After Deadly Second Covid-19 Wave Fiasco, Third Wave Looms Over Goa

24 May 2021 12 min read  Share

India’s most-prosperous state—overseen during a deadly second wave by a chief minister who ignored warnings, attended a large birthday party and popularised a slogan that said, don’t worry—was its most infected by proportion of positive cases to tests and second by death rate. Scientists now warn of a third wave within two months.

Grabs from two 13 May viral videos shot inside the state's leading hospital Goa Medical College.

Panaji: The lifeguards on the beaches along Goa’s 160-km coastline, where tourists frolicked till early May 2021, repeatedly warn swimmers about two things: the dangerous swells, so tall that at times they hide the horizon, and the deceptive rip tides they leave behind.

Both can kill, but a rip tide is “unapologetically skilful”, the life guards always explain.

The “dark hour” deaths—as Justice M S Sonak of the Goa bench of the Bombay High Court described the deaths characterised by Covid-19 patients perishing for lack of oxygen during a deadly second wave of infection—were like the rip tide here in India’s most prosperous state by per capita income.

As the government ignored warnings, made no preparations and allowed in tourists—most unmasked after they entered—without checking if they carried the coronavirus, infection and death spiralled at rates that were among the highest in a country that is the world’s worst hit.

That unpreparedness was evident as doctors at the Covid-19 wards of the state’s leading hospital, the Goa Medical College (GMC), suspected that 83 died (26 + 21 + 15 + 13 + 8) between the nights of 11 and 15 May when oxygen levels fell after a pressure drop in the hospital’s central oxygen pipeline.

In the first 23 days of May 2021, Covid-19 killed 1,058 people in Goa, India’s smallest state by area and the fourth-least populous. It had taken the first wave 10 months to breach this milestone. By 23 May, Goa reported 2,383 dead and 146,460 cases. Manipur, with a million people more, had less than a third of Goa’s deaths.

Goa’s fatality rate is India’s highest, and its test positivity rate (TPR)—the percentage of all coronavirus tests that are positive—has consistently been among India’s top three. On 22 May, the TPR was 36%, down from 51.4% on 5 May but it is now India’s highest, an indication of widespread infection.

Now, scientists warn of a third wave by September in a state still ridden with infection. The Goa government on 21 May announced a 15-member task force chaired by chief minister Pramod Sawant “to prepare for the third wave”, for which intensive care at paediatric wings would be strengthened, since children are likely to be particularly affected.

Whether this warning will prepare the government is difficult to say. There was, after all, adequate warning of the second wave that brought a state with some of India’s best health infrastructure to its knees. Many in government described overwhelmed hospitals, overstretched medical staff and patients starving for oxygen as an “unprecedented, sudden crisis”. It was anything but.

Early Warning Came In March

The second wave was flagged as early as 31 March, by the state’s scientific lifeguard, state epidemiologist Utkarsh Betodkar who publicly warned that the situation was “alarming” with 200 new infections a day—the highest since the first wave in December 2020.

By 4 April, Betodkar, nodal officer for Covid-19 at the directorate of health services, had declared the second wave. “Nobody can deny that…”, he told The Navhind Times, a local daily.

Between Betodkar’s warning and the resultant rip tide that is Goa’s Covid crisis is the story of a tourist state headed by two sparring leaders, chief minister Sawant and health minister Vishwajit Rane.

CM Pramod Savant (in white) talks to health minister Vishwajit Rane (in red) as GMC dean SM Bandekar looks on/TWITTER
The chief minister legitimised indifference towards the infection—his slogan bhivpachi garaz na (no need to be afraid) echoed through most of the state’s mass gatherings and tourist hotspots.

His lone instruction was, “do not mingle with tourists”, as he left state borders left open, even as neighbouring states, such as Maharashtra, insisted on Covid-negative certificates as early as February.

Weddings, municipal elections, tourism, traditional state festivals and markets continued to function alongside a spiralling positivity rate that crossed the 50% mark on three occasions in May and killed 439 patients in the second week of that month.

On the 60th year of its liberation from Portuguese colonial rule, Goa’s people gasped for oxygen, hunted for beds and medicines and the state government’s attention.

Court Petitions Instead Of Government Planning

Evident community transmission (or the inability to connect infections through chains of transmission) and the hands-off approach of the state government confused the people of Goa who watched the death rate and infections spiral.

Eventually, three public interest litigations (PILs) and two letter petitions by civil society, including one by the South Goa Advocate Association (that has lost a few of its members, including prominent criminal lawyer Rajeev Gomes), has now led to court-monitored governance.

Critical preparedness, which should have been the responsibility of the government, said experts, are now listed as petitions: provision of oxygen, expanding bed capacity, supply of life saving medicines, enhanced testing infrastructure, a functioning chain of emergency services like helpline, ambulance and home isolation kits.

Accountability, too, was tossed around, with health minister Rane asking for a probe into the GMC, for which he is responsible. Rane was the first elected representative to declare the deaths at the GMC between 2 am and 6 am on the night of 10 May as linked directly to the oxygen crisis—a claim he later retracted in a press conference, sitting alongside chief minister Sawant.

“When 12 died at Batra hospital the nation could not accept it, and here night after night, there is a total collapse. Somehow nobody seems to be bothered,” said political commentator Cleofato Almeida Coutinho. “One day you say it’s due to oxygen, the other day you say do a probe in my own ministry. It’s unheard of.”

Such was the extent of the crisis that on 6 May, the Goa High Court, which was informed of 71 deaths and the state’s positivity rate peaking at 51.64% the previous day, ordered the government to issue curbs and restrict border crossings.

“ permit virtually unrestricted entry in such a critical time is not justified…based on this unrestricted entry, Goa is touted as one of the few tourist destinations where all is well,” the court observed. “This is neither fair to the population in Goa already suffering from the overstretched medical infrastructure nor to the unsuspecting tourists who have to very often avail the overstretched facility at a great price.”

The court did not accept the chief minister’s argument that economic activity was a priority.

Too Little, Too Late

“The restrictions came too late,” said Pratik Savant, senior resident in surgery, president of the Goa Association of Resident Doctors (GARD).

It was in mid-March 2021, said Savant, that the math came undone, when customary molecular tests called Truenat, conducted on patients admitted in hospital wards for surgeries, trauma cases and non-Covid care, started turning up positive.

“Most would come negative till then,” said Savant. “Even one or two would be an exaggeration.”

By January, the state government scaled back the ESI Hospital, the designated Covid hospital during the first wave, allowing it to start its normal OPD, as Covid patients were moved to a newly-opened district hospital in south Goa.

By the third week of March, TrueNat tests, both at public and private hospitals, began turning positive. “Something had woken the pandemic again,” said Savant. “Messages from doctors across Goa started confirming this.”

In the first week of April, by which time both doctors and state scientific and health officers had flagged the second wave, a large birthday party was held in Mandrem, a coastal village in Pernem taluka, bordering Maharashtra, and 21 km north of Panaji.

The official permission—even as the state was under section 144 of the Code of Criminal Procedure, 1973 (CrPC), restricting gatherings to less than four people—was for 500 persons, but the ground saw over 1,000. In attendance were chief minister Sawant and top Bharatiya Janata Party (BJP) leaders, including a member of Parliament and a few members of the legislative assembly (MLAs), all celebrating the birthday of Mandrem MLA and Congress defector Dayanand Sopte.

The party photographs that went viral on WhatsApp groups revealed that almost everyone was without masks. Goa’s positivity rate had breached 10% for the first time that morning.

Goa CM Pramod Sawant and top Bharatiya Janata Party leaders attended a large birthday party even as the state was under section 144 which restricts gatherings.

Prior to the birthday party, another superspreader event occurred at a casino offshore deck, which infected many people including 31 casino staff.

Instead of taking this as a cue and shutting the casinos, the state classified a housing colony in Porvorim, 18 km from state capital Panaji, where the staff resided, as a micro-containment zone. No one heeded the warning signs.

Four Strains Of The Coronavirus

“By April second week, the deaths too started showing, an average between seven and 10 Covid deaths,” said the GARD’s Savant. “Internally, the 10%-mark breach was taken as community transmission. It was the second wave, and we found patients to be younger than the ones in the first wave.”

By 6 April, with their Covid and intensive care wards full, hospitals began converting trolleys and stretchers into beds, a fact confirmed by health minister Rane. On 10 April, the National Institute of Virology (NIV), Pune, confirmed the presence of four different strains of the coronavirus in Goa: from the UK, the USA, a double mutant found in Maharashtra and the variant found in the first wave.

The samples had been sent for testing a month ago in early March. As that happened, many super-spreader events—such as secret rave parties at the northern Goa beaches of Anjuna and Baga—continued unchecked between mid-January to late March.

By 16 April, when the state hit a 26% positivity rate—now the highest in the country—it announced municipal elections, with 402 candidates battling for positions in five municipal bodies.

By the last week of April, photographs circulated from Goa were not of celebrities vacationing by the beach, but of patients lying on trolleys, hospital floors, “on cardboards and newspapers—and some even pulling their home mattresses to the wards”, as viral videos (here, here and here) shook a state’s collective trust in its government.

The three nodal departments for Covid—medicine, pulmonary and anaesthesia—merged to fight their biggest enemy till date, a sea of strong mutant strains. Admissions increased every day. As administrators continued contradictory statements about the oxygen situation, the High Court said: “We have long passed the stage of determining whether patients are suffering from the lack of oxygen or not.”

The judges pointed to an affidavit submitted by GMC dean S M Bandekar, who said the GMC needed 700 large cylinders per day, in addition to its normal requirement.

Patients On The Floor, Oxygen Cylinders Attached

By the last week of April, the south Goa Covid district hospital’s 450 beds were occupied, and critical patients referred to GMC were spilling to the floor, loose oxygen cylinders attached to them.

“Suddenly, we saw all our Covid wards opening, and the surge was so fast that everything now seems a blur,” said a resident, stretched between 40 patients at any given hour at Ward 142, GMC. By mid May, state admissions crossed 2,500 patients.

Doctors recalled a pattern: critical patients were predominantly from north Goa—the profiles revealed taxi drivers, waiters and shack boys, hospital staff—“frontline workers of the tourism belt”, said a nurse who recalled three such cases brought in that day. “Only one survived.”

By 22 April, Rane, too, confirmed a study by the GMC indicating “a scary situation” with “cases emerging from hotspots in Baga and Calangute”. District hospitals too reported patients from the east hinterland, interior villages where the virus did not reach in the first wave.

Ashley Delaney, an engineer who trolleyed his father-in-law into GMC on the same night, recalled the chaos. “Every admission was (done) by an archaic method of counting and writing on paper, nothing was accounted properly, admissions weren't digitised and they were sending everyone to Ward 147,” said Delaney, It was so crowded that at one point 75 patients were huddled in the ward with a bed capacity of less than 30.”

Over the next 10 days Delaney saw patients in all corners, nurses and doctors trying their best to save lives, few oxygen ports from the central line divided between three patients, and finally the deaths—“where the body would gasp for breath, the person would keep shaking, and the constant red beeps from the ventilator screaming danger”.

Delaney said the bulletins issued during those days had not captured the correct picture. “There is a big difference between a bed and a patient,” he said. “Not everyone got a bed—not everyone (sic) got a cylinder either. Nurses were doing permutations, constantly jumping from one patient to another, asking a few to go into the prone position to save oxygen. If anyone cared, it was the nurses and doctors alone. The administration failed.”

A Nightly Spectacle Of Death

Bandekar admitted that the oxygen crisis was real, though he attributed it to late entry of patients, a high CT (scan) score of 18 and above —“in this wave patients require 15 lt of oxygen per minute; this new [variant] has a very strong effect on lung inflammation”.

Doctors at the ward said that in the earlier wave, the maximum requirement didn’t exceed 7 lt. A state government affidavit to the High Court said the GMC used “delivery of 62 oxygen trolleys a day” during the second week of May. Usually the hospital didn’t exceed 15 trolleys a day, confirmed a government official.

“Seeing one or two such deaths was one thing, but finally seeing over 70 patients’ ventilators beeping across wards was not possible,” Delaney recalled. “Every night the spectacle played out.”

The oxygen that was being supplied through ports from the central line would fall with the pressure drop. Six nurses and a doctor in each ward did what they could. Typically, they saved one patient when two collapsed.

“The entire ward would watch,” said Delaney. “Imagine if you were a patient and watched this day in and out. There were some who got anxious, and many were left without families with no one to comfort them.”

Finally on 4 May, at 8:41 pm, a hapless Delaney addressed a Facebook post directly to the constitutional office where the buck stopped: Sawant. “Ward 142 in GMC has run out of oxygen as of 7.00 pm, 4th May,” Delaney said. “Saturation of all patients is dangerously low. If you do not act immediately people will die.” His May day alert came a week after Goa breached a positivity rate of 50%.

About 60 cylinders were scrambled to plug the disaster. But his post had done its work, and Goans had taken note; the PILs would follow.

“As volunteers in the first wave, we approached the Goa government with a proposal to prepare a health dashboard, update real-time status of beds and all other Covid-related emergencies. The state helpline 104 never worked and we started getting SOS calls until late at night. It was like all of us were shouting in a void,” said Shruti Chaturvedi of Covid Care Goa, an outreach network of 75 volunteers. “I was frustrated one night and called an advocate friend, who heard me patiently and then asked me, ‘have you heard something called PIL?’” The 28-year-old promptly approached the court.

Three nights before Delaney’s public post, doctors tending to Covid-19 patients at GMC and the South Goa district hospital, too, complained of the oxygen crisis —“in writing”.

In a letter dated 1 May, the GARD said: “Oxygen supply in various Covid wards is not even close to sufficient”, the flow “inadequate to keep NIVs and ventilators working effectively”, “2-3 hours for replacement of oxygen cylinders in the middle of the night” with “patients kept without oxygen, saturations dropping to less than 60%.”

A check later proved that the pressure drop occurred between changes of oxygen trolleys being plugged to the main pipeline, said an engineer working at the spot.

The Fall Of Tests, Rise In Threats

Ralina D’ Souza, an expat in Kuwait who lost her father-in-law at GMC on 6 May, pointed to another crisis.

“My father in law did his test as soon as he had symptoms on 22 April, but could only be admitted on 30 April when the results came. We did everything as protocol demanded. The testing centres were running a week or two late,” said D’Souza. Testing centres confirmed they were indeed stretched.

A Mapusa clinic lab technician, speaking on condition of anonymity, said: “The burden was from all over. The primary centres couldn’t take it after a point as the number of those showing symptoms suddenly increased.”

“We also had to release reports for returning tourists,” said the technician. “It was all chaos between 17 April and 6 May — and we had a lag of eight to 10 days from issuing the results. Many even would threaten us on the phone if we didn't give results. but we were stretched."

Advocate Amit Palekar, a Covid Care volunteer himself intervened as a petitioner at the High Court and said Goa became “a free-for-all for residents running away from infected states”.

“The trust in GMC was replaced with fear,” said Palekar. “The visuals made one wonder if they would also die a bad death. One cannot blame them for being afraid.”

Things came to such a head that on 13 May, the state government pinned the entire failure at the GMC to “inexperienced tractor drivers”, who, it said, were delaying replacement of oxygen trolleys at the base of the pipeline resulting in the fall in pressure. The issue was temporarily resolved by plugging in more cylinders to compensate for the drop in pressure.

“The doctors were never informed of this. Imagine at insane hours after, our residents would run downstairs to pick a spare cylinder themselves and hurry upstairs to the patient as back-ups weren’t managed by the administration,” said Savant. “Do you know how heavy a cylinder can be, plus a doctor cannot leave the ward at such critical hours. It was dire.”

With the High Court pulling up the state government for pushing the “physics problem” as people continued to die, the administration put in all-nighters and plugged loopholes.

Vulnerable patients have been since been moved to a new speciality block with oxygen infrastructure, and a new 23,000-litre liquid medical oxygen plant installed for the old GMC block with help from the state’s industry network (industrial oxygen has been diverted, tankers have been arranged, and factories previously shut are being reopened to supply oxygen).

The chief minister noted that a new tank was put to operation “even without an inauguration”.

‘There Is A Guilt We Carry For Life’

With a lockdown now in progress, and panchayats enforcing strict measures and with new improvements, daily deaths decreased.

Addressing Goans last week, Dean Bandekar said: “We have enough facility (sic) for you. There has been a hue and cry in the media and right now we want to say come soon to hospitals, don’t wait till you have a high CT score..”

“There is a guilt we will now carry for life,” said D’Souza who lost her father-in-law. “We did everything that was expected but the state couldn’t protect our loved one. We can't say it's Covid alone that killed him… It’s something else. I do not know what to say. We feel helpless.”

For now, the only strong apology to Goa actually has come from the judiciary, with Justice Sonak beginning his proceedings on 13 May with “We are very sorry. We failed collectively…we owe an apology to all the people.”

(Smita Nair is an independent journalist based in Goa.)