India’s confirmed coronavirus caseload has crossed the 20m mark, making it the second country in the world after the US to reach the milestone, as ailing patients continued to overwhelm the country’s healthcare system.

More than 3,400 people died from Covid-19 on Monday, pushing India’s death toll from the pandemic to more than 222,000. The figure is widely believed to be an undercount given low levels of testing. 

Crematoriums and graveyards have struggled to cope with an overwhelming flow of bodies that has far exceeded the official number of Covid-19 deaths.

Among those who died on Monday were 24 patients in a Karnataka hospital that ran out of oxygen, highlighting the continued strain on oxygen supply lines.

India confirmed another 355,000 infections on Monday, down from a one-day peak of more than 400,000 on Friday, but testing has also dropped sharply, which could account for the lower case count.

Daily tests fell over the weekend from 1.9m on Friday to 1.5m on Sunday. However, the test positivity rate was 19 per cent, indicating that many cases were still going undetected.

India’s vaccination drive has also faltered amid a shortfall of vaccines, with just 1.6m people vaccinated on Monday, down from a peak of about 4m last month.

Health professionals reported large numbers of deaths in rural areas, where testing infrastructure is virtually non-existent, among patients who were experiencing Covid-19-like symptoms and difficulty breathing.

India’s leading business organisation, the Confederation of Indian Industry, has called for tougher restrictions on non-essential activities in order to staunch the second wave of infections.

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