© Provided by The GuardianPhotograph: Rajesh Kumar Singh/AP
India carried out a record 4.3m daily vaccinations as its second wave of coronavirus continued its rapid spread, with 115,000 fresh infections in 24 hours - the highest single-day total anywhere in the world.
While the vaccination rate, which had been been hovering at between 2-3m a day, was a triumph it was not enough to quell the sense of despondency over the sharp increase in cases.
A further 630 deaths for the previous 24 hours were reported on Wednesday, bringing the country's official death toll to 166,177 - the fourth highest in the world.
As cases and deaths rise, hospitals in some areas are once again approaching full capacity. In states such as Maharashtra, which includes Mumbai, hospitals that had until a few weeks ago felt confident of having enough beds to cope could become overwhelmed in days.
© Photograph: Rajesh Kumar Singh/APPeople wait to receive a Covid vaccine in Prayagraj, India. A further 630 Covid deaths were reported on Wednesday.
Maharashtra has been the worst affected of India's states from the startof the pandemic.
New restrictions on non-essential businesses were imposed on Sunday and among the worst affected will be restaurants and small roadside eateries where many migrant labourers are employed.
Rumours are rife in Mumbai, the state capital, of another total lockdown, prompting some labourers to make plans to leave the city again.
They do not want to be caught unawares as they were during the first national lockdown last March when they found themselves overnight without jobs and no money for food or rent, and having to walk or hitch rides back to their homes in villages many miles away because there was no public transport.
Video: India's daily virus cases soar past 100,000 for first time (PA Media)
India's daily virus cases soar past 100,000 for first time
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"Many of them are booking trains before tickets run out. They have been so badly scarred psychologically by what happened last time that they want to make sure they get out of the city before they are helpless," said Jayprakash Jaiswar, who works with the Society for Nutrition, Education and Health Action in Dharavi slum in Mumbai.
Jaiswar said some of the labourers had only summoned up the courage to return about four months ago and were now facing similar turmoil.
"It's back to the earlier choice. Die of Covid in the city or die of starvation in the village. If it's going to be death, since they'd rather die at home with their families, some, not all of them, are heading back," he said.
© Provided by The GuardianA health worker checks a passenger's temperature and pulse at a railway station in Mumbai. Photograph: Francis Mascarenhas/Reuters
A vaccine shortage is also looming in Maharashtra. The state health minister was quoted by NDTV news channel as saying some vaccination centres had already closed because they had run out of doses.
"Stocks of vaccines in the state remain only for three days. We have requested [Delhi] to send more vaccines. This, in the state with the highest number of cases coming every day," the state health minister, Rajesh Tope, told the channel.
The prospect of a vaccine shortage is alarming. India has so far administered only about 80.7m doses to its more than 1.3 billion population. The rating agency Crisil said in a report on Monday that India was lagging behind the global average, having administered only 5.5 doses per 100 people compared with the world average of 8.3 doses.
The two companies making vaccines, the Serum Institute of India and Bharat Biotech, have been told by the government to ramp up their capacity. It is believed they in turn have asked the government for funds to finance plant expansion.
The government is coming under pressure from alarmed state governments to open up vaccination to everyone over 18. At present, only Indians aged over 45 are eligible. So far, the government has not indicated where it stands on this request.
The only solace some states are able to take is that while the infection rate is higher in the second wave than India's peak last September, in some areas such as Delhi there are fewer patients in hospital, fewer in ICUs, and fewer deaths.
"This wave is less serious than the previous ones. More people are under home isolation," Delhi's chief minister, Arvind Kejriwal, said recently.
The Crisil report also said the mortality rate was lower compared with the period last year when the number of daily cases was the same nationwide.
It said the proportion of daily deaths to new cases stood at about 0.6% now, compared with 1.3% last year when there was a similar caseload, indicating that while the virus is spreading faster, the death toll is lower than last year.