COVID-19 infections and deaths are mounting with alarming speed in India with no end in sight to the crisis and a top expert warning that the coming weeks in the country of nearly 1.4 billion people will be “horrible”.

India’s official count of coronavirus cases has surpassed 20 million, nearly doubling in the past three months, while deaths officially have passed 220,000. On Tuesday, the health ministry reported 357,229 new cases in the past 24 hours and 3,449 deaths from COVID-19.

The country has witnessed scenes of people dying outside overwhelmed hospitals and funeral pyres lighting up the night sky.

India’s top health official, Rajesh Bhushan, refused to speculate last month as to why authorities were not better prepared. But the cost is clear: People are dying because of shortages of bottled oxygen and hospital beds or because they could not get a COVID-19 test.

Dr Ashish Jha, the dean of Brown University’s School of Public Health in the United States, said he is concerned that Indian policymakers he has been in contact with believe things will improve in the next few days.

“I have been … trying to say to them, ‘If everything goes very well, things will be horrible for the next several weeks. And it may be much longer,'” he said.

Jha said the focus needs to be on “classic” public health measures: area-specific shutdowns, more testing, universal mask-wearing and avoidance of large gatherings.

“That is what’s going to break the back of this surge,” he said.

Prime Minister Narendra Modi has faced criticism for his handling of the pandemic as India’s under-funded healthcare system struggles to cope with the surge, with hospitals running out of oxygen and beds.

The Delhi High Court said it will start punishing government officials if supplies of oxygen allocated to hospitals are not delivered. “Enough is enough,” it said.

Experts are also worried the prices being charged for COVID-19 vaccines will make it harder for the poor to get vaccinated. On Monday, opposition parties urged the government to make vaccinations free to all Indians.

India is vaccinating about 2.1 million people daily or approximately 0.15 percent of its population.

“This is not going to end very soon,” said Dr Ravi Gupta, a virus expert at the University of Cambridge in England. “And really … the soul of the country is at risk in a way.”