India has deadliest day for any country since pandemic began

India reported more than 4,500 deaths from covid-19 on Wednesday for the prior 24 hours, the highest single-day death toll in any country since the pandemic began and a grim marker of the scale of the outbreak ravaging this nation of 1.3 billion people.

The previous high for daily fatalities in the pandemic - 4,400 - occurred in the United States on Jan. 20, according to data from The Washington Post.

While the official statistics on covid-19 deaths in India are devastating, they do not capture the full scope of the calamity. Crematorium figures, obituaries and death certificates have repeatedly indicated higher numbers of deaths in this wave of infections than are reflected in the data from local and national authorities.

Deaths from covid-19, the illness caused by the novel coronavirus, lag infections by several weeks, and there are now signs that after an exponential rise, the surge in India appears to be moderating. The country has reported fewer than 300,000 new infections each day this week, still a large number but lower than the record-shattering figure of more than 414,000 daily cases recorded earlier this month.

In New Delhi, India's capital, the number of new cases has fallen sharply after more than a month of lockdown measures. The slowing growth rate has helped ease the immense pressure on the city's hospitals, which were turning away patients and grappling with shortages of oxygen earlier in May.

Yet the situation remains dire, notably in rural areas where the majority of Indians live and where health care is scarce. In India's vast hinterland, scores of people are dying with covid-19 symptoms without being tested. Hundreds of bodies have been found floating in the Ganges River or buried in shallow graves near its banks.

Sanjeev Goyal, a civil servant at India's Defense Ministry, lost his 23-year-old wife Nidhi Goyal, a teacher, to the virus in April. The family found her a hospital bed in Delhi after a frantic search, but when her condition turned critical, no ventilator was available, Goyal said. She was six months pregnant.

Goyal returned to his small ancestral village in the state of Bihar to immerse his wife's ashes according to tradition. The number of people complaining of fever, coughs and sore throats in the village is now on the rise, he said. But officially there are no coronavirus cases because "not even a single person has been tested."

He blames the Delhi authorities for forcing him to search for a ventilator and criticized a lack of preparation by the government for the second wave. "I will carry this pain for the rest of my life that I couldn't see her face properly one last time," said Goyal.

Indian Prime Minister Narendra Modi last addressed the nation on the coronavirus crisis on April 20. In recent days, he has talked about the need to help rural and remote areas combat the pandemic.

"The challenge is huge, but our morale is even bigger," he told local officials on Tuesday. "With spirit and resolve, we will take the country out of this crisis."

As India seeks to contain the current deadly wave of cases, it is also grappling with a faltering vaccination program. The number of doses administered in the country has tumbled over the past six weeks amid supply shortages and an abrupt change in procurement policy.

Epidemiologists believe that while the rate of growth of new cases appears to be decreasing, the actual toll of the current wave is far larger than official statistics indicate. Experts say the true number of deaths could be anywhere from two to eight times the government figures.

Shahid Jameel, a virologist and professor at Ashoka University, noted recently that under normal circumstances, India's death rate is about 27,600 a day. If the official figures of about 4,000 covid-19 deaths a day were accurate, he said, they would represent a 15% increase - not enough to overwhelm crematoriums or to generate the harrowing scenes witnessed across the country in recent weeks.

The country would not "see this kind of mayhem" unless the number of bodies at crematoriums had doubled, Jameel told the Indian Express newspaper.

The country's death toll reflects not just the rampant spread of the virus but also the strain on a chronically weak health-care system. Covid-19 patients have died at home because hospitals were full, as well as inside hospitals because ventilators were unavailable. Hospitals often have run out of supplemental oxygen, with fatal consequences.

India's Health Ministry reports the prior day's fatalities each morning. For some, Tuesday's more than 4,500 deaths were part of a now familiar routine.

Mayur Rathod, a doctor overseeing the treatment of covid-19 patients at Saroj Hospital in Delhi, began the day at 8 a.m. He often does not stop until the wee hours of the next morning. He updates the availability of hospital beds every two hours, checks stocks of supplemental oxygen and medicines, and submits death reports to a government website. The hospital reported three deaths on Tuesday and seven on Monday.

"We are mentally exhausted," Rathod said. "It is depressing to see patients dying in front of our eyes."

About 500 miles away in the central Indian city of Bhopal, Mamtesh Sharma, an official at one of the city's crematoriums, began the grim process of performing the final rites for dozens of covid-19 patients. For more than a month, he has spent 14 hours a day surrounded by the dead.

On Tuesday, his crematorium handled more than 30 covid-19 victims, including a prominent doctor and a wealthy businessman. In normal times, such funerals would draw crowds of friends and relatives. Instead, four people accompanied the bodies and left quickly, Sharma said. What he has seen in the past five weeks will haunt him for the rest of his life, he said.

Back in Delhi, later in the afternoon, about a dozen people gathered at a cemetery to bury Nabila Sadiq, a beloved 38-year-old professor of women's studies at Jamia Millia Islamia University. Sadiq wrote on Twitter about her illness, which she said began with "chills and a choked throat" on April 25. Early this month, her condition worsened. "Any icu bed leads? For myself," she wrote.

Sadiq's 76-year-old mother was also hospitalized with covid-19, said Farid Khan, a businessman who assisted the family in its search for medical care. Her mother died 10 days ago, and Sadiq died late Monday, Khan said. She is survived by her father and brother.

The situation in India is "unimaginable," Khan said. "Just pray for whatever we can salvage."