Covid-19 infections and deaths continue to mount at an alarming speed in India, with cases nearly doubling in the past three months, while deaths officially passed 220,000.
Staggering as those numbers are, the true figures are believed to be far higher, the undercount an apparent reflection of the troubles in the health care system.
The country has witnessed scenes of people dying outside overwhelmed hospitals and funeral pyres lighting up the night sky.
Infections have surged in India since February in a disastrous turn blamed on more contagious variants of the virus as well as government decisions to allow massive crowds to gather for Hindu religious festivals and political rallies before state elections.
India’s top health official, Rajesh Bhushan, refused to speculate last month as to why authorities were not better prepared.
But the cost is clear: People are dying because of shortages of bottled oxygen and hospital beds or because they could not get a Covid-19 test.
India’s official average of newly confirmed cases per day has soared from over 65,000 on April 1 to about 370,000, and deaths per day have officially gone from over 300 to more than 3,000.
On Tuesday, the health ministry reported 357,229 new cases in the past 24 hours and 3,449 deaths from Covid-19.
Boris Johnson held a virtual call with Indian PM Narendra Modi on Tuesday to discuss how the UK can assist.
During discussions the pair signed an agreement allowing young UK and Indian nationals to work and live in each other's countries, the Home Office said.
Under its terms young professionals aged 18 to 30 will be able to work and live in the other country for up to 24 months.
The Home Office said that the professional and cultural exchange programme would work similarly to current youth mobility schemes, with India being the first visa national country to benefit.
International Trade Secretary Liz Truss said the UK is "helping India" with its coronavirus crisis," adding: "We've sent over oxygen equipment - we've got more on the way".
She was speaking to announce £1 billion of trade with India, in a move set to create more than 6,000 jobs, as the UK looks to foster closer ties with the nation.
Dr Ashish Jha, dean of Brown University’s School of Public Health in the US, said he is concerned that Indian policymakers he has been in contact with believe things will improve in the next few days.
He said: “I’ve been trying to say to them, ‘If everything goes very well, things will be horrible for the next several weeks. And it may be much longer’.”
Dr Jha said the focus needs to be on “classic” public health measures: targeted shutdowns, more testing, universal mask-wearing and avoiding large gatherings.
The death and infection figures are considered unreliable because testing is patchy and reporting incomplete.
Municipal records for this past Sunday show 1,680 dead in the Indian capital were treated according to the procedures for handling the bodies of those infected with Covid-19.
But in the same 24-hour period, only 407 deaths were added to the official toll from New Delhi.
The deaths reflect the fragility of India’s health system. Prime Minister Narendra Modi’s party has countered criticism by pointing out that the underfunding of health care has been chronic.
But this was all the more reason for authorities to use the several months when cases in India declined to shore up the system, said Dr Vineeta Bal of the Indian Institute of Science Education and Research.
“Only a patchwork improvement would’ve been possible,” she said. But the country “didn’t even do that”.
Now authorities are scrambling to make up for lost time. Beds are being added in hospitals, more tests are being done, oxygen is being sent from one corner of the country to another, and manufacturing of the few drugs effective against Covid-19 is being scaled up.
The challenges are steep in states where elections were held and unmasked crowds probably worsened the spread of the virus.
The average number of daily infections in West Bengal state has increased by a multiple of 32 to over 17,000 since the balloting began.
“It’s a terrifying crisis,” said Dr Punyabrata Goon, convener of the West Bengal Doctors’ Forum.
Dr Goon added that the state also needs to hasten immunisations. But the world’s largest maker of vaccines is short of jabs — the result of lagging manufacturing and raw material shortages.
Experts are also worried the prices being charged for shots will make it harder for the poor to get vaccinated. On Monday, opposition parties urged the government make vaccinations free to all Indians.
India is vaccinating about 2.1 million people daily, or around 0.15% of its population.
Dr Ravi Gupta, a virus expert at the University of Cambridge, said: “This is not going to end very soon. And really … the soul of the country is at risk in a way.”