India became the third country to cross four million coronavirus cases on Saturday, also setting a new global record for a daily surge in infections and closing in on Brazil’s total as the second-highest in the world.

The 86,432 cases added in the past 24 hours pushed India’s total to 4,023,179.

Brazil has confirmed 4,091,801 infections while the United States has 6,200,186 people infected, according to Johns Hopkins University.

India’s health ministry on Saturday also reported 1,089 deaths for a total of 69,561.

Initially, the virus ravaged India’s sprawling and often densely populated cities. It has since stretched to almost every state in India, spreading through villages and smaller cities where access to healthcare is crippled.

With a population of nearly 1.4 billion people, India’s massive caseload does not surprise experts. The country’s delayed response to the virus forced the government to implement a harsh lockdown in late March. For more than two months, the economy remained shuttered, buying time for the underfunded healthcare system to prepare for the worst.

But with the economic cost of the restrictions rising, authorities saw no choice but to reopen activities.

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Most of India’s cases are in western Maharashtra state and the four southern states of Tamil Nadu, Andhra Pradesh, Telangana and Karnataka.

In rural Maharashtra, the worst-affected state with 863,062 cases and 25,964 deaths, doctors said measures like wearing masks and washing hands had now largely been abandoned.

“There is a behavioural fatigue now setting in,” said Dr S P Kalantri, the director of a hospital in the village of Sevagram.

He said that the past few weeks had driven home the point that the virus had moved from India’s cities to its villages.

“The worst is yet to come,” said Kalantri. “There is no light at the end of the tunnel.”

Controlling Maharashtra’s outbreak

Shamika Ravi, an economics professor and former government adviser who has closely followed pandemic trends in India, said that India is “nowhere close” to a peak and Maharashtra must become the “focus” of the campaign against the coronavirus.  

“There is no controlling COVID-19 in India without controlling the outbreak in Maharashtra,” she said on Twitter.    

“Given its economic significance, Maharashtra will continue to influence the spread of infection elsewhere in the country.”

Even as testing in India has increased to more than a million a day, a growing reliance on screening for antigens or viral proteins is creating more problems. These tests are cheaper and yield faster results but are not as accurate. The danger is that the tests may falsely clear many who are infected with COVID-19.

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In Uttar Pradesh, India’s most populous state with a limited healthcare system, the situation is already grim. With a total 253,175 cases and 3,762 deaths, the heartland state is staring at an inevitable surge and with a shortage of hospital beds and other health infrastructure.

Sujata Prakash, a nurse in the state’s capital, Lucknow, has recently tested positive for the coronavirus. But the hospital ward where she worked diligently refused her admission because there were no empty beds. She waited for more than 24 hours outside the surgical ward, sitting on patients’ chairs, before she was allotted one.

“The government can shower flower petals on the hospitals in the name of corona warriors, but can’t the administration provide a bed when the same warrior needs one?” said Prakash’s husband, Vivek Kumar.

Others have not been so lucky.

When journalist Amrit Mohan Dubey fell sick this week, his friends called the local administration for an ambulance. It arrived two hours late and by the time Dubey was taken to hospital, he died.

“Had the ambulance reached in time, we could have saved Amrit,” said Zafar Irshad, a colleague of the journalist.



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