India’s top health official, Rajesh Bhushan, refused to speculate last month as to why the authorities were not better prepared. But the cost is clear: people die from lack of oxygen in bottles and hospital beds, or because they couldn’t get a COVID-19 test.

India’s official average of newly confirmed cases per day has increased from over 65,000 on April 1 to about 370,000, and daily deaths have officially increased from over 300 to over 3,000.

On Tuesday, the Department of Health reported 357,229 new cases and 3,449 deaths from COVID-19 in the past 24 hours.

Dr. Ashish Jha, dean of the School of Public Health at Brown University in the United States, said he was concerned that Indian politicians with whom he has been in contact believe things will improve in the next few days.

“I was … trying to tell them,” If everything goes very well, things will be terrible for the next few weeks. And it can take a lot longer, “he said.

Jha said the focus needs to be on “classic” public health measures: targeted shutdowns, more testing, universal mask wear and avoidance of large gatherings.

“That’s what will break the back of this wave,” he said.

Death and infection numbers are considered unreliable because tests are patchy and incomplete. For example, government guidelines urge Indian states to include suspected COVID-19 cases in their records of deaths from the outbreak, but many do not.

The US, with a quarter of India’s population, has recorded more than 2 1/2 times as many deaths at around 580,000.

Municipal records for this past Sunday show that 1,680 dead in the Indian capital have been treated according to the procedures for handing over the bodies of those infected with COVID-19. However, only 407 deaths were added to the official toll from New Delhi in the same 24-hour period.

The New Delhi Supreme Court announced that it would punish government officials if hospitals are not supplied with oxygen. “Enough is enough,” they said.

The deaths reflect the fragility of the Indian health system. Prime Minister Narendra Modi’s party countered the criticism by pointing out that underfunding of health care was chronic.

However, this was all the more reason for authorities to take advantage of the several months in which cases in India refused to shore up the system, said Dr. Vineeta Bal from the Indian Institute for Science Education and Research.

“Only a patchwork improvement would have been possible,” she said. But the country “didn’t even do that”.

Now the authorities are trying to make up for the lost time. Hospitals are adding beds, doing more tests, sending oxygen from one corner of the country to another, and increasing production of the few drugs that are effective against COVID-19.

The challenges are great in states where elections have been held and exposed crowds likely aggravated the spread of the virus. The average number of daily infections in the state of West Bengal has increased many times over from 32 to over 17,000 since the vote began.

“It’s a terrible crisis,” said Dr. Punyabrata Goon, organizer of the West Bengal Doctors’ Forum.

Goon added that the state must also expedite vaccinations. However, the world’s largest manufacturer of vaccines is missing the shots – the result of declining manufacturing and raw material shortages.

Experts are also concerned that the prices of shots will make it harder for the poor to get vaccinated. On Monday, opposition parties called on the government to make vaccinations free of charge for all Indians.

India vaccinates about 2.1 million people, or about 0.15% of its population, every day.

“This is not going to end very soon,” said Dr. Ravi Gupta, a virus expert at Cambridge University in England. “And really … the soul of the country is in some way endangered.”

___

Associate press writer Danica Kirka from London contributed to this report.

___

The Associated Press Department of Health and Science is supported by the Department of Science Education of the Howard Hughes Medical Institute. The AP is solely responsible for all content.