NEW DELHI (AP) – The number of confirmed coronavirus cases in India surpassed 5 million on Wednesday, maintaining the upward trend and testing the fragile healthcare system in tens of thousands of impoverished towns and villages.

The Ministry of Health reported 90,123 new infections in the last 24 hours, which raised the total number of confirmed infections in the country to 5,020,359, equivalent to 0.35% of its almost 1,400 million inhabitants. In addition, 1,290 more people lost their lives in that period due to the pandemic, for a total of 82,066, it added.

India is approaching 6.6 million infections in the United States, the country hardest hit by the coronavirus, and is expected to overtake it in a matter of weeks.

The country announced its daily record of cases, 97,570, on September 11, and has added more than a million patients so far this month.

Experts warn that the death rate could rise in the coming weeks with the easing of the restrictions, which will not apply in high-risk areas. But authorities ruled out a second nationwide quarantine, as the percentage of COVID-19 recovered exceeds 78%. Its death rate is 1.6%, a far cry from the 3% in the United States and Brazil, according to Johns Hopkins University.

The increase in infections in India was inevitable, said Dr. Gagandeep Kang, an infectious disease expert at Christian Medical College in the southern state of Vellore. But the nation still has the opportunity to limit cases through a strategy of testing and isolating the affected places, he said.

Most of the deaths are concentrated in the big cities: Mumbai, Delhi, Bengaluru, Chennai and Pune. But smaller urban centers like Nagpur or Jalgaon, in Mahrashtra, have also reported more than 1,000 deaths from the virus.

Health Secretary Rajesh Bhushan said Tuesday that just 6% of the country’s coronavirus patients needed oxygen – 0.31% required respirators; 2.17% were in the ICU with oxygen and 3.69% were hospitalized with oxygen.

The state of Maharashtra, with more than a million infections, continues to be the most affected, followed by Andhra Pradesh, Tamil Nadu, Karnataka and Uttar Pradesh. These regions accumulate more than 60% of the positives to the virus of the whole nation.

According to the Ministry of Health, 155 health workers, including 46 doctors, have died so far from COVID-19.

India’s scarce medical resources are poorly distributed across the country. About 600 million Indians live in rural areas, and with the virus spreading rapidly across the vast hinterlands, experts fear hospitals could be overwhelmed.

Authorities perform more than a million screening tests per day, exceeding the World Health Organization recommendation of 140 per million inhabitants. But most are antigen tests, which look for proteins present in the virus and are faster but less accurate than RT-PCR, the standard for confirming the presence of the virus by detecting its genetic code.

With the economy contracting 23.9% in the quarter between April and June and with millions of unemployed, the Indian government continues to relax the quarantines imposed at the end of March. A $ 266 billion stimulus package was announced in May, but consumption and production have not yet recovered.

A large number of offices, shops, businesses, liquor stores, bars and restaurants have reopened. National and international repatriation flights take place every day, as well as train journeys. Schools will reopen for some students next week.

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The Associated Press science journalist Aniruddha Ghosal contributed to this report.