Extract from ABC News
By South Asia correspondent James Oaten and Som Patidar in New Delhi
Every year, elders in India's rural towns and villages anticipate the arrival of what they call "viral fever".
The illness, which is considered mysterious and largely unavoidable, is often influenza. Annual flu jabs are rare in these parts.
But this year's viral fever was vastly different to previous infections.
The virus hit like a sledgehammer, rapidly tearing through entire communities where access to healthcare is poor at best.
In the village of Kuwankheda, in western Uttar Pradesh, around half the population of 3,500 were struck with illness, residents told the ABC.
It's likely to be COVID-19, but a chronic lack of testing capability means many cases are not officially detected and recorded.
The sheer scale of the spread of COVID-19 in India means many towns and villages that escaped the worst of the pandemic last year are now drowning in cases.
Rural areas are particularly vulnerable due to lack of healthcare, preparation, and awareness.
Buildings marked as healthcare clinics are often just shells without staff, while those that do have health workers are overworked, with limited resources.
Finding oxygen is near impossible.
'Who cares about the villages?'
It's a harsh reality Mr Sachaan knows too well. His 87-year-old mother-in-law died this week. COVID-19 is suspected to have been the cause.
"We do not have any oxygen support or healthcare facilities in our village," he said.
"We cannot flee from here, so we are fighting alone."
Of the 12 village elders who died within a fortnight, only a few were able to find treatment in a hospital and get a test, locals said.
"There are no COVID-19 testing or health facilities here," retired teacher Virendra Nath said.
"When there are so many problems in the cities, who cares about the villages?"
As a second wave peaks, experts are already fearing the third
India this week broke records, with more than 412,262 confirmed cases and 3,980 deaths in one day — figures which are believed to greatly underestimate the true scale of the problem.
Last week, the nation accounted for about half of the global cases and a quarter of all deaths related to the pandemic.
More infectious variants, including the so-called "double mutant" variant, are increasingly blamed for the ferocity of the second wave.
The sheer spread of the infection means a "third wave" is "inevitable", government scientific advisor K Vijay Raghavan has warned.
Public health and vaccine safety expert Jyoti Joshi, from the Centre for Disease Dynamics, Economics and Policy, said "chronic disinvestment" in regional healthcare meant villages were obvious blind spots in India's crisis.
"[Healthcare workers] are working in a black hole," Dr Joshi said.
"[They are] just aiming to save lives first and count the number of casualities in the wards later."
Rural patients gasping for air
A severe lack of oxygen has seen patients dying in multiple hospitals across the country.
The ABC is supporting an appeal by Australian NGOs to help families and communities affected by the COVID-19 outbreak in India. Click here to see how you can help.
A court in Uttar Pradesh ruled that the deaths of patients in hospitals due to a lack of oxygen was a "criminal act" that was "not less than genocide".
Infectious disease expert Abdul Ghafur said the states which invested most in healthcare, such as Kerala and Tamil Nadu in the south, were tending to fare better, despite also suffering problems.
"It's a message to everybody, everywhere, how important it is to invest in the public healthcare system," Dr Ghafur said.
"Our public spending on the healthcare system is 1.25 per cent of GDP. That's grossly inadequate."
With no real doctors, villagers turn to quack healers
While the pandemic has brought out the best in people, with countless volunteers helping those in desperate need find oxygen, drugs or hospital beds, it has also brought out some of the worst.
Black market operators across the country have been profiteering by selling oxygen cylinders at exorbitant prices.
In Delhi, three people were arrested for selling fire extinguishers as oxygen supplies.
Misinformation has also reared its head, with one viral message on WhatsApp spreading bogus information that menstruating women should not get vaccinated.
Other rumours have falsely claimed vaccines are not safe for people with conditions like diabetes.
Dr Joshi said regional communities were particularly vulnerable because of their isolation.
"This information is very hard to nip in the bud," she said.
A lack of education and access to healthcare means many rely on unproven remedies to "boost immunity" and cure COVID-19.
"Most of the villagers know them personally so they do have some confidence in them and rely on their treatment.
"It is risky but there is no other option available."
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