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India has been going through a vicious second wave of COVID-19 throughout the past month. The total reported coronavirus cases in the country passed the 22 million mark, with an average of 350,000 new cases and over 3,440 deaths each day.

As of May 9th, India had reported over 246,000 deaths, with a seven-day average of new cases around 391,000.

The snowballing numbers of COVID-19 cases are overwhelming the nation’s healthcare facilities, which are now facing a major shortage of supplies, particularly oxygen.

But one of the country’s largest medical gas installation and medical gas service companies says the reason for the shortage is not a lack of supply – it’s getting the medical gas and equipment to where it needs to be. Before the coronavirus pandemic hit the world, nobody expected the demand for oxygen flowmeters, tanks and regulators to hit such high levels.

Last week, at least 24 people died at a hospital in the southern state of Karnataka after the facility ran out of oxygen. It was the latest tragedy in a growing series of such calamities throughout the country. Madhya Pradesh in central, Haryana in the North, and Maharashtra in west India, are all facing an oxygen shortage.

In the northern state of Uttar Pradesh, some healthcare facilities have put ‘medical oxygen out of stock’ notifications, while in the state capital of Lucknow hospitals have asked COVID-19 patients to move somewhere else.

For a couple of weeks, India has been constantly re-experiencing this calamity on repeat, waiting for the petrifying moment when there is no oxygen left at all. For the people who have been following the coronavirus pandemic in India, from doctors to journalists, this all feels like déjà vu.

Several months ago, India had struggled with the same medical oxygen shortage amid a rapid surge of COVID-19 cases. However, this second wave has been far more damaging. In a country where only 15 percent of oxygen is used medically, the rest is for industrial use, 90 percent of the country’s oxygen production has now been diverted to medical use.

If trends in other nations are anything to go by, India’s coronavirus catastrophe might continue for several months. Reports by CLSA, a Hong Kong-based brokerage firm, suggest that this second wave in India is likely to peak only in June. Based on the analysis of 12 other countries, including the UK, US, and Brazil, all who faced a similar surge of COVID-19 cases, India may remain in this dire situation for more than two months.

CLSA found that the second COVID-19 wave in the 12 selected countries peaked when incremental cases had hit the median 2 percent of the population. Given this, CLSA estimates that India may take about two months to get incremental infections equal to two percent of the population, from 0.5 percent currently, in this second wave.

This is bad news for the country as the present situation is already very distressing, and will become worse if new cases continue to be reported. What is more worrying is that these grim figures aren’t illuminating the full picture, since there are obvious lapses in the collection of data related to coronavirus infections and deaths.

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If India continues to report new cases, the oxygen shortage and lack of sufficient medical gas equipment could be felt throughout more states. The country also lacks sufficient transportation infrastructure and storage capacity for medical gas. For instance, liquid oxygen is kept at a very low temperature and has to be transported in cryogenic tankers to distributors, from there it is then converted to gas and filled in cylinders. Currently, India lacks enough cryogenic tankers to transport the liquid oxygen to distribution centers.

According to Meher Prakash of the Jawaharlal Nehru Centre for Advanced Scientific Research, there are only a limited number of cylinders and oxygen tankers in the country. So, the logistics of refilling them and bringing them to healthcare facilities is a major bottleneck. This shortage of oxygen and medical gas requirements is not only felt in cities, but also in villages and smaller towns where the healthcare infrastructures are already exceedingly weak.

Critics have accused various state governments and healthcare facilities of being completely unprepared for the devastating second wave. Prominent virologists and doctors say the oxygen shortage was more of a symptom than a direct cause of the crisis – implementing operational safety protocols along with strong public messaging could have kept more people socially distanced, and ultimately helped keep the virus at bay.