On 15 March, the Indian Council of Medical Research convened a meeting with national health experts about the rising cases of COVID-19 in the country, and the way forward for the healthcare system to address the growing crisis. “I know for a fact that India does not have testing kits,” a public-health expert who attended the meeting told me, on the condition of anonymity. “They are delaying expanding testing criteria because if they include patients who have no travel history, they will very quickly run out of tests.” The union health ministry has limited testing in central government hospitals to international travellers or those who have come in contact with them, and only at the government-accredited centres. Yet, with just over a hundred cases, India’s healthcare system is already showing its fragility.

This was evident in the circumstances surrounding India’s first death from COVID-19. On 11 March, in the southern city of Kalaburagi, in Karnataka, a 76-year-old man who had returned from Saudi Arabia on 29 February, died after being turned away from two private hospitals. The tests results confirming the COVID-19 infection came a day after his death. India’s first casualty from COVID-19, public health experts told me, is a peek at the grim and impending health crisis staring at us: government hospitals are ill-equipped, and the private hospitals are not accountable to anyone.

These fears were confirmed the next day. Troubled by the inordinate delay in testing people showing symptoms of COVID-19, TS Deo, the Chhattisgarh health minister, wrote to Harsh Vardhan, the union health minister, imploring him to expand testing facilities. In the letter, he wrote, “The current testing criteria is too restrictive … In Chhattisgarh, like many other states, only one centre is carrying our testing currently. We are concerned whether Government of India will provide us the adequate number of kits if we allow wider testing.” Kerala, too, has expanded its guidelines for testing. Now, patients with severe symptoms or with underlying conditions of the lungs, heart, liver and kidney, pregnant women, and those older than 60 years will be tested for the virus even if they have no travel history. The revised guidelines are for testing, quarantine and hospital admission of COVID-19 patients based on a risk assessment.

The centre’s failure to competently deal with the ongoing crisis has reached a point where not just the state governments, but even government doctors have publicly expressed their concerns about the situation. On 14 March, Dr SP Kalantri, a professor of medicine and medical superintendent at the Kasturba Hospital—a government-run facility in Sevagram, Maharashtra—aired his frustration at not being able to care for his patients on Twitter. He tweeted, “Caring for a patient with severe pneumonia and multi-organ failure in an ICU. Unable to figure out who the villain is: bacteria or viruses. The regional lab refused to test his sample for #COVID2019 because he lacked a travel history. Aren’t testing criteria too restrictive?” The following evening, he tweeted once again, “If only 10% of the lab capacity for testing #COVID19 has been used so far, why should government labs refused to test seriously ill patients with #Pneumonia simply because they lack travel history?”

According to Dr Yogesh Jain, a community doctor and activist, who runs a rural clinic in Chhattisgarh, the patient from Karnataka “died because the hospitals gave up on him and his family.” Jain continued, “There has so far been no reasonable explanation as to why the patient was allowed to leave after his samples were taken. Clearly, the government suspected something to take the samples, but did not ensure the patient would get care, leaving the family to go from hospital to hospital.” The patient’s daughter, too, subsequently tested positive for COVID-19. Jain was one of the founding members of Jan Swasthya Sahyog—People’s Health Movement—an NGO that provides health care in rural Chhattisgarh.