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A surge of Covid-19 in a bastion of support for the Indian prime minister has been met with cover-ups and intimidation as his party workers scramble to limit political damage from the crisis during local elections, doctors allege.
Doctors claim test results are being fudged, medical staff gagged and death tolls deliberately under-counted as the coronavirus begins to tear through Uttar Pradesh, a state ruled by the man predicted to be prime minister Narendra Modi's successor.
Yogi Adityanath, chief minister of Uttar Pradesh, is accused of using authoritarian tactics to suppress reporting of the scale of medical shortages as the pandemic takes hold among the state's 240m inhabitants.
Uttar Pradesh, which is home to over 200 million people, also has strong symbolic importance to the ruling Bharatiya Janata Party as it contains some of the holiest sites in Hinduism, including Varanasi and Ayodhya.
An estimated 30 million people voted to elect local village leaders from 520,000 candidates in Uttar Pradesh on Thursday, with fears crowding at polling booths would worsen what has become India's fastest-growing state epidemic.
Uttar Pradesh is also predicted to overtake Maharashtra, the state home to Mumbai, for new daily cases by the end of April, according to an Indian government think tank. Uttar Pradesh, along with Bihar and Rajasthan, has seen the highest weekly growth in new cases.
One doctor, who works in the state's capital, Lucknow, estimated only one in every 20 Covid deaths were being officially recorded in the state.
“Definitely, deaths are being undercounted,” the doctor told the Telegraph. “It is huge. It is deliberate so as to show less number of deaths so that image of the government is protected.
"You go anywhere, any locality, people are cremating or burying their dead. Covid deaths happening at home are not counted at all.”
Testing labs had also been told to sit on positive results to keep official figures down, he alleged.
“Obviously, there is a fear among the doctors,” he said. “The government will terminate doctors if they talk about the crisis. And Yogi is just trying to downplay the havoc that is there in Uttar Pradesh.”
Mr Adityanath earlier this week triggered panic after saying police could arrest individuals and hospitals reporting a shortage of medical oxygen or beds.
Police in the state also this week prosecuted a man who had used Twitter to plead for oxygen for an elderly relative. Shashank Yadav was accused of making misleading statements, even though his appeal simply read: “Need oxygen cylinder, ASAP.”
Mr Adityanath has insisted there is no shortage of oxygen or beds in the state, but the state will enter a full lockdown from Friday.
Another doctor in the state said the government was trying to “hide the truth”.
“If the chief minister visits hospitals, he shall regret his comments that there is no shortage of oxygen,” said an officer in a private hospital in Lucknow, who wished to remain anonymous.
“He wants hospitals [to] hide the truth. He is least bothered about the people dying in hospitals and at homes,” he said.
Reports of crematoriums overwhelmed by bodies have become increasingly at odds with official death tolls in the state.
On Tuesday this week the local government reported 39 deaths in Lucknow, despite a single crematorium in the city's Bhainsakund district reporting 60 Covid-19 cremations.
Bodies are allegedly lying for days in overwhelmed hospitals and there are long queues outside crematoriums in the state's major cities of Varanasi, Allahabad, and Kanpur.
In Agra, in the same state, the authorities were forced to deny accusations they had taken an oxygen cylinder from an 85-year-old woman, who later died, to give to a well-connected patient.
Cities including Delhi and Mumbai have so far borne the brunt of the pandemic in India, but the spread into more rural Uttar Pradesh would make it more difficult to count deaths, said Bhramar Mukherjee, professor of public health and epidemiology at the University of Michigan.
“It is spreading now in rural areas and that is where India has the weakest infrastructure of reporting of deaths. In big metropolitan areas, people die in hospitals, but in rural areas they die outside of hospitals and the number of those deaths is much higher in somewhere like Uttar Pradesh."
The state is hugely important to the ruling BJP in the local elections.
“It is one of the most demographically and politically heavyweight states, which has a huge parliamentary representation. Whoever gains political weight in Uttar Pradesh has a lot of say in the central government and that is why it is so important for the BJP and other political parties," said Avinash Paliwal, Senior Lecturer in International Relations at SOAS University of London.
Nationwide, India reported nearly 380,000 new infections on Thursday, and some 3,645 new deaths.
As pressure on Mr Modi mounted, Arundhati Roy, the Man-Booker winning author, said his government had failed. “Perhaps 'failed' is an inaccurate word, because what we are witnessing is not criminal negligence, but an outright crime against humanity," she wrote in the Guardian.
Meanwhile, after a major backlash against vaccine shortages, the chief executive of the Serum Institute of India manufacturing doses has been put under security protection.
In the city of Nagpur in Maharashtra, an 85-year-old man died at home after giving up his hospital bed to a 40-year-old man with young children.
"I am 85 years old, have seen life, but if that woman's husband dies then the children will be orphaned. So, it's my duty to save him," said Narayan Dabhalkar, before he died.