'A horror story on repeat': India's Covid crisis

The city of Mumbai - which sits in the state of Maharashtra, India's biggest hotspot - has been in complete lockdown for two weeks.

There's a sense of deja vu - the pictures are eerily reminiscent of a period of time last year when large parts of the entire world went into a state of lockdown.

But the pictures are a reminder that for millions in India - this is still their reality.

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The western state of Maharashtra, which has been India's Covid ground zero from the start of the pandemic, is back at the top after briefly reporting a drop in cases.

The state, among India’s richest and home to its financial hub, Mumbai, confirmed more than 66,000 cases last night.

That’s more than any other state, adding to an active caseload that is already the highest in India.

Maharashtra accounts for more than a quarter of India’s 17.9 million cases and nearly a third of India's 201,000 deaths so far.

Mayank Bhagwat of BBC Marathi explains more.

It's widely agreed among experts that both cases and deaths are being under-reported in India right now - and one expert tells me that she thinks the real figures could be as high as 10 times the official numbers in some areas.

Dr Amita Gupta is a professor of medicine in international health at the US-based Johns Hopkins Bloomberg School of Public Health and she facilitates the university's partnerships with clinics and labs across India.

"We were estimating that the problem is 10 times worse in places like Maharashtra than the official numbers, based on what we're hearing," she says.

One of the main problems is that only people with symptoms are being tested, and even then testing labs are already at capacity.

"We've heard from many of the big lab chains around India... they're running 24/7 and are essentially overrun with tests. There's only so many they can test."

Queues of patients and their families have been forming outside hospitals as people get increasingly desperate to access treatment. But Dr Jayesh Lele told BBC World TV that this was causing patients to get sicker and leaving medical staff scared.

The surge in cases has meant delays in people getting admitted to hospital.

As these pictures from today show, patients have been left waiting in cars or rickshaws in the western city of Ahmedabad.

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Neha Singh Ghalote, in Rajasthan, had Covid earlier in the pandemic and feels grateful she received the care she needed.

Neha says she often wonders what would have happened if she had contracted Covid now instead, because there "just isn't the infrastructure" to keep people well.

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India’s hospitals are using 7,500 metric tonnes of oxygen a day - equating to 90% of the oxygen supply, according to Rajesh Bhushan, a senior health official.

That’s a massive leap, not just from pre-Covid times, when healthcare facilities used just 15% of India’s oxygen supply, but also three times more than was used in the peak of the first wave last September.

You can read more about India’s oxygen struggles here.

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Right now Soma is working on getting medical supplies and treatments to people living on the streets of Kolkata. She's just finished an ambulance round with the Hope foundation, and is heading back into the hospital when I speak to her.

I ask how her day has been so far, and she replies with one word: "Hectic."

Her hospital has 45 beds and 40 of them are currently occupied by confirmed Covid patients. The remaining five are suspected to have the virus. On top of that, they're facing the same dire shortages of equipment and oxygen that are hitting medical centres across the country.

Vulnerable people, she says, "are coming here from across West Bengal," after failing to get admitted to government hospitals.

"This is because there is no proper treatment for these people from our government."

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As part of our special day of India coverage, BBC Asian Network has a programme on BBC Sounds asking: Has India been let down by Narendra Modi’s government?

You can listen here.

We have spoken to the ruling BJP party and campaigners in India, as well as the Asian Network audience.

We also hear from our reporters in London, Leicester and Bolton, to find out how Indian communities there have been affected.

A day after the Board of Control for Cricket in India urged players to play on for "humanity" we also ask whether the IPL should be suspended.

And Haroon Rashid looks at how Bollywood is responding to the unfolding tragedy.

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In the vast, 1,100 sq km Chilika Lagoon in Odisha lies a group of island villages - cut off from the mainland, and accessible only by boat.

Dr Manoranjan Mishra, head of an organisation called Jeevan Rekha Parishad (JRP), says access to food and education there has been limited over the past year because of lockdowns.

JRP organises food deliveries to the islands via local volunteers, to avoid people from the mainland travelling over.

The impact has been particularly hard on the Dalit community, formerly known as "untouchables".

"They have no income, no connectivity, no electricity... because they're completely excluded from the mainstream of society," Dr Mishra tells me.

But has the virus itself reached the islands?

"Fortunately, you'll not believe, the island people are completely safe," Dr Mishra tells me. "Not a single positive case has been found so far. Nobody is going there, and they're not going out - so they're completely safe."

India’s Prime Minister Narendra Modi has come in for criticism over his handling of the crisis. He is currently working relentlessly with the health ministry and other countries to tackle oxygen shortages, the Bharatiya Janata Party (BJP) national spokesperson Shaina Nana Chudasama has said.

“It is most unfortunate that we have lost lives and nobody expected this double mutant to shape up in this particular way,” she told BBC World TV earlier.

Harrowing scenes are emerging from India by the hour - some of which we've pictured and reported on in this live page today.

The official death toll has exceeded 200,000 - though experts believe the actual total is higher - and people are dying while waiting for hospital beds as oxygen supplies run low and hospitals collapse under the strain.

The crisis has also affected those reporting on it every day. Two of the BBC's Delhi-based reporters - Soutik Biswas and Vikas Pandey - have been sharing their experiences of striving to help family and friends, while also working overtime to report the nightmare unfolding around them.

In the last two weeks, 45 journalists in India have died with Covid-19. Overall, more than 100 have died with the virus, according to Press Emblem Campaign, a Switzerland-based media group.

However a group of mental health professionals have raised questions about how some sections of the media have been reporting on the crisis - and the impact on those reading or watching.

Experts including Dr BN Gangadhar of New Delhi's National Medical Commission, have signed an open letter urging journalists to show "restraint in their coverage, without compromising upon facts or public interest".

They write that reporting images of "bodies burning in cremation grounds [and] relatives of the deceased wailing inconsolably" might "help garner eyeballs" but there was a "steep price to be paid for such coverage".

They warn a "hidden mental health epidemic" is already emerging from the Covid-related restrictions on peoples' lives, and that seeing such "disturbing and depressing visuals" while stuck at home could push people "much deeper into the abyss".

Reporting on shortages of certain supplies is the "right thing to do so that action can be taken" but it must include specifics such as exactly where the shortage is.

"Specific information empowers people and prepares them to face any challenge. But panic weakens them," the experts say.

They stress they are not saying that facts should not be reported but instead that "hysteria and panic-inducing coverage" should be avoided.

"In such times the media has great power to inform, educate, and most importantly infuse hope in the people. This includes the sharing of authentic information and allaying of fears.

"These are extremely important weapons in the fight against the pandemic."

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Back in January, it was the beginning of India’s vaccination drive. In Delhi, brightly coloured balloons hung over an archway to the hospital entrance.

On that day, there was a mood of celebration. The hospital’s medical director, Suresh Kumar, smiled from under his mask. It was a smile of relief - as he told me how wards which had been dedicated to coronavirus cases were now able to treat other, routine conditions.

Covid-19 cases were low, and many thought India was past the worst.

Months later, and that couldn’t be further from the distressing reality. Gone are the balloons and buoyancy - replaced instead by a sense of desperation.

Back then there were around 10,000-15,000 cases reported a day - with under 100 deaths. Now there are more than 300,000 daily cases, and more than 2,000 daily deaths.

Scrolling through my social media feeds I see message after message, written by families struggling to find beds for friends and relatives. Indian health experts I’ve talked to believe the numbers dying with, or because of, Covid are far higher than the official statistics.The pyres that burn through the night at some of the crematoriums are visual testament to this.

How did India get here? Many say it was a sense of complacency. Mass gatherings had taken place, with no social distancing and few people wearing masks.

In my circle of friends in Delhi, almost everyone now knows someone who’s lost a loved one to Covid-19.

A friend’s three-year old son has the virus – doctors say they’re seeing more younger patients this time round.

The joy of that January morning has now turned into sheer horror, which is unfolding across the country.

Listen to more from Rajini on BBC Sounds here.

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Shishir Joshi is from Project Mumbai, a non-profit working on Covid relief for people living in the city's slum areas.

He tells me that last year they mostly focused on getting food and funds to people below the poverty line who weren't able to work in lockdown - but now, the priority is healthcare.

"We are also now providing what we call oxygen concentrators," he says. An oxygen concentrator is a machine that allows someone to have oxygen treatment administered at home - and with hospitals in the city packed to capacity, it is becoming a vital piece of equipment.

"We started a project to provide these machines to people below the poverty line in Mumbai - for free of course.... In the absence of hospital beds, people need oxygen concentrators."

With Covid has also come the "shadow pandemic" - a term the UN has used to describe the steep rise in cases of domestic violence.

The country’s National Commission for Women says it received 23,722 complaints of crimes against women in 2020 - the highest in the past six years. Of those, almost a quarter were complaints of domestic violence.

The trend has continued into 2021 - with 1,463 complaints of domestic violence reported between 1 January and 25 March.

In rural India, many men who returned home from the cities after losing their jobs brought along financial stress and fears of sickness. Some took out their frustrations on their wives and children.

The frequency and the brutality of assaults are said to have gone up, says Urvashi Gandhi of charity Breakthrough, with its partner NGOs "receiving frantic calls to rescue women trapped in unsafe homes".

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Dr Clare Wenham, assistant professor of global health policy at the London School of Economics, has been telling the BBC's Newscast podcast what the world needs to do to stop more countries suffering like India.

She said: "Rather than sending donations, we need to stop them getting like that, massively ramping up global distribution and global production of vaccines."

Which country could be next?

"I think Peru is one to look at, the numbers there are getting really scary", said Dr Wenham. "What the last 14 months has taught us, is that if you take your eye off the ball for a second and get complacent, it can happen anywhere."

Read more here on why India's crisis matters to the whole world.

It was only a couple of weeks ago when the mood in West Bengal state was "There is no more coronavirus, why use a mask?"

That has now changed.

Cases in the state are surging in the wake of huge election rallies - and it's likely to be the next big hotspot.

The eastern state in is the middle of a heated election and rallies are continuing. Some of the biggest ones, including those attended by Prime Minister Narendra Modi, have seen throngs of people not wearing masks or maintaining social distancing.

Although Modi has since cancelled his rallies, amid mounting criticism, local politicians are yet to do so The election commission has now limited them to a maximum of 500 people.

There is also no lockdown or curfew in the state - despite a new high of 16,403 new Covid cases over the past 24 hours.

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BCCI/IPLCopyright: BCCI/IPL

Despite the continued rise in cases and deaths across India, the Indian Premier League - the world's top Twenty20 competition, compromising the world's best players - is continuing.

The tournament has moved to Delhi - where a match is taking place right now - and Ahmedabad, after starting in Mumbai and Chennai.

There have been no cases within the tournament, which is taking place in a bubble, but some overseas players have started to leave the tournament because of travel restrictions that their home countries are putting into place.

England's Liam Livingstone left Rajasthan Royals, while Australia's Andrew Tye, Adam Zampa and Kane Richardson have all departed. India spinner Ravichandran Ashwin has also decided to take a break to "support his family".

Despite that, the tournament is expected to continue, with a senior IPL official arguing it keeps people's spirits up.

"We should not underestimate the power of sport to spread positivity. It's probably more important now to hold the IPL, when there is so much negativity around," the official told Reuters.

"At least fans are absorbed in it at home. Otherwise many of them will step out without masks.

"The league generates considerable money for the economy. It has to be seen from that context too. How does stopping IPL help?"

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Radhika Howarth lives in London but is currently stuck in Gwalior in Madhya Pradesh state, where she has been caring for her 84-year-old mother.

Radhika arrived in India on 30 March and was allowed to enter Gwalior after spending a week in quarantine in Delhi.

Before that, she had not seen her mother, Shamoli, for 18 months because of the pandemic.

Shamoli was in need of support after she recently had a fall and her carer had to stop visiting because of the surge in Covid-19 cases.

Radhika told BBC Radio 5 Live in the UK that she did not even want to step out of her front door, for fear of herself or her mother catching coronavirus.

"What I am hearing is very grim, all we can hear outside are the sirens of ambulances up and down… it just makes your heart sink," she said.

"I feel guilty even asking for a test [PCR Covid-19 test] to be able to fly back because I know people are desperate to get the test and get the treatment."

Radhika said hospitals had put out signs saying ‘No beds available.’

She and her mother have essential supplies but they are currently sticking to one meal a day to try to manage.

“I want to come back, but I don’t want to come back, because how will people like my mother cope?" she said.

"In a situation like this you are so disempowered, you have no rights, and there’s no one around to turn to.

"It’s just me and my mum and when you call people… everybody’s in the same situation," Radhika said.

Listen to 5 Live on the free BBC Sounds app.