Covid-19 infections in India surged past five million on Wednesday, piling pressure on hospitals grappling with unreliable supplies of oxygen which they need to treat tens of thousands of critical patients.
In the big states of Maharashtra, Gujarat and Uttar Pradesh, some of the areas worst affected by the coronavirus, demand for oxygen has more than tripled, doctors and government officials said, prompting urgent calls for help.
"Desperate patients have been calling me through the night but I don't know when I will get stock," said Mr Rishikhesh Patil, an oxygen supplier in the western city of Nashik.
At least six per cent of India's nearly one million active cases need oxygen support, Central health ministry official Rajesh Bhushan said.
Supplies were adequate but state governments should monitor usage and flag shortages, he said.
In Lucknow, the capital of India's most populous state Uttar Pradesh, the total requirement of oxygen cylinders stood at 5,000 compared with 1,000 cylinders in normal times, a government official said.
Dr Ravindra Khade Patil, who manages two private hospitals on the outskirts of Mumbai, spoke of the stress he faces trying to ensure he can supply his patients with oxygen.
Two days ago, the supplier of oxygen to his hospitals did not turn up at his usual time.
Dr Patil made frantic calls to the supplier and then to nearby hospitals and lawmakers, knowing that if the oxygen did not arrive on time, it would be too late for some of his most critical patients.
Finally, past midnight, thanks to pressure from a government official, the oxygen tanks arrived.
"If they had arrived even a couple of hours late, we could have lost five or six patients. Every day, we are worried if we will be able to meet our requirements, if the oxygen will arrive or not," Dr Patil said.
India's Central health ministry reported 90,123 new infections on Wednesday, taking the total caseload to 5.02 million. The death toll from Covid-19 is now 82,066, the ministry said, with 1,290 fatalities recorded in the previous 24 hours.
India has the world's fastest growing Covid-19 epidemic with the caseload soaring from four million to five million in just 12 days. It is only the second country in the world to have more than five million cases, after the United States.
Not surprisingly, demand for oxygen has risen exponentially. Hospitals and care centres are consuming up to 2,700 tonnes of oxygen every day this month, compared to 750 tonnes in April, according to data obtained from All-India Industrial Gases Manufacturers' Association.
Oxygen manufacturers say the demand for industrial oxygen has also shot up because more factories are now reopening. It's a lives-versus-livelihoods question that India is grappling with now.
"Now 45 per cent of the oxygen we are producing is going to industries, while 55 per cent is going to hospitals and nursing homes," Mr Saket Tikku, the president of the All-India Industrial Gases Manufacturers' Association, told the BBC. "The government is in a bit of a bind.
"If we cut supplies of industrial oxygen to factories, industry will get hurt. On the other hand, if we are not able to augment supplies of medical oxygen, then lives will be in danger."
India will now need to increase capacity to make sure that neither industries nor patients suffer.
On Wednesday, another senior minister in Prime Minister Narendra Modi's cabinet, Mr Nitin Gadkari, tested positive for Covid-19.
He said in a tweet: "I request everyone who has come in contact with me to be careful and follow the protocol."
The Indian parliament reopened after six months on Monday, with at least 17 members testing positive.
Mr Gadkari is part of the 245-strong upper house of parliament, known as the Rajya Sabha, where it was not yet clear how many members are infected.