry said on Twitter Monday.

Hamas has rejected the accusation.

Palestinians say 201 people have been killed in Gaza since the fighting started, with hundreds more hurt, including those wounded by shrapnel or injured by collapsing buildings.

Israel has reported 10 dead in the rocket salvoes, with many more injured, some directly by the blasts and others when dashing to safety. Some are in a critical condition.

“We have a very bad time over here,” said Racheli Malka, an Israeli living in Ashkelon, a city north of Gaza repeatedly hit by rockets. “I hope it will finish fast.”

Nearby, Israelis celebrated the Jewish festival of Shavuot in a synagogue that had a hole caused by a rocket strike.

The Israeli military said Hamas – regarded by Israel, the United States and European Union as a terrorist group – and others militants had fired about 3,150 rockets in the past week.


Sacha Bootsma, the head of the World Health Organization in Gaza, said COVID-19 had strained the enclave’s struggling system.

“Before COVID, the health system could be categorized as fragile because it has very old equipment, old buildings, a shortage of properly trained health staff and, of course, a chronic shortage of essential medicines,” she said.

Gaza has reported about 106,000 cases of COVID-19, or about 5.3% of the population, with 986 deaths, health official say.

While Israel has rolled out one of the fastest vaccination programs in the world, fully inoculating about 55% of its 9.3 million people, Gaza received about 110,000 doses, or enough for 55,000 people, health officials say, to be distributed among one of the most densely populated areas in the world.

One ward at Shifa, still marked “Corona Isolation Department”, has had to be turned into an intensive care unit for those injured in the conflict.

“We require more urgent support from international and relief institutions,” said Ashraf Al-Qidra, spokesman for the ministry of health, calling for medicines and ambulances.

For those living near Shifa hospital, the sound of ambulances wears on their already shattered nerves. “As long as we hear sirens we know it is not over yet,” said Karam Badr, 57.

Yet, healthcare workers keep the creaking medical facilities going. WHO’s Bootsma said scarce resources were still reaching those most in need.

“The resilience of the health system is remarkable,” she said.

(Reporting by Nidal al-Mughrabi in Gaza; Additional reporting by Eli Berlzon in Ashkelon; Writing by Edmund Blair; Editing by Alex Richardson)

‘A hell out here’: COVID-19 ravages rural India

By Danish Siddiqui and Sanjeev Miglani

NEW DELHI (Reuters) -India’s coronavirus death toll crossed 250,000 on Wednesday in the deadliest 24 hours since the pandemic began, as the disease rampaged through the countryside, leaving families to weep over the dead in rural hospitals or camp in wards to tend the sick.

Boosted by highly infectious variants, the second wave erupted in February to inundate hospitals and medical staff, as well as crematoriums and mortuaries. Experts still cannot say for sure when the figures will peak.

Indian state leaders clamored for vaccines to stop the second wave and the devastation that it has wrought, urging Prime Minister Narendra Modi to stop exporting vaccines, ramp up production and help them procure urgent supplies from overseas.

“People will die in the same way in the third and fourth waves as they have this time” without more vaccines, Delhi’s Deputy Chief Minister Manish Sisodia told reporters.

Deaths grew by a record 4,205 while infections rose 348,421 in the 24 hours to Wednesday, taking the tally past 23 million, health ministry data showed. Experts believe the actual numbers could be five to 10 times higher.

Funeral pyres have blazed in city parking lots, and bodies have washed up on the banks of the holy river Ganges, immersed by relatives whose villages were stripped bare of the wood needed for cremations.

Lacking beds, drugs and oxygen, many hospitals in the world’s second-most populous nation have been forced to turn away droves of sufferers.

“We seem to be plateauing around 400,000 cases a day,” the Indian Express newspaper quoted virologist Shahid Jameel as saying. “It is still too early to say whether we have reached the peak.”


India is using the AstraZeneca vaccine made at the Serum Institute in the western city of Pune and Covaxin by Bharat Biotech but has fully vaccinated barely 2.5% of the population.

Indians need vaccines “here and now”, the chief minister of West Bengal state, Mamata Banerjee, said in a letter to Modi.

The country accounts for half of COVID-19 cases and 30% of deaths worldwide, the World Health Organization said in its latest weekly report.

The full impact of the B.1.617 variant found in India, which the WHO has designated as being of global concern, is not yet clear, it added.

The variant has been detected in six countries in the Americas, the Pan American Health Organization said, adding that it was worried that it was highly transmissible.

Britain, which has also detected the variant, is looking at all possible solutions to tackle a surge of related cases, including in the northern English town of Bolton, Prime Minister Boris Johnson told parliament.


Daily infections are shooting up in the Indian countryside in comparison to big towns, where they have slowed after last month’s surge, experts say.

More than half the cases this week in the western state of Maharashtra were in rural areas, up from a third a month ago. That share is nearly two-thirds in the most populous, and mainly rural, state of Uttar Pradesh, government data showed.

Television showed images of people weeping over the bodies of loved ones in ramshackle rural hospitals while others camped in wards tending to the sick.

A pregnant woman was taking care of her husband who had breathing difficulties in a hospital in Bhagalpur in the eastern state of Bihar, which is seeing a case surge its health system could barely have handled at the best of times.

“There is no doctor here, she sleeps the whole night here, taking care of her husband,” the woman’s brother told India Today television.

In a corridor outside, two sons were wailing over the body of their father, saying repeatedly that he could have been saved if only he had been given a bed in an intensive care unit.

At the general hospital in Bijnor, a town in northern Uttar Pradesh, a woman lay in a cot next to a garbage can and medical waste.

“How can someone get treated if the situation is like this?” asked her son, Sudesh Tyagi. “It is a hell out here.”

(Reporting by Anuron Kumar Mitra and Manas Mishra in Bengaluru, Shilpa Jamkhandikar and Aishwarya Nair in Mumbai, Tanvi Mehta in New Delhi, Subrata Nagchoudhary in Kolkata and Stephanie Nebehay in Geneva; Writing by Raju Gopalakrishnan; Editing by Simon Cameron-Moore, Clarence Fernandez, Mark Heinrich and Giles Elgood)

In COVID-hit India, a 26-year-old doctor decides who lives and who dies

By Alasdair Pal

NEW DELHI (Reuters) -Rohan Aggarwal is 26 years old. He doesn’t even complete his medical training until next year. And yet, at one of the best hospitals in India, he is the doctor who must decide who will live and who will die when patients come to him gasping for breath, their family members begging for mercy.

As India’s healthcare system teeters on the verge of collapse during a brutal second wave of the novel coronavirus, Aggarwal makes those decisions during a 27-hour workday that includes a grim overnight shift in charge of the emergency room at his New Delhi hospital.

Everyone at Holy Family Hospital – patients, relatives and staff – knows there aren’t enough beds, not enough oxygen or ventilators to keep everyone who arrives at the hospital’s front gates alive.

“Who to be saved, who not to be saved should be decided by God,” Aggarwal says.

“We are not made for that – we are just humans. But at this point in time, we are being made to do this.”

India has reported a global record of more than 300,000 daily cases for the last two weeks – figures experts say are almost certainly conservative. In the capital, fewer than 20 of more than 5,000 COVID-19 ICU beds are free at any one time. Patients rush from hospital to hospital, dying on the street or at home, while oxygen trucks move under armed guard to facilities with perilously low stocks. Crematoriums work round the clock, throwing up plumes of smoke as the bodies of victims arrive every few minutes.

During his marathon shift, which Reuters documented to provide one of the most comprehensive accounts of overwhelmed hospitals during India’s harrowing surge, Aggarwal says he fears what will happen if he gets infected too, knowing that his own hospital will be unlikely to find him a bed.

He is unvaccinated: He was sick in January when shots for medical professionals were being rolled out, and then by February, he began to relax.

“We were all under the misconception the virus had gone,” he says.


When Aggarwal begins his shift around 9 a.m., four bodies lie in one of the areas where staff are supposed to remove their protective equipment.

In the emergency room, conditions are even more cramped. Patients and relatives crowd every available space, many wearing no protection except for a simple cloth mask. Doctors and nurses have stopped wearing full protective equipment too – it is simply too difficult to work in.

Trolleys are close enough for patients to touch each other. One man even lies in a storage area surrounded by bins of medical waste, a relative dragging in a new oxygen cylinder as one runs out.

In normal circumstances, Holy Family is one of the best hospitals in the country, attracting patients from across the world – and it still is, considering the conditions in government hospitals, where patients lie two to a bed, or die outside on trolleys in the baking sun.

But the facility is still in a desperate position.

The hospital, which normally has capacity for 275 adults, is currently caring for 385. A sign posted outside shows the number of available general and intensive-care COVID beds remains the same as it has for weeks: zero.

Heading the ER, with its broken bones and coughs and colds, is usually a relatively simple task, left to a more junior doctor while senior consultants and specialists work in the ICU, where serious cases are quickly escalated. That system has long broken down, and the on-duty doctor in the ER is now one of the most critical in the hospital.

Before he begins his turn in the ER, Aggarwal first makes his rounds of the general COVID wards. Along with a senior colleague, he is responsible for 65 patients. That gives him a maximum of three to four minutes to see each one before any emergencies, which frequently occur.

He is minutes into his rounds when he receives an urgent call – one of his patients is sick. He sprints down the stairs and along a dimly lit corridor to Room 323, where an elderly man is barely conscious.

“He is on the way down,” Aggarwal explains to the man’s son.

The son sits with his head in his hands while space is made in the ICU. The patient is one of the lucky ones: He’s already been admitted to a COVID ward, unlike those pleading to get in, and thus has access to intensive care.

“They don’t have beds, but they will have to manage,” Aggarwal says.

A security guard, Mahendar Baisoyar, is posted outside the emergency room door to ensure relatives don’t try to secure a bed “by force,” he says.

Last month, relatives at another hospital in the capital attacked staff with knives after a patient died. The city state’s top court has warned that more law-and-order problems at hospitals are likely if shortages continue.

Like many others in Delhi, Holy Family has taken to Twitter to beg state and federal politicians for help securing oxygen.

Its medical staff look at everyone, give first aid as best they can, but there just isn’t space for everyone.

Slumped in the back of a car, 62-year-old Vijay Gupta is one patient turned away, his family and friends debating what to do next.

“We have been roaming around since 6 a.m. looking for a bed,” says Gupta’s friend Rajkumar Khandelwal.

There is a moment of indecision as he and Gupta’s son, Kushal, debate what to do next.

“Where shall we go?” Khandelwal asks the son helplessly, before they leave to try another hospital.

Others in the ER are so sick they are in urgent need of a ventilator, and Aggarwal pleads with families to look elsewhere. But they already have.

By the time his morning rounds end after about three hours, Aggarwal’s eyes are already burning from tiredness.


Aggarwal, who was brought up in Delhi, wanted to be a doctor since he was 6 years old – a job that carries huge prestige in India.

He passed his first set of exams when he was 19, and began training at a medical college attached to a government hospital in the east of the capital.

But this wasn’t what he expected when he moved to the missionary-founded Holy Family, where depictions of Christ are everywhere: looming over the main staircase, watching over patients in the ICU, in cheap plaster idols wrapped in plastic in the shuttered gift shop.

“I am vaccinated by the precious blood of Jesus,” one poster says. “No virus can touch me.”

Sumit Ray, the hospital’s medical superintendent and head of the ICU, says the hospital staff are doing everything they can. “The doctors and nurses are demoralized,” he says. “They know they can do better, but they just don’t have the time.”

No matter where Aggarwal is, he hears the sound of heart-rate monitors as he tries to sleep. He hears their gentle chimes and staccato bursts as he naps fitfully at the hospital. But he also hears them at home in his own bed, making it impossible to forget about the deaths under his care not from lack of trying, but lack of resources.

Aggarwal normally takes lunch in the hospital, but on this day, the sound – “the ICU noise,” as he calls it – is too much for him to bear.

He finds respite in a nearby 24-hour convenience store, with its powerful air conditioning, imported cereal and Selena Gomez playing softly on the in-store stereo.

“It’s really a depressing atmosphere,” he says of the hospital as he eats from a takeaway carton of biryani. “I just want to have a break of an hour or so outside the hospital so that I can just recollect myself. Because I have to be there for another 24 hours.”

Like many young Indians, he still lives with his parents, and worries constantly about their safety.

Aggarwal used to barricade himself in his first-floor apartment, but his mother has other ideas.

“I used to go and see them every 10 days or two weeks. But my mom wants to have food with me; she can’t be away from me,” he says.


A little before 3 p.m., Aggarwal returns for his shift in the emergency room. He sits behind a desk as relatives crowd around him, pleading for admission.

He makes the decision-making process sound simple.

“If a patient has a fever, and I know he’s sick but he’s not requiring oxygen, I can’t admit him,” he says.

“That’s the criteria. People are dying on the streets without oxygen. So people who don’t require oxygen, even if they are sick, so we don’t admit them usually.”

That’s one choice.

“Another choice is I have an old male and I have a young guy. Both are requiring high-flow oxygen; I have only one bed in the ICU. And I can’t be emotional at that time, that he is a father to someone. The young have to be saved.”

He begins touring the ER, his manner brisk. He barely looks at patients who are sitting up and conscious.

“Will he recover?” one relative asks as Aggarwal looks at the patient’s X-ray.

“I will try my best, but I can’t promise anything,” he replies, already turning to the next patient.

One woman, Pratibha Rohilla, is moaning and clutching at her oxygen mask.

Her son, Aditya, looks angrily as another patient is moved onto a ward. He tries to argue with a nurse.

“I understand, but not a single bed is there,” she replies.

“There are no beds,” the son says of hospitals in the capital, a refrain that almost everyone in the emergency room says minutes after meeting anyone. “We have tried 15, 20 hospitals.”

He starts reeling off their names, but begins to forget where he has tried.

One woman, 74-year-old Karuna Vadhera, is in critical condition.

Aggarwal punches the woman’s shoulder and puts his thumb gently into her eye socket to test for resistance.

There is none; her head lolls forward, oxygen levels perilously low.

“She might die at any time,” he tells her nephew Pulkit, imploring him to move her to a hospital with an ICU bed free.

“We have five family members in different parts of Delhi each trying,” Pulkit replies, his phone barely leaving his ear. “No one has found a bed.”


Aggarwal spends the night fighting constant emergencies in the wards. Three of his patients die, including a young woman.

While helping out in the ICU, Aggarwal sees a senior colleague. Both of their fathers have been sick, and have recently recovered. They share a private joke, and Aggarwal realizes it is the first time he has laughed in weeks.

It isn’t until 5 a.m. that he manages some sleep in the break room of the ER.

By the time he emerges, bleary-eyed, a few hours later, Vadhera, the older woman who didn’t get a bed in the ICU, has died. Her nephew Pulkit stands by as her body, wrapped in a white shroud, is loaded into an ambulance for cremation.

Rohilla, the woman whose son had tried 15 to 20 hospitals before Holy Family, will take her place in what is a slightly less cramped corner of the emergency room, though she should be in the ICU, too.

Finally, after 27 hours, his shift is over, and an exhaustion has taken hold that makes him want to sleep for the rest of the day, and the next one too.

But he has one final job: A friend’s father is sick, and he’s asked Aggarwal for help – one of many such calls he receives each day. Nine times out of 10, there is nothing he can do, no matter how loved or insistent the caller, but he tries all the same.

And so he puts his mask back on and heads back inside.

(Reporting by Alasdair Pal; editing by Kari Howard)

India infections top 18 million as gravediggers work round the clock

By Alasdair Pal and Francis Mascarenhas

NEW DELHI/MUMBAI (Reuters) -India’s total COVID-19 cases passed 18 million on Thursday after another world record number of daily infections, as gravediggers worked around the clock to bury victims and hundreds more were cremated in makeshift pyres in parks and parking lots.

India reported 379,257 new infections and 3,645 new deaths on Thursday, health ministry data showed, the highest number of fatalities in a single day since the start of the pandemic.

The world’s second most populous nation is in deep crisis, with hospitals and morgues overwhelmed.

Mumbai gravedigger Sayyed Munir Kamruddin, 52, said he and his colleagues were working non-stop to bury victims.

“I’m not scared of COVID, I’ve worked with courage. It’s all about courage, not about fear,” he said. “This is our only job. Getting the body, removing it from the ambulance, and then burying it.”

Each day, thousands of Indians search frantically for hospital beds and life-saving oxygen for sick relatives, using social media apps and personal contacts. Hospital beds that become available, especially in intensive care units (ICUs), are snapped up in minutes.

“The ferocity of the second wave took everyone by surprise,” K. Vijay Raghavan, principal scientific adviser to the government, was quoted as saying in the Indian Express newspaper.

“While we were all aware of second waves in other countries, we had vaccines at hand, and no indications from modelling exercises suggested the scale of the surge.”

India’s military has begun moving key supplies, such as oxygen, across the nation and will open its healthcare facilities to civilians.

Hotels and railway coaches have been converted into critical care facilities to make up for the shortage of hospital beds.

India’s best hope is to vaccinate its vast population, experts say, and on Wednesday it opened registration for all above the age of 18 to receive shots from Saturday.

But although it is the world’s biggest producer of vaccines, India does not have the stocks for the estimated 800 million now eligible.

Many who tried to sign up for vaccination said they failed, complaining on social media of being unable to get a slot or even to simply get on the website, as it repeatedly crashed.

“Statistics indicate that far from crashing or performing slowly, the system is performing without any glitches,” the government said on Wednesday.

More than 8 million people had registered, it said, but it was not immediately clear how many had got slots.

A local official in Mumbai said the city had paused its vaccination drive for three days as supplies were running short, while officials said the worst-hit state of Maharashtra was likely to extend strict coronavirus curbs by another two weeks.


Only about 9% of India’s population of about 1.4 billion has received a dose since the vaccination campaign began in January.

However, while the second wave overwhelms the health system, the official death rate is below that of Brazil and the United States.

India has reported 147.2 deaths per million, the Reuters global COVID-19 tracker shows, while Brazil and the United States reported figures of 1,800 and 1,700 respectively.

However, medical experts believe India’s true COVID-19 numbers may be five to 10 times greater than the official tally.

At Delhi’s Holy Family Hospital, patients arrived in ambulances and private vehicles, some gasping for air as their oxygen cylinders ran out. In the ICU, patients lay on trolleys between beds.

“Someone that should be in the ICU is being treated in the wards,” Dr. Sumit Ray, head of the unit, told Reuters.

“We are completely full. The doctors and nurses are demoralized, they know they can do better, but they just don’t have the time. No one takes a break.”

The U.S. State Department issued a travel advisory on Wednesday against travel to India because of the pandemic and advised its citizens to leave the country.

Prime Minister Narendra Modi has been criticized for allowing massive political rallies and religious festivals which have been super-spreader events in recent weeks.

“The people of this country are entitled to a full and honest account of what led more than a billion people into a catastrophe,” Vikram Patel, a global health expert at Harvard Medical School, said in the Hindu newspaper.


India expects close to 550 oxygen generating facilities from around the world as medical aid starts pouring in, Foreign Secretary Harsh Vardhan Shringla said on Thursday.

Two planes from Russia, carrying 20 oxygen concentrators, 75 ventilators, 150 bedside monitors, and 22 tonnes of medicine, have arrived in Delhi.

The United States is sending supplies worth more than $100 million, including 1,000 oxygen cylinders, 15 million N95 masks and 1 million rapid diagnostic tests, the White House said on Wednesday.

The supplies will begin arriving on Thursday, it added.

The United States also has redirected its own order of AstraZeneca manufacturing supplies to India, to allow it to make more than 20 million doses, the White House said.

India will receive a first batch of Russia’s Sputnik V vaccine on May 1. Russia’s RDIF sovereign wealth fund, which markets Sputnik V globally, has signed deals with five Indian manufacturers for more than 850 million vaccine doses a year.

Bangladesh said it would send about 10,000 vials of anti-viral medicines, 30,000 PPE kits, and several thousand mineral and vitamin tablets.

Germany will send 120 ventilators on Saturday, and a mobile oxygen production facility next week, its defense ministry said.

(Additional reporting by Shilpa Jamkhandikar in Mumbai, Anuron Kumar Mitra in Bengaluru, Neha Arora and Tanvi Mehta in Delhi, Ruma Paul in Dhaka, Subrata Nag Choudhury in Kolkata; Writing by Michael Perry and Giles Elgood; Editing by Raju Gopalakrishnan and Gareth Jones)

‘Unnecessary sadness’: Inside Ontario’s strained intensive care units

By Anna Mehler Paperny

TORONTO (Reuters) – Over the course of a single shift last week, critical care physician Laveena Munshi saw her intensive care unit (ICU) at Toronto’s Mount Sinai Hospital fill with pregnant and post-partum COVID-19 patients.

During that week, the ICU doubled the total number of pregnant COVID-19 patients it had previously seen throughout the entire pandemic. Swamped with patients with complex medical needs, one day Munshi ended up pulling a 36-hour shift.

“You do what you have to do,” she said.

Ontario’s hospitals and ICUs have been crushed by a punishing third coronavirus wave, as depleted resources and overworked staff push Canada’s healthcare system – often held up as a model for the rest of the world – to the brink.

Last week, Munshi and her colleagues spent agonizing hours discussing what to do if a pregnant woman needed an artificial lung to help her get enough oxygen.

“Having delivery equipment outside an ICU room is never a thing you want to be walking into at the beginning of your shift,” she said. “It just adds an added layer of unnecessary sadness to this whole pandemic.”

By Thursday, ICUs in Ontario, Canada’s most populous province, had 800 COVID-19 patients, with such admissions at the highest point since the pandemic began.

Patients are coming in younger and sicker, driven by more highly transmissible virus variants. Hospital staff say they are seeing whole families infected due to transmission at front-line workplaces that have remained open through lockdowns and stay-at-home orders.

Mount Sinai Hospital just added a third ICU. It has seconded non-ICU nurses to help deliver critical care to the most seriously ill patients as it braces for the worst.

“The next couple of weeks are going to be extremely busy, there’s no question,” Munshi said, adding that people most affected by the current wave do not come from privileged backgrounds that would allow them to protect themselves, for example by working from home.

The provincial government has promised more ICU beds and requested medical staff from other provinces.


Ramping up vaccinations targeting high-risk communities will help bring the third wave under control, experts said. But that will not relieve the immediate pressure on hospitals.

Exhausted staff are pulling overtime shifts and doctors are bracing for the tipping point no one wants to talk about: The activation of a “triage protocol” that will dictate who gets critical care when there isn’t enough for everyone who needs it.

Ontario’s Ministry of Health did not respond when Reuters asked what criteria would activate that protocol.

The protocol provides a standardized way to predict who is more likely to survive the subsequent 12 months, “trying to prioritize so that the most lives could be saved,” explained Dr. James Downar, one of its authors.

It does not include a provision for withdrawing life-sustaining measures, he said.

Raman Rai, manager of the ICU at Toronto’s Humber River Hospital, said she has never seen such a volume of critical care patients.

The hospital has redeployed staff, is treating people in “unconventional spaces,” and is stretching resources so a nurse who might have been responsible for one or two patients now has three, Rai said.

“We have already gone over capacity,” she said. “How much more can we stretch?”

Hospitals have been conducting drills and exercises in preparation for the triage scenario, said Ontario Hospital Association Chief Executive Anthony Dale.

“If it is used, it means we’ve failed as a province,” he said. “This did not have to happen. But are we preparing with everything we’ve got? Yes.”

In Toronto’s Sunnybrook Hospital on Wednesday morning, the ICU was buzzing with health workers having bedside discussions, punctuated by alarms from pumps and various equipment monitoring patients’ vital signs.

“It’s particularly distressing when we see someone who is 30 years old and healthy who comes in unable to breathe,” said intensivist doctor Hannah Wunsch. She is also seeing younger patients, pregnant patients and whole families with COVID-19.

From a medical perspective much of the work is the same, Wunsch said – save for ubiquitous masks.

“I haven’t seen anyone smile in a long time.”

(Reporting by Anna Mehler Paperny; Editing by Denny Thomas and Bill Berkrot)

After 114 days in ICU, Catalan COVID-19 patient soaks up seaside sunshine

By Luis Felipe Castilleja and Nacho Doce

MADRID (Reuters) – Medical staff rolled Joan Soler Sendra, 63, across the street in his hospital bed to bask on the sunlit seashore, in his first outing after almost four months in intensive care in Barcelona’s Hospital del Mar.

Sendra and his two brothers were infected with the coronavirus last November in Catalunya – but only Sendra had to go to hospital.

After finally managing to breathe without a respirator this week, Sendra, the ward’s longest-staying patient, was due for some sea-and-sun therapy.

“To us it’s a shot of morale, a boost,” said Sendra’s brother, Jaume Soler, lowering his mask so that Sendra, who lost his hearing as a baby due to meningitis, could read his lips.

Dr. Andrea Castellvi, deputy head of the hospital’s intensive care service, said being able to go out and see their families, the sun and the sea gave long-haul COVID-19 patients “a boost of vitality and a desire to continue fighting.”

Castellvi said Sendra’s initial symptoms were flu-like, but worsened within days to a high fever and body weakness, meaning he could neither walk nor breathe by himself. “But now we are progressing, little by little.”

(Reporting by Luis Felipe Castilleja and Nacho Doce; writing by Clara-Laeila Laudette; editing by Giles Elgood)

French coronavirus patients in intensive care highest since end November

PARIS (Reuters) – The number of people in intensive care in France who have COVID-19 is at the highest level since the end of November, health officials said on Tuesday as new infections rose slightly to 23,302 from 22,857 a week ago.

The new cases pushed the cumulative total since the start of the pandemic a year ago to 3.93 million, the health ministry reported, and the seven-day moving average of new cases was virtually steady at 21,333.

While France has been registering over 20,000 new cases per day since late January, week-on-week increases have slowed from nearly five percent in mid-January, when a tighter curfew at 6 p.m. was imposed, to less than four percent over the past five days.

But despite a vaccination campaign focused on the oldest and most vulnerable people, those in intensive care with COVID-19 has risen steadily from less than 3,000 people at the end of January to nearly 4,000 on Tuesday.

The number of COVID-19 patients in intensive care units was up by 69 to 3,918 people, the most since the of November, in the last days of the second month-long lockdown. That month, ICU numbers peaked at just under 5,000.

In the Paris region alone, almost 1,000 people are in ICU with COVID-19, but the government is not planning to put the Ile-de-France region around the capital into lockdown, France’s public health chief said.

He said lockdown would be a last-resort measure imposed only if the hospital system could no longer cope.

The health ministry also reported on Tuesday that 4.15 million people, or 7.9 % of the adult population, had received a first coronavirus vaccine and 2.04 million had also received a second shot, for a total of nearly 6.2 million injections.

The government aims to vaccinate 10 million people by mid-April, 20 million by mid-May and 30 million by summer.

(Reporting by Geert De Clercq; editing by Grant McCool)