A health worker adjusts the oxygen mask of a patient at the BKC jumbo field hospital, one of the largest COVID-19 facilities in Mumbai. File/ Associated Press

David Pierson and Ahmer Khan, Tribune News Service

The men stood shoulder to shoulder in the blazing heat, their chests leaning against empty oxygen cylinders lodged in the dirt.

They had come from all over to this makeshift oxygen tank-refilling center in a city 40 miles northeast of the Indian capital of New Delhi in a desperate bid to score what has become the most precious commodity in this pandemic-stricken nation.

Police and government officials guarded what little supply was available. They demanded to see medical records to ensure oxygen wouldn’t be siphoned to the black market. One man who didn’t have the proper paperwork held up a video showing his 6-year-old daughter struggling to breathe.

“How am I supposed to show and prove that my daughter is dying?” he said. “There are no beds available at the government hospital.”

A 25-year-old man who gave only his first name, Arif, pleaded with a police officer for help. “I beg you. Please give me one cylinder of oxygen,” he said. “If I don’t get one, my mother will die.”

The policeman apologized and said there was nothing he could do. Arif collapsed to the ground and sobbed. “COVID isn’t killing us,” yelled another man in line. “The lack of oxygen is killing us.”

Meerut represents a snapshot of the despair spiraling across India as demand for oxygen far outpaces availability in a nation where hundreds of thousands are being infected with COVID-19 each day. The crisis is reminiscent of the shortages of masks, sanitizer and gloves earlier in the pandemic, though with far more devastating consequences. Patients are suffocating to death in hospitals that have emptied their tanks. Many are paying the equivalent of several months’ salary to buy oxygen cylinders on the black market. Gangs are hoarding cylinders and devices called “concentrators” that can draw medical oxygen from the air. Meanwhile, social media are flooded with hashtags such as #SOSoxygen, #OxygenCrisis and #OxygenShortage.

“Oxygen cylinder required in Deoria. Patient name — Vedvyash Saini. Age — 45. Oxygen level — 80%,” read a typical tweet. A blood oxygen level of 95% or above is normal for most adults.

The clamour for what is so elemental to life has eclipsed India’s vaccination drive and brought widespread criticism of its leaders, some of whom declared the virus defeated months ago despite warnings of new, highly contagious variants. India’s crisis is a foreshadowing of what may unfold with its neighbours, such as Nepal, whose overburdened medical systems are also facing steep rises in infections.

India’s lack of preparation for the virus’s surge in March meant there was no increased production of oxygen in a country that already lacked an adequate supply. The government of Prime Minister Narendra Modi has at times appeared more interested in silencing critics of its COVID-19 response and threatening hospital workers who reported oxygen shortages than in confronting the breadth of a disaster that now has infected more than 23 million people. The death toll is rising faster than bodies can be cremated in some parts of India, leading to scores of dead found floating in the Ganges River.

The national response has been in disarray as Modi has been mostly absent during the crisis and the central government has largely delegated policy and procurement of medical supplies to the states.

“India’s COVID-19 response has failed because it ignored a fundamental first principle of good governance — the principle of subsidiarity, which means that the central authority performs only those functions that cannot be performed at the local level and no other,” Yamini Aiyar, president and chief executive of the New Delhi-based Center for Policy Research, wrote in an editorial published by the Hindustan Times on May 9.

“Rather than a coordinated response, states are at war with the [central government] and each other,” she continued.

The mishandling of medical support prompted India’s Supreme Court to announce May 8 that it would establish a task force to ensure an “effective and transparent” distribution of oxygen.

Modi’s government says the country produces enough oxygen, up to 9,000 tons a day, to meet demand. The problem, it claims, is getting it to people in need. Many of India’s oxygen plants are on the coasts and away from areas hardest hit by the second wave, including New Delhi and Bengaluru, a city of more than 8 million formerly known as Bangalore.

India recently mobilized the military to airlift oxygen supplies and has sent thousands of tons of liquid medical oxygen across the country on trains dubbed the Oxygen Express. Despite those efforts, oxygen remains scarce — leading to rising tension and growing anger. In Muzaffarnagar, a city just north of Meerut, over 200 people lined up recently to request oxygen from a government official. When many learned they would leave empty-handed, they yelled at and berated the official, who was guarded by police.

“The government has failed and collapsed completely,” said Muzamil Rana, 28, who was denied a cylinder and said he has spent nearly $1,300 — an astronomical sum for him — on black market oxygen for a relative. “We can pay money to the government if they can at least provide us oxygen.”

Medical experts warn it will be impossible to distribute enough oxygen if cases in India keep multiplying. Calls for a national lockdown are growing to break the chain of transmission that’s resulted in 250,000 recorded deaths, though the actual number is believed to be significantly higher.

Doctors are also reporting the emergence of a rare fungal disease called mucormycosis in current and former COVID-19 patients with weakened immune systems. The infection, also known as black fungus, attacks the nose, brain and lungs and has required some doctors to remove patient’s eyes.

The country’s second wave is being partly blamed on a coronavirus variant known as B.1.617, first found in India last year, that the World Health Organisation has classified as a “variant of global concern” because it has shown signs of being more infectious. The crisis in India underscores how ill equipped poorer countries are at delivering basic medical treatment.

Hospitals in the US often have their own oxygen plants, but medical facilities in impoverished countries rely on the delivery of oxygen tanks — a far more costly and inefficient form of distribution. Common scenes in India these days are of people trying to move unwieldy cylinders weighing more than 100 pounds over unpaved roads. And with all that effort, a single tank may last only one to a few dozen hours, depending on how badly the virus has affected a patient’s lungs.

The pandemic has fueled an unprecedented worldwide demand for oxygen. In the last four months alone, global oxygen needs have nearly tripled, primarily because of the crisis in India. Shortages have also been reported in Brazil, Iran, Mexico, Argentina, Turkey and the Philippines.

“While no country has ever needed oxygen as much as India does right now, other countries who are far less prepared than India may soon experience similar surges,” said Evan Spark-DePass of PATH, a global health nonprofit organization. “The COVID-19 pandemic is the biggest wake-up call the world has ever faced, revealing decades of inequities regarding access to oxygen.”