Russia for the first time reported more than 20,000 COVID-19 cases in the last day as a surge in some regions is overwhelming local hospitals’ ability to care for patients.

There were 20,582 new coronavirus infections in the last day, with two-thirds of them outside of Moscow, the government’s virus response center said Friday. Russia has reported 1,733,440 total cases, the fourth-most globally.

“The trend is alarming,” Kremlin spokesman Dmitry Peskov said on a conference call Friday. “Additional measures are being taken” to limit the spread, but it’s “early” to discuss imposing a broad lockdown, he added.

Moscow Mayor Sergei Sobyanin Thursday said infection rates and hospitalizations in the capital resumed their upward trend early this week and extended an order to keep older schoolchildren at home for another two weeks.

“We’re not far from the peak and then there will be a plateau,” said virus specialist Anatoly Altshtein, according to state-run RIA Novosti. “I fear the plateau will last a long time and relief will come only in the second half of the spring.”

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The disease’s spread in regions beyond Moscow and St. Petersburg has highlighted the problems plaguing Russia’s underfunded health-care system, with many areas struggling to handle the influx of sick people. The surge comes as federal authorities resist wider lockdowns, even as European countries from the U.K. to Greece have tightened restrictions this week.

Health authorities announced an investigation last month of the deaths of 13 patients in a single Rostov-on-Don hospital due to a lack of oxygen, while social media posts from clinics around the country show the ill crowded into corridors due to a lack of facilities.

More than 57,000 people have died with COVID-19, according to Federal Statistics Service data covering April-August, combined with virus-response center figures for the period since then.

Deputy Prime Minister Tatyana Golikova said Oct. 28 the situation was “critical” in 16 regions, with over 90% of beds devoted to COVID-19 occupied. That’s even after authorities set up more than 25% more emergency places in hospitals for virus patients than during the spring peak.

“We will continue to help regions that don’t have capacity on their own, sending teams of doctors to help local medics and deploying additional beds,” Prime Minister Mikhail Mishustin said Monday. “But it is important that the regions do not cover up the problems.”

Officials said some regional governments had been slow to enforce measures limiting large gatherings of people and mandating residents wear masks.

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Even as colder weather pushes more people indoors, the Kremlin has resisted new restrictions to combat the epidemic’s second wave in hopes of reducing the economic fallout from the pandemic. Instead, it issued a nationwide order last week to wear masks in public.

The authorities are placing their hopes on the rollout of a handful of vaccines — still in the testing phase — to stem the tide of infections. Moscow will begin offering free public vaccinations in late November or early December, Mayor Sobyanin said Nov. 1, though officials have warned that ramping up production is proving difficult.

However, getting people to agree to the inoculations, none of which have completed Phase 3 testing to establish their safety and effectiveness, may be difficult. An October poll by the Levada Center found 59% of Russians would not take a free, voluntary COVID-19 vaccine.

The poll of 1,601 Russians showed a growing number of people expect to get sick and that 61% doubted official statistics on the number of ill.