a leaked government document outlining how Uyghurs were tracked and chosen for detention.

The circumstances of Ms. Erkin’s death remain unclear.

Radio Free Asia, which cited a national security officer from Ms. Erkin’s hometown as saying she had died while in a detention center in the southern city of Kashgar. Mr. Ayup said he believed it was the same place where he himself had been beaten and sexually abused six years earlier.

Ms. Erkin’s family was given her body, Mr. Ayup said, but were told by security officials to not have guests at her funeral and to tell others she died at home.

In a statement to The New York Times, the Xinjiang government said that Ms. Erkin had returned from overseas in June 2019 to receive medical treatment. On Dec. 19, she died at a hospital in Kashgar of organ failure caused by severe anemia, according to the statement.

From the time she went to the hospital until her death, she had always been looked after by her uncle and younger brother, the government wrote.

Before she returned to China, Ms. Erkin seemed to be aware that her return could end tragically.

“We all leave alone, the only things that can accompany us are the Love of Allah and our smile,” she wrote in text messages to Mr. Ayup when he tried to dissuade her from going home.

“I am very scared,” she admitted. “I hope I would be killed with a single bullet.”

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Flood Deaths in China Show Road Risks From Climate Change

ZHENGZHOU, China — More than 200 cars were caught in a highway tunnel on Tuesday in central China when record-setting rainfall soaked the area. Torrents of water poured in the tunnel’s entrances, nearly filling it to the ceiling.

The death toll that day probably would have been higher had it not been for a semiretired special forces commando who swam back and forth among the bobbing, colliding vehicles to rescue drowning drivers as their cars filled with water and sank. The authorities are still draining the tunnel, and have said that at least four people died.

Initially, international attention to transportation safety risks from extreme weather focused on drownings in a subway tunnel that filled with water during the same cloudburst in Zhengzhou, in central China’s Henan Province. But the highway-tunnel flooding deaths highlight the risks that climate change can also pose to motorists, transportation safety experts said this weekend.

Indeed, the deaths show that road engineers, like subway-system designers, will need to cope with the more intense rainfalls associated with climate change, said Kara M. Kockelman, a transportation engineering professor at the University of Texas at Austin.

1993 during the Mississippi River floods in the Midwest to alleviate pressure on dams when the water behind them became dangerously high.

Only two months ago, the Henan Province government was promoting its “smart tunnel” investments in the same mile-long, four-lane highway tunnel that flooded on Tuesday. Sensors could be used to track and precisely locate any person or vehicle, and to closely monitor the tunnel’s water pumps. An artificial intelligence system could be used to instantly analyze problems and suggest solutions.

Highway tunnels, including Zhengzhou’s, are built with their own pumping systems. But extreme cloudbursts like the one last week, in which eight inches of rain fell in a single hour, pose formidable challenges for road designers.

To work, such pumping systems need to be able to move the water somewhere that is not underwater itself. Zhengzhou is nearly flat and slow to drain. The entire street at the south end of the tunnel filled with water several feet deep.

Dr. Kockelman said that any investigation of what went wrong in Zhengzhou would need to examine whether the exit point for the pumps had become submerged. That could cause the flow of water through the pumps to reverse direction and fill the tunnel.

Liu Chunge, an owner of a tiny grocery store that sits two stairs above the sidewalk next to the south end of the tunnel, said that the water in the streets rose fast. She was soon calf-deep inside her store.

The freezer from which she sells ice cream began to float, so she loaded beverage bottles onto it to force it back down to the floor.

“I’ve never experienced such a big flood,” said Ms. Liu, 50. “In previous floods, the water never rose above the two steps.”

Zhengzhou officials have held three news conferences since the tunnel floods, but they have yet to directly explain what went wrong.

Local authorities have struggled to remove water from the highway tunnel. On Friday afternoon, they were operating a pair of pumps nearly the size of commercial jet engines attached to bright red, fire engine-size suction trucks at the tunnel’s south end. But the muddy water was still deep enough in the tunnel that only the roof of a white car inside was visible.

Several workers maneuvered a large yellow tow truck to try to pull a mud-covered black minivan out of the tunnel’s exit. The minivan had its rear wheels on a nearly yard-high highway median, and its driver’s door hung open. Five other mud-soaked cars and vans lay in the water nearby, including a dark blue Ford sedan with a white car on its roof.

Many Zhengzhou residents watched and filmed the crews’ work on Friday afternoon, and were occasionally chased away by a few municipal police officers.

As for Mr. Yang, Caocao gave him a new, $25,000 electric minivan on Friday night.

Li You, Claire Fu and Liu Yi contributed research.

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Cable-Car Tragedy Shakes a Town Already Wounded by the Pandemic

STRESA, Italy — The sun shone brightly Sunday on Lago Maggiore, a spectacular alpine lake that traverses the Italian-Swiss border. Fabrizio Bertoletti, the owner of a small hotel with a restaurant perched atop Mottarone mountain, was feeling upbeat.

After months of off-and-on coronavirus restrictions, restaurants and hotels here were finally starting to open. Indoor dining is still banned but, he said, “it was a beautiful day and people weren’t going to complain even if they had to eat outside.”

On a terrace with breathtaking views of the lake and the mountains that cradle it, Mr. Bertoletti’s restaurant can seat about 70, and it was completely booked. The hotel and restaurant, aptly named “Eden,” sit just a few feet from the upper station of a cable car that links the summit to the lakeside town of Stresa, a popular vacation destination almost 5,000 feet below.

“We were feeling relieved, there was a sense of re-beginning. And then … ” Mr. Bertoletti’s voice trailed off.

a cable car carrying 15 passengers plunged to the ground. All but one died. The sole survivor, 5-year-old Eitan Biran, lost both of his parents, his 2-year-old brother and two great-grandparents.

“All the seasons of life were in that cabin,” said the Reverend Gian Luca Villa, Stresa’s parish priest.

It is an incomprehensible loss for the victims’ families, but people here cannot help noting that it is also another in a series of blows, stretching back more than a year, for a tourism-dependent area that has suffered greatly from the pandemic.

Borromeo family, and an annual music festival in the fall.

The lake, more than 30 miles long, lies on the boundary between the regions of Piedmont and Lombardy, making it a favorite getaway for people from Milan and Turin, and it also draws many foreigners. The tourist season normally begins at Easter and lasts well into autumn, luring visitors with mild temperatures and colors of leaf-turning brilliance.

But last year, in March and April, Lombardy became the first part of Europe to be hit in full force by the new virus, which killed tens of thousands of people here.

The pandemic put a halt to most vacation plans, and several hotels around the lake never opened their doors. Proximity to Switzerland, which had less stringent coronavirus rules, penalized towns on the Italian side, said Gian Maria Vincenzi, the president of the local hoteliers’ association.

The cable car accident “is a tragedy within the tragedy of Covid, which nearly wiped out work,” he said.

Antonio Zacchera, whose family owns four hotels on Lago Maggiore, said that last year, two remained shuttered.

“About a quarter of our clients are Americans, and the fact that we were dependent on foreigners used to be an advantage,” he said. But with pandemic-induced travel restrictions, “it was a disadvantage this round.”

Like other hoteliers in the area, Mr. Zacchera made rooms available to the families of the cable-car victims. “Our first thoughts are with them,” he said.

The cable car was popular with tourists, but also with locals, who would ride to the top to get to the ski schools in winter, or just for the view. “You never thought anything bad could happen, until it does, and it’s a disaster,” said Alberto De Martini, the owner of the Enoteca Da Giannino in Stresa’s central square, as he sanitized his restaurant’s tables and chairs.

On Monday, the city commemorated the dead, ringing bells and shuttering stores for 14 minutes, one for each victim. Massimo Colla, the owner of the wine bar and bistro Al Buscion, said he kept it closed for the entire day. “When tragedy happens close to home, you feel it intensely,” he said. “It’s going to take time for the city to get over this.”

Father Villa, the priest, said that he had gathered the faithful in prayer soon after the crash and held other services on Monday. With the city, he has planned a commemorative mass on Wednesday, for the emergency workers and others who combed the mountainside searching, mostly in vain, for survivors among the dead. He said that 14 candles would be lit during the service and the victims would be named and remembered, one by one.

Marcella Severino, Stresa’s mayor of just eight months, said she was looking for a permanent way to commemorate the victims. “May 23 will be our September 11,” she said in an emotional interview in her office.

“Though citizens were in shock,” she said that locals had stepped up as best they could. Civil protection volunteers immediately arrived on the scene, along with the emergency workers. Hotel owners took in victims’ families, taxi drivers transported people without charge and local health authorities had provided psychologists.

“People come to Stresa because they feel safe,” Ms. Severino said — the town is small and tight-knit, with little crime. “Obviously, for the families of the victims, Stresa will become a nefarious name,” she said. “But I hope that they will remember how the city tried to be close to them.”

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Italian Cable Car Tragedy Shakes a Town Already Wounded by the Pandemic

STRESA, Italy — The sun shone brightly Sunday on Lago Maggiore, a spectacular alpine lake that traverses the Italian-Swiss border. Fabrizio Bertoletti, the owner of a small hotel with a restaurant perched atop Mottarone mountain, was feeling upbeat.

After months of off-and-on coronavirus restrictions, restaurants and hotels here were finally starting to open. Indoor dining is still banned but, he said, “it was a beautiful day and people weren’t going to complain even if they had to eat outside.”

On a terrace with breathtaking views of the lake and the mountains that cradle it, Mr. Bertoletti’s restaurant can seat about 70, and it was completely booked. The hotel and restaurant, aptly named “Eden,” sit just a few feet from the upper station of a cable car that links the summit to the lakeside town of Stresa, a popular vacation destination almost 5,000 feet below.

“We were feeling relieved, there was a sense of re-beginning. And then … ” Mr. Bertoletti’s voice trailed off.

a cable car carrying 15 passengers plunged to the ground. All but one died. The sole survivor, 5-year-old Eitan Biran, lost both of his parents, his 2-year-old brother and two great-grandparents.

“All the seasons of life were in that cabin,” said the Reverend Gian Luca Villa, Stresa’s parish priest.

It is an incomprehensible loss for the victims’ families, but people here cannot help noting that it is also another in a series of blows, stretching back more than a year, for a tourism-dependent area that has suffered greatly from the pandemic.

Borromeo family, and an annual music festival in the fall.

The lake, more than 30 miles long, lies on the boundary between the regions of Piedmont and Lombardy, making it a favorite getaway for people from Milan and Turin, and it also draws many foreigners. The tourist season normally begins at Easter and lasts well into autumn, luring visitors with mild temperatures and colors of leaf-turning brilliance.

But last year, in March and April, Lombardy became the first part of Europe to be hit in full force by the new virus, which killed tens of thousands of people here.

The pandemic put a halt to most vacation plans, and several hotels around the lake never opened their doors. Proximity to Switzerland, which had less stringent coronavirus rules, penalized towns on the Italian side, said Gian Maria Vincenzi, the president of the local hoteliers’ association.

The cable car accident “is a tragedy within the tragedy of Covid, which nearly wiped out work,” he said.

Antonio Zacchera, whose family owns four hotels on Lago Maggiore, said that last year, two remained shuttered.

“About a quarter of our clients are Americans, and the fact that we were dependent on foreigners used to be an advantage,” he said. But with pandemic-induced travel restrictions, “it was a disadvantage this round.”

Like other hoteliers in the area, Mr. Zacchera made rooms available to the families of the cable-car victims. “Our first thoughts are with them,” he said.

The cable car was popular with tourists, but also with locals, who would ride to the top to get to the ski schools in winter, or just for the view. “You never thought anything bad could happen, until it does, and it’s a disaster,” said Alberto De Martini, the owner of the Enoteca Da Giannino in Stresa’s central square, as he sanitized his restaurant’s tables and chairs.

On Monday, the city commemorated the dead, ringing bells and shuttering stores for 14 minutes, one for each victim. Massimo Colla, the owner of the wine bar and bistro Al Buscion, said he kept it closed for the entire day. “When tragedy happens close to home, you feel it intensely,” he said. “It’s going to take time for the city to get over this.”

Father Villa, the priest, said that he had gathered the faithful in prayer soon after the crash and held other services on Monday. With the city, he has planned a commemorative mass on Wednesday, for the emergency workers and others who combed the mountainside searching, mostly in vain, for survivors among the dead. He said that 14 candles would be lit during the service and the victims would be named and remembered, one by one.

Marcella Severino, Stresa’s mayor of just eight months, said she was looking for a permanent way to commemorate the victims. “May 23 will be our September 11,” she said in an emotional interview in her office.

“Though citizens were in shock,” she said that locals had stepped up as best they could. Civil protection volunteers immediately arrived on the scene, along with the emergency workers. Hotel owners took in victims’ families, taxi drivers transported people without charge and local health authorities had provided psychologists.

“People come to Stresa because they feel safe,” Ms. Severino said — the town is small and tight-knit, with little crime. “Obviously, for the families of the victims, Stresa will become a nefarious name,” she said. “But I hope that they will remember how the city tried to be close to them.”

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William Shakespeare, Early U.K. Vaccine Recipient, Dies of Unrelated Illness

William Shakespeare, the man with a famous name who inspired headline writers across Britain last year when he became the second person in the country to receive a coronavirus vaccine, has died after suffering a stroke, his family said in a statement. He was 81.

Since Mr. Shakespeare was vaccinated on Dec. 8 at University Hospital, Coventry, in central England, 57 percent of Britain’s population has received at least one dose of a coronavirus vaccine, one of the highest vaccination rates in the world.

On Tuesday, people older than 30 in Britain became eligible to receive a vaccine.

In a statement released through the hospital where Mr. Shakespeare was vaccinated, his wife of 53 years, Joy, said he had been grateful for becoming one of the first people to be vaccinated against the coronavirus.

“It was something he was hugely proud of,” she said. “He loved seeing the media coverage and the positive difference he was able to make to the lives of so many.”

Margaret Keenan, then 90, became the first person in Britain to be vaccinated and the first in the world to receive a clinically authorized, fully tested coronavirus vaccine.

Their vaccinations brought a sense of optimism to Britain: “If I can have it at 90 then you can have it, too!” Ms. Keenan said at the time.

At least 127,000 people have died of the coronavirus in Britain, according to a New York Times database, the world’s fifth-highest known death toll.

used as a vaccination center this spring.

The family of the modern Mr. Shakespeare said he would be remembered for much more than sharing a name with one of England’s most famous historical figures. He was an amateur photographer and jazz aficionado, a parish councilor and an official at local schools for more than two decades.

A local councilor and friend of Mr. Shakespeare’s, Jayne Innes, said on Twitter, “Bill will be remembered for many things, including a taste for mischief.”

“Bill loved meeting people and helping them in any way possible,” Ms. Shakespeare said. “Most of all he was a wonderful husband, father and grandfather.”

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What It’s Like to Be in India’s Covid-19 Crisis

Infections are soaring. So are deaths. Whole cities are under lockdown. And the government seems powerless to help.

India is in the grip of a coronavirus crisis. Experts agree that the spread is probably even worse than the official statistics suggest. In many parts of the country, hospital beds, supplemental oxygen and other vital supplies are running short.

As Western countries roll out mass vaccination campaigns, only about 3 percent of India’s population is fully inoculated. Though conditions are slowly improving in New Delhi and Mumbai, the virus appears to be spreading largely unchecked through the rest of the country.

The New York Times asked readers in India to describe their lives in the midst of the pandemic with words and photos. They wrote about fear and loss, anxiety and boredom. Some wrote about their anger at the stumbling response by India’s government under Prime Minister Narendra Modi. But they also wrote about family and friends who have helped them cope, and efforts they have made to help neighbors and strangers alike.

“A lot of people my age have been helping people find resources like hospital beds, oxygen cylinders, medication, etc., through social media by verifying whatever leads are floating around on the internet and sending them to whoever needs them. I’ve been working with one such group. I realize that it is a necessary job in these times, but it’s also incredibly draining. It is the sign of a completely broken system that teenagers have to band together and work themselves to exhaustion trying to answer all these desperate pleas all over Twitter. And it’s getting harder to do by the day as things worsen because resources get exhausted very quickly. Most of the time we just end up calling a lot of numbers and get no response, and when we do it’s usually people saying there’s nothing they can do for us. It’s heartbreaking when people around are just suffering and dying and there’s so little you can do to help. We’re all terrified and burnt out and this is a very unsustainable system of getting people access to health care. You can’t leave it to the citizens to bear the brunt of a health care system that’s crumbling.” — Arunima Tiwari, New Delhi

“I miss spontaneity. I hate that I now have to plan everything out and even when I do, the plans feel like they can just disappear. I’m trying not to focus on what could have been. Instead, I’m determined to stay focused on what I can do. I have reactivated my long-dormant social media accounts to amplify what I can, and I now volunteer at a response center that offers assistance to Covid-positive patients. I don’t have a choice but to help because elected authorities have made it loud and clear that they aren’t going to.” — Anindita Nayak, Bangalore

“Life in Delhi at the moment feels like you’re having an out-of-body experience. It’s hard to imagine this is actually real and happening. Every social media feed, every WhatsApp group is full of requests from people looking for oxygen, hospital beds, critical lifesaving medicines. The worst part: There’s almost nothing you can do to help anyone immediately. It takes hours of verifying, calling, begging for help to actually find some solutions, if that even happens. By that time, you feel almost too scared to call back and find out if help is still needed for fear of hearing the inevitable — that the person has died without getting adequate care. Indians are dying not because of Covid but because they’re not receiving treatment and care.” — Shweta Bahri, Delhi

“Both my parents got Covid. I lost my mother yesterday. Father is on ventilator support. The reason I lost my mother is because she didn’t get treatment. I live in Bangalore, and there is no way you can get a bed in any hospital. The help line numbers never work. If they do, then they just take details or transfer your call with no help. Being completely helpless, I took my mother to a hospital that I’m not sure is even legitimate. They just wanted money from me. They did not have trained staff. Oxygen was always in short supply. I felt helpless that I could not take her anywhere. I knew that if I kept her there she would not survive. I had to bring my father there, and his condition deteriorated due to lack of oxygen. I managed to take him to a different hospital, but it was too late. Now he is on a ventilator.” — Paresh Patil, Bangalore

Rahul Patil died on May 17, Paresh Patil said, after this submission was received.

“It has been challenging, but I maintain a mood log throughout the day and encourage my family to do the same. I also post a mood meter on social media so people can reply with how they are feeling using an emoji and we can talk about it. I also help my parents with their medicines, food, oximeter and temperature readings. Since both have different sets of medications, it’s really important we keep a record of the medicines along with a chart of the vitals. My extended family has been very helpful during this time. They remain connected through calls and texts and remind us not to lose faith.” — Rachita Ramya, Delhi

“Since I have been going to work every day, I have not really experienced the lockdown in terms of staying inside. But it has been a very stressful year when it comes to working. When the lockdown lifted last year, people immediately rushed into the bank where I work. It has been very difficult and almost impossible here, in a rural part of India, to make people understand the importance of masks and social distancing.”

“The government has done little to make people aware of the situation. Also, the lockdowns initially were more of a television ratings stunt rather than a precautionary measure. A lot of workers in banks have died on duty, and some have been denied leave even when they were sick. The precautionary measures on paper are nowhere close to reality. In the past few months, we played dumb to something which we clearly saw coming.” — Shweta Beniwal, Kolar

“As I type this out, four doors lay ajar or wide open in my home. Three of us have now developed Covid symptoms. My old dad has been taking care of cooking, cleaning, medicating and sanitizing all day. My dad sleeps in fits through the day and night, interrupted by calls for food, tea, hoarse coughing, and groans of pain and frustration. How do I cope? Each night, as a 21-year-old, lying wide-awake — the weather is unbearably hot, and my fever rarely subsides — I make up positive scenarios in my mind. Getting a job and earning enough to secure my family’s well-being in this cruel dog-eat-dog world. Being more bold, less hesitant, in fighting people who didn’t see the warning signs of a corrupt, inept distribution of resources. Slapping each of those complacent idiots who voted into power a ruthless demagogue who wins elections by stoking fear and resentment but is a dud when it comes to long-term policymaking, tough decision-making and leadership.” — Harmandeep Khera, Chandigarh

Since sending his submission, Mr. Khera said, he and his family have recovered.

“Many friends have been infected, and we call each other every day to share a joke and to stay positive and make plans to meet in the future. Still frightening, but we are coping. I also try to help people overcome disinformation and keep telling people that most of us who are infected will recover. I ask people to avoid panic buying and seeking unvalidated cures. Since last year I have exercised regularly and continue to do so even while infected and isolated. I am also a pistol shooter for my state of Maharashtra, so mental conditioning has been an important part of my training. I meditate for 10 minutes each day to stay positive.” — Raj Khalid, Mumbai

“It is very frightening. Half of the people I know have been tested positive or have been previously infected. We haven’t stepped out of the house for the past two weeks, and it has taken a greater toll on our physical and mental health. The only rule is to avoid contact. If you want to keep your close ones safe, then you need to keep them away for a while. My mother is an essential worker, and I have seen her doing grocery shopping for many needy people who are quarantined. It’s something I’m proud of. In times like these, we need to hold on to humanity and have faith in whatever you believe in. Being an atheist, I have faith in science and myself.” — Akash Helia, Mumbai

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Poets in Myanmar Are Killed After the Coup

On March 4, his sister received a police summons to the Monywa mortuary. She identified her brother’s body, Ms. Khin Sandar Win said. A bullet hole punctured his left temple. A long slash ran down his torso.

The family wondered whether the gash signaled that his internal organs had been removed, a desecration increasingly found among those killed by the military in Myanmar. But Mr. Chan Thar Swe was cremated before his relatives could find out more.

His mother now spends her days looking at photographs of him, her oldest child, on Facebook. Along with his ashes, it is all she has of him.

“My brother did not support us financially because he was a poet, but he protected us whenever we needed,” Ms. Khin Sandar Win said.

At Mr. Chan Thar Swe’s funeral, another poet, Ko Khet Thi, recited a poem he had written for those killed by the security forces, many with a single bullet to the head and some when they were not even protesting.

They began to burn the poets

When the smoke of burned books could

No longer choke the lungs heavy with dissent.

Weeks after the funeral, Mr. Khet Thi, a onetime engineer, was hauled into detention and later turned up dead, according to his family. His corpse also had an unexplained incision down his torso, the family said.

“I am also afraid that I will get arrested and killed, but I will keep fighting,” said Ko Kyi Zaw Aye, yet another poet from Monywa who was close to both men.

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Delhi Considers Lifting Covid Limits, Despite Vaccine Shortage

NEW DELHI — Delhi is considering relaxing its Covid-19 restrictions six weeks after a devastating coronavirus surge rocked the Indian capital, with a pledge to ramp up vaccinations to protect the city’s more than 20 million people from another wave.

But the vow came after a weekend in which city officials were forced to close vaccination centers for lack of supply, a problem plaguing the entire country as the coronavirus continues to spread. India does not have the vaccine manufacturing capacity to inoculate a big portion of its population anytime soon, while the prospect of importing new supplies from abroad has bogged down amid squabbling between the central and local governments.

As a result, any decision to lift coronavirus restrictions could be a mistake if the government allows large maskless gatherings to take place as it did before.

“The only answer is vaccination,” said Dr. Anand Krishnan, a professor of community medicine at the All India Institute of Medical Sciences in New Delhi.

health ministry reported. While India’s total of 26.8 million infections still lags behind the United States, with more than 33 million, the U.S. government has rolled out a wide vaccination campaign that has sent new infections plummeting. Only about 3 percent of India’s population has received two doses.

Experts also widely caution that India’s official numbers severely undercount new infections and deaths because of a lack of testing and other resources in a vast, developing country of 1.4 billion people.

Officials across India face pressure to reopen their local economies. Factory workers and members of the country’s vast, informal work force of shopkeepers and countless others cannot work from home and are anxious to restart their lives.

local news media on Sunday that Moderna, the American vaccine maker, had rejected its purchase request, saying the company would sell only to national governments. The company did not immediately respond to an emailed request for comment.

State governments — particularly those controlled by political factions opposed to Mr. Modi’s Bharatiya Janata Party — have been clashing with the Modi administration over vaccines and other issues, saying the central government had left them to fend for themselves.

advance purchase agreements to buy vaccines in bulk. Experts have criticized Mr. Modi and his government for the delays.

Dr. Gagandeep Kang, one of the country’s top virologists, said in a video interview on Sunday that the country was “late to the table” in buying vaccines from the international market.

NDTV.

Instead of competing with the rest of the world, Dr. Kang suggested that the country should invest in ramping up production of other potential vaccine candidates from Indian manufacturers that are expected to have their doses ready by the end of the year.

“I think we’ll get more doses that way,” she said.

Emily Schmall contributed reporting.

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How India’s Kerala Has Battled Coronavirus

When India’s second coronavirus wave slammed the country last month, leaving many cities without enough doctors, nurses, hospital beds or lifesaving oxygen to cope, Sajeev V.B. got the help he needed.

Local health workers quarantined Mr. Sajeev, a 52-year-old mechanic, at home and connected him with a doctor over the phone. When he grew sicker, they mustered an ambulance that took him to a public hospital with an available bed. Oxygen was plentiful. He left 12 days later and was not billed for his treatment.

“I have no clue how the system works,” Mr. Sajeev said. “All that I did was to inform my local health worker when I tested positive. They took over everything from that point.”

has failed, in many ways, to provide relief for victims of the world’s worst coronavirus outbreak.

online networks, charities and volunteers has emerged in India to fill the gaps left by the stumbling response of the central government and many states. Patients around India have died for lack of oxygen in hospitals where beds filled up quickly.

Deaths are rising. Workers face long hours and tough conditions. The situation could still worsen as the outbreak spreads.

On paper, Kerala’s death rate, at less than 0.4 percent, is one of India’s lowest. But even local officials acknowledge that the government’s data is lacking. Dr. Arun N.M., a physician who monitors the numbers, estimates that Kerala is catching only one in five deaths.

A relatively prosperous state of 35 million, Kerala presents particular challenges. Over 6 percent of its population works abroad, mostly in the Middle East. Extensive travel forces local officials to carefully track people’s whereabouts when a disease breaks out.

tackling a 2018 outbreak of the Nipah virus, a rare and dangerous disease.

As borders closed last year and migrant workers came home, the state’s disaster management team swung into action. Returning passengers were sent into home quarantine. If a person tested positive, local officials traced their contacts. Kerala’s testing rate has been consistently above India’s average, according to health data.

Experts say much of the credit for the system lies with K.K. Shailaja, a 64-year-old former schoolteacher who until this week was Kerala’s health minister. Her role in fighting the Nipah virus inspired a character in a 2019 movie.

drove India into recession. This year, Mr. Modi has resisted a nationwide lockdown, leaving local governments to take their own steps.

India’s states are also competing against each other for oxygen, medicine and vaccines.

“There has been a tendency to centralize decisions when things seemed under control and to deflect responsibility towards the states when things were not,” said Gilles Verniers, a professor of political science at Ashoka University.

has worsened the country’s outbreak, though they have been hindered by a lack of data. Kerala has used gene sequencing since November to track variants, helping to drive policy decisions, said Dr. Vinod Scaria, a scientist at the CSIR Institute of Genomics and Integrative Biology in New Delhi.

“It’s the only state that has not given up at any point in time,” Dr. Scaria said, adding that “they’re eager to use evidence to drive policies.”

A political shuffle has led some experts to wonder whether Kerala can keep its gains. This past week the Communist Party of India, which controls the state government, excluded Ms. Shailaja from its cabinet. The party said it wanted to give young leaders a chance, but observers wondered whether Ms. Shailaja had grown too popular. She didn’t respond to requests for comment.

“Even the best-performing governments,” Professor Verniers of Ashoka University said, “are not immune from shooting themselves in the foot due to misguided political calculations.”

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How India’s Kerala Has Battled Covid-19

When India’s second coronavirus wave slammed the country last month, leaving many cities without enough doctors, nurses, hospital beds or lifesaving oxygen to cope, Sajeev V.B. got the help he needed.

Local health workers quarantined Mr. Sajeev, a 52-year-old mechanic, at home and connected him with a doctor over the phone. When he grew sicker, they mustered an ambulance that took him to a public hospital with an available bed. Oxygen was plentiful. He left 12 days later and was not billed for his treatment.

“I have no clue how the system works,” Mr. Sajeev said. “All that I did was to inform my local health worker when I tested positive. They took over everything from that point.”

has failed, in many ways, to provide relief for victims of the world’s worst coronavirus outbreak.

online networks, charities and volunteers has emerged in India to fill the gaps left by the stumbling response of the central government and many states. Patients around India have died for lack of oxygen in hospitals where beds filled up quickly.

Deaths are rising. Workers face long hours and tough conditions. The situation could still worsen as the outbreak spreads.

On paper, Kerala’s death rate, at less than 0.4 percent, is one of India’s lowest. But even local officials acknowledge that the government’s data is lacking. Dr. Arun N.M., a physician who monitors the numbers, estimates that Kerala is catching only one in five deaths.

A relatively prosperous state of 35 million, Kerala presents particular challenges. Over 6 percent of its population works abroad, mostly in the Middle East. Extensive travel forces local officials to carefully track people’s whereabouts when a disease breaks out.

tackling a 2018 outbreak of the Nipah virus, a rare and dangerous disease.

As borders closed last year and migrant workers came home, the state’s disaster management team swung into action. Returning passengers were sent into home quarantine. If a person tested positive, local officials traced their contacts. Kerala’s testing rate has been consistently above India’s average, according to health data.

Experts say much of the credit for the system lies with K.K. Shailaja, a 64-year-old former schoolteacher who until this week was Kerala’s health minister. Her role in fighting the Nipah virus inspired a character in a 2019 movie.

drove India into recession. This year, Mr. Modi has resisted a nationwide lockdown, leaving local governments to take their own steps.

India’s states are also competing against each other for oxygen, medicine and vaccines.

“There has been a tendency to centralize decisions when things seemed under control and to deflect responsibility towards the states when things were not,” said Gilles Vernier, a professor of political science at Ashoka University.

has worsened the country’s outbreak, though they have been hindered by a lack of data. Kerala has used gene sequencing since November to track variants, helping to drive policy decisions, said Dr. Vinod Scaria, a scientist at the CSIR Institute of Genomics and Integrative Biology in New Delhi.

“It’s the only state that has not given up at any point in time,” Dr. Scaria said, adding that “they’re eager to use evidence to drive policies.”

A political shuffle has led some experts to wonder whether Kerala can keep its gains. Earlier this week, the Communist Party of India, which controls the state government, excluded Ms. Shailaja from its cabinet. The party said it wanted to give young leaders a chance, but observers wondered whether Ms. Shailaja had grown too popular. She didn’t respond to requests for comment.

“Even the best-performing governments,” Professor Vernier of Ashoka University said, “are not immune from shooting themselves in the foot due to misguided political calculations.”

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