Indonesia has converted nearly its entire oxygen production to medical use just to meet the demand from COVID-19 patients struggling to breathe. Overflowing hospitals in Malaysia had to resort to treating patients on the floor. And in Myanmar’s largest city, graveyard workers have been laboring day and night to keep up with the grim demand for new cremations and burials. Images of bodies burning in open-air pyres during the peak of the pandemic in India horrified the world in May, but in the last two weeks the three Southeast Asian nations have now all surpassed India’s peak per capita death rate as a new coronavirus wave, fueled by the virulent delta variant, tightens its grip on the region. The deaths have followed record numbers of new cases being reported in countries across the region which have left health care systems struggling to cope and governments scrambling to implement new restrictions to try to slow the spread. When Eric Lam tested positive for COVID-19 and was hospitalized on June 17 in the Malaysian state of Selangor, the center of the country’s outbreak, the corridors of the government facility were already crowded with patients on beds with no room left in the wards. Read:India's deaths during pandemic 10X official toll The situation was still better than in some other hospitals in Selangor, Malaysia’s richest and most populous state, where there were no free beds at all and patients were reportedly treated on floors or on stretchers. The government has since added more hospital beds and converted more wards for COVID-19 patients. Lam, 38, recalled once during his three weeks in the hospital hearing a machine beeping continuously for two hours before a nurse came to turn it off; he later learned the patient had died. A variety of factors have contributed to the recent surge in the region, including people growing weary of the pandemic and letting precautions slip, low vaccination rates and the emergence of the delta variant of the virus, which was first detected in India, said Abhishek Rimal, the Asia-Pacific emergency health coordinator for the Red Cross, who is based in Malaysia. “With the measures that countries are taking, if people follow the basics of washing the hands, wearing the masks, keeping distance and getting vaccinated, we will be seeing a decline in cases in the next couple of weeks from now,” he said. So far, however, Malaysia’s national lockdown measures have not brought down the daily rate of infections. The country of some 32 million saw daily cases rise above 10,000 on July 13 for the first time and they have stayed there since. The vaccination rate remains low but has been picking up, with nearly 15% of the population now fully inoculated and the government hoping to have a majority vaccinated by year’s end. Doctors and nurses have been working tirelessly to try to keep up, and Lam was one of the fortunate ones. After his condition initially deteriorated, he was put on a ventilator in an ICU unit filled to capacity and slowly recovered. He was discharged two weeks ago. But he lost his father and brother-in-law to the virus, and another brother remains on a ventilator in the ICU. “I feel I have been reborn and given a second chance to live,” he said. With India’s massive population of nearly 1.4 billion people, its total number of COVID-19 fatalities remains higher than the countries in Southeast Asia. But India’s 7-day rolling average of COVID-19 deaths per million peaked at 3.04 in May, according to the online scientific publication Our World in Data, and continues to decline. Indonesia, Myanmar, and Malaysia have been showing sharp increases since late June and their seven-day averages hit 4.17, 4.02 and 3.18 per million, respectively, on Thursday. Cambodia and Thailand have also seen strong increases in both coronavirus cases and deaths, but have thus far held the seven-day rate per million people to a lower 1.29 and 1.74, respectively. Individual countries elsewhere have higher rates, but the increases are particularly alarming for a region that widely kept numbers low early in the pandemic. With the Indian experience as a lesson, most countries have reacted relatively quickly with new restrictions to slow the virus, and to try to meet the needs of the burgeoning number of people hospitalized with severe illnesses, Rimal said. “People in this region are cautious, because they have seen it right in front of them — 400,000 cases a day in India — and they really don’t want it to repeat here,” he said in a telephone interview from Kuala Lumpur. Read:Vietnam puts southern region in lockdown as surge grows But those measures take time to achieve the desired effect, and right now countries are struggling to cope. Indonesia, the world’s fourth most populous nation with some 270 million people, reported 1,383 deaths on Wednesday, its deadliest day since the start of the pandemic. Daily cases through about mid-June had been about 8,000, but then began to spike and peaked last week with more than 50,000 new infections each day. Because Indonesia’s testing rate is low, the actual number of new cases is thought to be much higher. As hospitals there began to run out of oxygen, the government stepped in and ordered manufacturers to shift most production from industrial purposes and dedicate 90% to medical oxygen, up from 25%. Before the current crisis, the country needed 400 tons of oxygen for medical use per day; with the sharp rise in COVID-19 cases, daily use has increased fivefold to more than 2,000 tons, according to Deputy Health Minister Dante Saksono. Though the production of oxygen is now sufficient, Lia Partakusuma, secretary general of Indonesia’s Hospital Association, said there were problems with distribution so some hospitals are still facing shortages. In Indonesia, about 14% of of the population has had at least one vaccine dose, primarily China’s Sinovac. There are growing concerns that Sinovac is less effective against the delta variant, however, and both Indonesia and Thailand are planning booster shots of other vaccines for their Sinovac-immunized health workers. In Myanmar, the pandemic had taken backseat to the military’s power seizure in February, which set off a wave of protests and violent political conflict that devastated the public health system. Only in recent weeks, as testing and reporting of COVID-19 cases has started recovering, has it become clear that a new wave of the virus beginning in mid-May is pushing cases and deaths rapidly higher. Since the start of July its death rate has been climbing almost straight up, and both cases and fatalities are widely believed to be seriously underreported. “With little testing capacity, low numbers in the country vaccinated, widespread shortages of oxygen and other medical supplies, and an already beleaguered health care system under increasing strain, the situation is expected to get increasingly worse in the coming weeks and months,” said ASEAN Parliamentarians for Human Rights, a regional advocacy group. “Meanwhile, the junta’s confiscation of oxygen, attacks on health care workers and facilities since the coup, and the lack of trust in any services they provide by the majority of the population, risks turning a crisis into a disaster.” On Tuesday, the government reported 5,860 new cases and 286 new deaths. There are no solid figures on vaccinations, but from the number of doses that have been available, it’s thought that about 3% of the population could have received two shots. Read:Covid-19: Government orders 66 crore vaccine doses worth RS 14,505 crore Officials this week pushed back at social media postings that cemeteries in Yangon were overwhelmed and could not keep up with the number of dead, inadvertently confirming claims that hospitals were swamped and many people were dying at home. Cho Tun Aung, head of the department that oversees the cemeteries told military-run Myawaddy TV news on Monday that 350 staff members had been working three shifts since July 8 to ensure proper cremations and burials of people at Yangon’s seven major cemeteries. He said workers had cremated and buried more than 1,200 people on Sunday alone, including 1,065 who had died at home of COVID-19 and 169 who had died in hospitals. “We are working in three shifts day and night to inter the dead,” he said. “It is clear that there is no problem like the posts on Facebook.”

Ever since the pandemic began, Haiti had perplexed experts with seemingly low infection and death rates from COVID-19 despite its rickety public health system, a total lack of vaccines and a widespread disdain for safety measures like masks and distancing. That is no longer the case. The few Haitian hospitals treating COVID cases have been so swamped in recent days that they report turning away patients, while plans to open another hospital to treat the infected have been delayed. Official figures remain relatively low for a nation of more than 11 million people: Just 2,271 cases and 62 deaths have been recorded over the past month in government data collected by Johns Hopkins University. A total of 15,700 cases and more than 330 deaths have been reported since early last year. Read:Sinovac vaccine restores a Brazilian city to near normal But experts are united in saying those figures miss the true scale of what they say is the largest spike in cases since the new coronavirus first landed. The government declared a health emergency on May 24 and imposed a curfew and safety measures — though few Haitians appear to be following them. Most shun, or can’t afford, face masks and it’s nearly impossible to keep a distance while shopping in bustling marketplaces or riding the crowded, colorful buses known as tap taps that most Haitians rely on to get around. “There is no time to waste,” said Carissa Etienne, director of the Pan American Health Organization, which is working with the government to scale up testing to identify and isolate infected people — a difficult task in a place where few think they can afford to be sick. Sanorah Valcourt, a 27-year-old mother and hairstylist, said she felt sick for for two weeks last month with a fever and symptoms including loss of taste. But she didn’t get tested, or even take measures such as wearing face masks she finds uncomfortable. “I didn’t feel well enough to hop on a tap tap and spend hours at a hospital to get tested,” she said. The lack of cases early this year had led authorities to reduce the number of beds available for COVID patients to about 200 — more than half of those at the nonprofit St. Luke Foundation for Haiti in the capital of Port-au-Prince. But by early this month, that clinic was at capacity and announced it was turning away patients. “Many people are dying on arrival in ambulances,” the foundation said. “We have received many nuns as patients, a sure sign (COVID-19) is in the poorest areas.” Marc Edson Augustin, medical director of the St. Luke hospital, said he’s especially worried about the deaths he has seen among those aged 17 to 22, and that groups of up to seven people are showing up at the same time seeking treatment for COVID. Read:In Argentina, doctors adapt as COVID-19 strains hospitals “The situation is real, and we want to tell people that the situation is getting worse,” he said. “We’re working to keep people alive as much as possible.” Haiti’s Health Ministry had planned to have another 150 beds elsewhere for COVID-19 patients, but that effort was delayed. Meanwhile, Bruno Maes, representative in Haiti for UNICEF, said the children’s agency is working to help hospitals get oxygen and fuel. “It’s not enough, for sure,” he said. “We have to be ready for a bigger influx of cases. ...It could get out of control.” So far, Haiti hasn’t received a single vaccine, though officials say they expect to get 130,000 AstraZeneca doses this month. The U.S. government also said it would donate a portion of six million doses for Haiti, though officials haven’t specified how many or when they will arrive. Some 756,000 doses of AstraZeneca shots had been slated to arrive in May via the United Nations’ COVAX program for low-income countries, but they were delayed due to the government’s concern over possible clotting as a side effect and a lack of infrastructure to keep the vaccines properly refrigerated. PAHO said it would help Haiti’s Health Ministry solve those problems, and is prioritizing vaccinating health workers. The medical system also has been struggling with other problems, including unpaid wages for some workers. President Jovenel Moïse recently asked the Ministry of Economy and Finance to ensure they get paid. Even when vaccines arrive, experts worry many people may not get a jab — some for fear of venturing through crime-wracked neighborhoods to reach a clinic. Read:Why are so many babies dying of Covid-19 in Brazil? Valcourt mentioned such dangers as one reason why she avoided getting tested. Like many Haitians, she turned to a home remedy — in her case, a tea made with parsley, garlic, lime, thyme and cloves. Manoucheka Louis, a 35-year-old street merchant who sells plantains and potatoes, said she got sick earlier this year but didn’t have the roughly $20 needed to see a private doctor, who she trusts more than public institutions. “Health care is not something I can afford,” she said, adding that she was coughing a lot and was fighting a fever, loss of taste and an aching body and head. Her two children had the same symptoms, and they all relied on homemade teas and regular cold medicine. She said she still can’t afford to always wear a mask. They can cost about 50 cents each in a country where many people make less than a dollar or two a day.

The U.S. saw remarkable increases in the death rates for heart disease, diabetes and some other common killers in 2020, and experts believe a big reason may be that many people with dangerous symptoms made the lethal mistake of staying away from the hospital for fear of catching the coronavirus. The death rates — posted online this week by federal health authorities — add to the growing body of evidence that the number of lives lost directly or indirectly to the coronavirus in the U.S. is far greater than the officially reported COVID-19 death toll of nearly 600,000 in 2020-21. For months now, researchers have known that 2020 was the deadliest year in U.S. history, primarily because of COVID-19. But the data released this week showed the biggest increases in the death rates for heart disease and diabetes in at least 20 years. “I would probably use the word `alarming,’” said Dr. Tannaz Moin, a diabetes expert at UCLA, said of the trends. Read:AP source: US to buy 500M Pfizer vaccines to share globally Earlier this year, the Centers for Disease Control and Prevention reported that nearly 3.4 million Americans died in 2020, an all-time record. Of those deaths, more than 345,000 were directly attributed to COVID-19. The CDC also provided the numbers of deaths for some of the leading causes of mortality, including the nation’s top two killers, heart disease and cancer. But the data released this week contains the death rates — that is, fatalities relative to the population — which is considered a better way to see the impact from year to year, since the population fluctuates. Of the causes of death for which the CDC had full-year provisional data, nine registered increases. Those included Alzheimer’s disease, Parkinson’s, chronic liver disease, stroke and high blood pressure. Some of the increases were relatively small, but some were dramatic. The heart disease death rate — which has been falling over the long term — rose to 167 deaths per 100,000 population from 161.5 the year before. It was only the second time in 20 years that the rate had ticked up. This jump, of more than 3%, surpassed the less than 1% increase seen in 2015. In raw numbers, there were about 32,000 more heart disease deaths than the year before. Diabetes deaths rose to 24.6 per 100,000 last year, from 21.6 in 2019. That translated to 13,000 more diabetes deaths than in 2019. The 14% increase was the largest rise in the diabetes death rate in decades. The death rate from Alzheimer’s was up 8%, Parkinson’s 11%, high blood pressure 12% and stroke 4%. Read:EXPLAINER: The US investigation into COVID-19 origins The CDC offered only the statistics, not explanations. The agency also did not say how many of the fatalities were people who had been infected with — and weakened by — the coronavirus but whose deaths were attributed primarily to heart disease, diabetes or other conditions. Some experts believe a larger reason is that many patients did not seek treatment in an emergency because they feared becoming infected with the virus. “When hospitalization rates for COVID would go up, we would see dramatic declines in patients presenting to the emergency room with heart attacks, stroke or heart failure,” Dr. Donald Lloyd-Jones, a Northwestern University researcher who is president-elect of the American Heart Association. Other possible explanations also point indirectly to the coronavirus. Many patients stopped taking care of themselves during the crisis, gaining weight or cutting back on taking high blood pressure medications, he said. Experts said the stress of the crisis, the lockdown-related disappearance of exercise options, and the loss of jobs and the accompanying health insurance were all factors, too. Increases in Kentucky, Michigan, Missouri, and West Virginia pushed the four into the group of states with the highest rates of death from heart disease, the CDC data showed. For diabetes, similar changes happened in Indiana, New Mexico, West Virginia and some other Southern and Plains states. The death rate from the nation’s No. 2 killer, cancer, continued its decline during the year of COVID-19. It fell about 2% in 2020, similar to the drop seen from 2018 to 2019, even though cancer screenings and cancer care declined or were often postponed last year. Read:FDA approves much-debated Alzheimer’s drug panned by experts Lloyd-Jones’ theory for the decline: Many of the virus’s victims were fighting cancer, “but COVID intervened and became the primary cause of death.” Earlier research done by demographer Kenneth Johnson at the University of New Hampshire found that an unprecedented 25 states saw more deaths than births overall last year. The states were Alabama, Arizona, Arkansas, Connecticut, Delaware, Florida, Indiana, Kentucky, Maine, Massachusetts, Michigan, Mississippi, Missouri, Montana, New Hampshire, New Mexico, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Vermont, West Virginia, and Wisconsin. Traditionally the vast majority of states have more births than deaths.

The numbers of both corona-infected people and deaths in Bangladesh have declined, Health Minister Zahid Maleque said on Sunday.