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The influenza pandemic of 1918, also known as ‘Spanish Flu’, was an unusually deadly pandemic that lasted from February 1918 to April 1920. Spanish flu infected 500 million people—about a third of the world’s population at that time. The estimated number of deaths ranging from 20 million to a possible high of 100 million makes it one of the deadliest pandemics in human history.

There are stories documented in the pages of history from the Spanish flu era (1918-20) from which we can learn a lesson or two. On 28 September 1918, the Liberty Loan Parade was organized in Philadelphia, US, to economically support the soldiers who fought in World War I. Intellectuals opposed the event. They were of the opinion that as the Spanish flu was still going strong, a crowded event may result in a new disaster. Ignoring such objections, local administration allowed the event. It was a matter of patriotism, so more than 200,000 people gathered. What followed was along the expected lines. Within the next few days, 47,000 fresh cases were reported and 12,000 people lost their lives. In October 1918, over 195,000 people had lost lives in the US alone.

The tragic Indian chapter

Spanish flu struck India at the same time and 10-20 million people, then three-six percent of the population, had died. The major damage was caused in a short period from June 1918 to early 1919. The second wave lasted for less than three months—but was most devastating.

A worker at the cremation ground in Delhi said that they were doing 25-plus cremations a day at the time.

One of the famous Hindi poet and writer of that era, Suryakant Tripathi Nirala, wrote a book based on his personal experience of the 1918 pandemic. The writer famously known as ‘Nirala’ received a telegram message that read “Come back urgently, your wife is seriously ill”. The writer was in Bengal (province in East India) and he took the next train to his hometown in Uttar Pradesh. When Nirala reached his hometown on the banks of river Ganga, he observed that ‘the River Ganga was swollen with bodies’. By the time he reached home, his teenage wife was already dead. In the days to follow, all other family members got the infection and died. Reports from government documents had made similar observation that “all rivers across India were clogged with bodies because of shortage of firewood for cremation.”

History is repeating itself

Looking at images and reports in Indian media this week, it seems nothing has changed even after a century. Locals in Buxar district of Bihar province reported about floating dead bodies in River Ganga on May 9. Similar was the sight in Ghazipur district in Uttar Pradesh province the very next day. Local administrations performed the last rights and are investigating the cases.

The bodies are suspected to be those of Covid-19 patients who were dumped in the river, revealing the scale of Covid emergency in India. Locals said, following the Hindu cremation rituals, people either burn their dead or immerse the bodies in the river. Due to the lack of firewood at the crematoriums owing to the rise in Covid-related deaths, the poor immersed them in the river.

These may be stray cases, but even isolated cases put a big question-mark on the progress of medical science and human development. Such incidents depict a real picture of the catastrophe this planet is going through at present.

Social media feeds are filled with videos of Covid funerals at crowded cemeteries, wailing relatives of the dead outside hospitals, long queues of ambulances carrying gasping patients, mortuaries overflowing with the dead, and patients, sometimes two to a bed, in corridors and lobbies of hospitals.

What went wrong?

In early March, politicians and parts of the media believed that India was truly out of the woods. While customary guidance on Covid-appropriate behavior was issued, it was policymakers and elected leaders who tacitly encouraged crowding in festivals, election rallies and religious congregations.

The second wave of Covid-19 had come a few months after the second wave in other countries; there was no reason to believe it would be any different in India or in any other country.

Close to 100 million died in 1918 Influenza Pandemic. Photo: The Gurdian

More than ventilators and ICU beds, what was essential was an adequate supply of oxygen in hospitals to treat critically-ill patients. Nonetheless, when the second wave arrived, India’s medical oxygen supply network collapsed.

Availability of hospital beds was nowhere close to meeting the sudden demand. WHO standard is 30 hospital beds per 10,000 people; India has only 5.3, much less compared to even smaller countries like New Zealand (25.7) and South Korea (124). Nepal has three hospital beds available per 10,000 people, which is way below WHO standards. India and Nepal, both South Asian countries, need to increase the numbers.

India recorded a worrying test positivity ratio (TPR) of 22.36 percent in the end of second week of May, way above the 5 percent TPR needed to control the pandemic. But India’s testing numbers seem to be dipping instead of keeping pace with the rate of transmission.

Battle is far from over

Experts are raising concerns that inoculation is not helping turn the tide in some places. Of the Seychelles, Israel, the UAE, Chile and Bahrain—the world’s five most vaccinated countries, in that order—only Israel is not fighting to contain a dangerous surge in Covid-19 infections.

Seychelles, which has vaccinated more of its population against Covid-19 than any other country, saw active cases more than double in the end of first week of May.

Cremation grounds in Delhi saw over 700 ‘Covid cremations’ in a day.

In the Maldives, where over 35 percent of the population had received two shots, is also struggling with rising number of new cases, which jumped to 12,000 plus on May 12.

The world is at war with Covid; more than 3 million people have lost their lives so far. But while some countries move forward with vaccination campaigns and business reopening, a resurgence in India and South America is a stark reminder of the pandemic’s severe and ongoing toll. Society’s staggered return towards “normal” also begs the question of what we will learn when this once-in-a-century pandemic is finally over and how the three million lives lost (and counting) will be remembered.

The author is former senior editor of The Times of India group and writes for Annapurna Express. He is based in New Delhi

A harrowing personal account of trying to call an ambulance in Kathmandu

A week ago, my aunt’s blood sugar dropped and she lost consciousness. It was 7:00 pm and we called an ambulance. One finally arrived. It was 8:15 pm.

It was an hour of mad frenzy with my husband and I calling a particular number only to be given another as my aunt lay unconscious and sweating profusely. On our way to her place, we called 102, the emergency hotline for ambulance services. A very sleepy sounding woman picked up after what felt like an eternity and told us to call another number. And so, it started.

This process continued for a while till one ambulance driver finally agreed to come. We must have called at least a dozen numbers by then. This driver said he was at Tribhubhan University Teaching Hospital in Maharajgunj and that it would take him 15 minutes to get to our location in Battisputali.

Five minutes later, he called back and ranted about how it was going to be difficult for him to find us, going on and on about needing to know the exact distance from the Gaushala crossroad. We told him we would be standing on the street, keeping an eye out for an ambulance, and that he would see us as soon as he passed Hotel Dwarika.

He called us again 10 minutes later. We could see an ambulance headed in our direction. We asked him if he could see us, waving our arms. It shouldn’t have been difficult, considering there were very few people out on the street and my husband is over six feet tall. But, very nonchalantly, he said he had decided not to come and that we should try somewhere else.

Every ambulance service/driver we called asked us the same thing: Covid ho ki hoina? (“Is it Covid?”), Jworo cha ki chaina? (“Does she have fever?”). Some said they weren’t equipped to handle Covid cases. Most blatantly said they wouldn’t come if she had had fever at any point in recent days. Others just seemed uninterested to do their jobs. I say this because their response was quite literally along the lines of ‘can’t come because we don’t want to’.

One particular ambulance service told us to wait as the ‘Covid ambulance’ had gone to Bhaktapur to pick up three patients and that would take at least two hours.

What complicated things more was that my husband and I had been quarantining at home as one of our friends/colleagues had recently tested positive. We didn’t have any signs of infection but, as we had received both the vaccines, we feared we could be asymptomatic.

So, we didn’t think it was a good idea to take my aunt to the hospital in our car. We also felt we wouldn’t be able to carry her down two flights of stairs without chancing further injury. But it was becoming increasingly likely that this was the risk we would have to take.

Then, giving it one last try, I called Dr Shailendra Kushwaha, consultant cardiologist at Norvic International Hospital. Dr Kushwaha had been, until recently, working with Dr J. P Jaiswal who has been my parent’s go-to doctor for two decades now and who has saved both my parents lives at least once.

My aunt was recently discharged from the hospital where she had been under Dr Kushwaha’s care. He has been our knight in shining armor. After talking to me, he got in touch with Norvic’s ambulance services and messaged me a number to call. He even rang back to confirm I had received the text.

When I called the number, in the background, I could hear someone say ‘yo doctor le bhannu bhayeko case ho’ (“This is the case the doctor was talking about”). I sensed they would have said no if they could have. However, even with Dr Kushwaha requesting them to attend to us, we had to go through the rigmarole of talking to two different people, twice each, and assuring them that my aunt didn’t have fever at the moment, and that she had ‘just fainted’. Finally, an ambulance was dispatched.

What happened when the ambulance arrived is another story: With only the driver, who behaved like he was coming to pick up a bag of groceries, and no trained paramedic, more time was wasted in getting someone who couldn’t move on her own into the vehicle and then taking her to the hospital with no medical intervention whatsoever. When we finally reached the hospital and my aunt was rushed to the emergency, her blood glucose level was 25. Had it dropped any further (had there been more delays) she could have gone into a coma.

They say all’s well that ends well. And, fortunately, that has been true for us. But thoughts of that night still make me shudder. We could have been too late. There might have been people for whom it has been too late. I wonder how many people must have lost their lives because they didn’t make it to the hospital on time. That’s the sad reality of the times we live in today.

I reached out to family and friends and asked them if they had faced similar issues. A friend complained about no one picking up the hotline number. Another said the driver started negotiating, saying he would come provided he would be paid 10 times the going rate. Quite a few have had to deal with rude drivers who said they would come, hung up, and then didn’t take their calls anymore.

It’s said that pre-hospital handling is a crucial part of medical care. Various studies have suggested that injuries and deaths can be drastically reduced if you get professional help within a certain time. Ambulance drivers and paramedics are at great risk but given the importance of their work and also the fact that they haven’t quit their jobs in favor of staying at home, should they be allowed to endanger lives by their couldn’t-care-less attitude?

Hospitals and frontline workers are inundated. Despite that, every hospital is still miraculously managing to attend to emergency cases, whether it’s related to covid or not. But inefficient ambulance services with unscrupulous drivers who want to get their paychecks without doing their jobs are unnecessarily putting more lives at risk.

Over coffee, looking at sunrise in Nagarkot, my brother as usual made a savage comment, “One time I see you all nice and hanging out with a friend and next you are all cold and not talking to them, why are you so mean?” I took a sip of my coffee and replied, “I am not the Greek God Atlas to take the entire burden of the world on my back and walk. If people constantly give me negative vibe, I think I don’t want that friendship. I couldn’t choose a brother but I can choose my friends.”

At three different coffee meetings a colleague I was friends with kept on complaining about how her husband doesn’t look after her and her needs, how she doesn’t have friends, how mundane life is, the sacrifices she has made and lack of appreciated, and how my life is so full of excitements and events. At one point I couldn’t take it and asked her what is one thing she does to make a difference or to solve the problem. There was a surprised glare and no reply. I asked her if she expects me to intervene and solve her problems to which there was no reply as well. That day I realized how much we all love to complain and not do a thing to solve our problems. Maybe we enjoy playing victims and get attention.

After a few weeks I realized I was avoiding her. It was not intentional but my reflexes were that I didn’t want to be around people who keep acting miserable. My Grand Aunt once told me, you will be the company you keep, so girl, choose your friends wisely. It did not make sense when I was 11 but at 40 it makes all the sense in the world.

Psychologists say people impersonate the friends they keep. We pick words, behaviors, antics and values of our friends or people we are close with. So it is important to choose wisely. Our brains are mostly attracted to negative thoughts but there are ways to channelize them.

First and foremost, it is fine to avoid negative people. I don’t have a precise deifinition of negative but I mean anything that exhausts you or does not let you grow into a better person. It is absolutely okay to let it out of your system. Sometimes it could be a toxic relationship or marriage or just a friend who keeps complaining about everything and not doing anything about it. Your mental health is more important that anything and anyone else. People might find you rude or selfish for moving on, but trust me, this is for your own good.

Last year, when the world was first hit by Covid, people thought it was a hoax. Some considered it a biological weapon and some thought it was a conspiracy to control population. We stayed home, we tried to survive, thinking it would all be over. We all were looking for a chance to survive so that we could get back to normalcy, even if it would be a new normal. Life suddenly became more precious than anything else. Family and friends started becoming dearer. People staying home learned to cook, to bake, learned a new skill. Staying positive was difficult but not impossible.

But the second wave feels like a second fracture on your already plastered bone. People we know are getting infected faster than we thought, our loved ones are dying. We are all equally scared and feeling anxious. We still don’t have a choice but to hope and try to stay positive. We have to hold on to that little hope that we will survive this. For that, your mental health needs to be on constant check.

A few basic coping strategies then. Practice gratitude for all the good things around you. It could be a plate of decent meal, or a family that is annoying but healthy, alive and together with you. Calling your close friends and appreciating their presence in your life each day also helps instill positive thoughts in your mind. Above all, right now, cut yourself off from people who add negativity in your life. It could be a friend who shares unnecessary fake news on social media (block them, it is okay), a friend who keeps whining about not been able to go out, or a relative who only talks about death numbers in your WhatsApp group. These are things you can right now avoid for your mental peace.

Watch the sunrise or the sunset, read a good book, call at least one person you care about each day. Be that person people can draw positive energy from in this time of crisis. And a little selfishness makes this world a better place—by adding one positive person to it. I would say let us become selfish for a change.

It is hard not to despair. The sick in Nepal are now waiting in their cars, on the roads, in parking lots, waiting for even a basic level of care. Inside, medical facilities are filled beyond maximum capacity. Medical professionals stretched beyond limit. Infections are soaring. The death toll is mounting. Bodies have piled up in riverbanks awaiting cremation. Grief and loss are everywhere.

As the crisis cuts deeper and the despair broadens, where do we look for hope? Our traditional sources of hope—political, economic, religious, cultural—have failed to provide meaningful reassurance against the despair that engulfs us at a ferocious speed. Where are our sources of hope?

In an interview with CNN earlier this week, Prime Minister KP Oli made an appeal for international assistance. He offered no account of what his government was doing, reading instead through the list of customary statistics—infections, positivity rate, recoveries, fatalities. When the anchor asked if large political, religious, and cultural gatherings had been a mistake, the prime minister responded vaguely, pointing instead to political instability. He did not explain that he was as much a part of the political instability.

Political instability has distracted Nepal from the fight against the disease. Like vultures hovering menacingly over a man gasping for his last breath, Nepal’s political leadership has spent more time squabbling and maneuvering than directing a meaningful response to the crisis.

Political instability has always been deeply entrenched in our system of governance. Political leadership has rarely been a source of hope. So, it wasn’t entirely surprising that they failed yet again. But the most telling was how everything around it collapsed. No other government institution rose to force political decision-makers to focus on the crisis: not the civil service, judiciary, president, army, provincial governments, or local governments. It is like our constitution offered no safeguards: not a single institution could get the government to focus on the crisis.

A system that is so entirely beholden to the political leadership, lacking the will or capacity to respond even in an unprecedented emergency, can offer no source of hope. Nepal’s constitution is dead.

Earlier this week, several media reports published details about how demands for commissions had delayed Nepal’s purchase of vaccines. Nepal’s effort to vaccinate its people is now in disarray. The story on commissions implicates leading business houses and personalities.

Many of the media reports appeared more interested in implicating than in telling the story. The demands for commissions appeared strikingly callous, almost inhumane. Our first impulse should have been to say it couldn’t possibly be true. Surely, even the greediest of traders would flinch at such inhumanity. Instead, the stories ripped through our conscience and were immediately absorbed as reality. There was no reason to doubt it, for it resonated deeply with our long-held perception about lack of ethics and hunger for profits within Nepali businesses. Businesses offer no source of hope.

In these troubled times, perhaps religion and culture could have been our sources of hope. Instead, religious and cultural leaders pushed ahead in the opposite direction. They allowed, and often encouraged, large crowds to congregate and mass celebrations to continue. Many religious and social groups have now banded together to offer medical aid to those in need, but they do so largely on the strength and generosity of the volunteers that run those aid camps and not on the institutional strength of the religious groups or cultural societies.

As traditional political, economic, religious, and cultural sources of hope fail, we are now discovering strength in the many individual stories of courage, compassion, and perseverance. They are becoming our sources of hope.

Medical caregivers and other service providers relentlessly on the frontlines every day, often understaffed and under-resourced. Many volunteer groups across the country that have banded together with whatever resources they can muster, assisting even strangers in need. Within our homes, individuals who are juggling the loss of livelihoods, caring for loved ones, sharing with neighbors, or simply fighting to stay alive. The countless untold individual stories of compassion, courage, and perseverance—these are our new sources of hope.

The message of hope as we rise from this despair is that we must let go of the false symbols of hope that had us trapped and return to the core of our individual compassion, courage and perseverance that has allowed us to overcome.         

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