Russia’s coronavirus outbreak is getting bad. Putin says the worst is yet to come.

The crisis continues to be a massive challenge for the Russian dictator.

Russia’s much-feared coronavirus crisis is here — and it doesn’t look like it’s slowing down anytime soon.

Russia was always going to struggle if a large outbreak occurred in the country, and experts predicted one almost certainly would due to the country’s proximity to China and tightly packed cities, including the capital, Moscow.

Plus, hospitals in urban areas lack reliable medical equipment and staff to operate them, to say nothing of the state of medical facilities in rural areas.

But few expected it to be this bad. As of April 28, Russia reported nearly 100,000 confirmed coronavirus cases and nearly 1,000 deaths. Those numbers make Russia the eighth-hardest-hit country in the world.

Russian President Vladimir Putin on Tuesday admitted that the country had a shortage of critical personal protective equipment for healthcare workers, and warned that the worst the pandemic is yet to come.

“Ahead of us is a new stage, perhaps the most intense stage of the fight against the epidemic,” he said in a national address, in which he also announced an extension of his nation’s lockdown until May 11. “The risks of getting infected are at the highest level, and the threat, the mortal danger of the virus persists.”

“Russia has managed to slow down the spread of the epidemic, but we haven’t passed the peak yet,” Putin continued.

His pessimism is warranted. Hospitals have become overrun with patients, leaving ambulances stuck idling in long lines outside hospitals just to deliver sick patients. At least one driver had to wait about 15 hours. Moscow might run out of intensive care unit beds before the end of this week. And nurses have quit en masse to protest poor working conditions and low pay.

Millions of Russians could lose their jobs this year due to the lockdown and oil revenues, which make up a significant portion of Russia’s economy, have dropped sharply as people around the world have stopped traveling and business have shuttered due to the coronavirus.

As if that weren’t bad enough, a top Russian nuclear official said Tuesday that the virus is threatening the safety of three “nuclear towns” — places where nuclear research is conducted in Russia, including the birthplace of the Soviet atomic bomb — by getting top scientists sick.

This is perhaps the biggest test has Putin faced during his 20 years in power. He markets himself as Russia’s hero, the only man who can restore the former Soviet Union’s greatness and bring stability to his country. Anything that messes with that image — such as a nationwide health crisis — ruins the myth he and his allies have cultivated for decades.

The problem for him, and the millions of Russians counting on his leadership, is that when it comes to fighting the coronavirus, macho posturing and disinformation just don’t cut it.

Russia’s health care system is quickly reaching capacity, if it hasn’t already

Earlier this month, Michael Favorov, who led the US Centers for Disease Control and Prevention’s Eastern European and Central Asian programs, told me that Russia is “probably in the early stage of the same epidemic which is going on in the United States now.”

“They are facing significant increases of cases within the next month” in the capital and beyond, “and a significant increase in the number of deaths.”

Favorov’s prediction seems to have come true. Just look at the chart below, which I made using coronavirus statistics from the Our World in Data website. What it shows is that after a late start, Russia’s daily confirmed cases (in purple) have steadily risen over the past month, more so than in previous European epicenters like Spain and Italy.

Our World in Data

And those growing numbers are starting to overwhelm Russia’s health care system.

A viral video circulating throughout Russia, filmed by an ambulance driver who says he waited nine hours to drop off a patient, shows a long line of ambulances waiting silently to get into a hospital just outside Moscow.

Yelena Alikhashkina, a patient who feared she had the coronavirus, told Radio Free Europe/Radio Liberty two weeks ago about her experience.

“I waited 3.5 hours for the ambulance,” she said, and it didn’t get much better after that. After she got in the ambulance, she said, it took 40 minutes before anybody answered the hotline to tell the ambulance where to take her. And when she finally arrived at the designated hospital, “there were 30 ambulances already in the line.”

Judy Twigg, an expert on Russia’s health care system at Virginia Commonwealth University, told me the long lines could be a function of Russia’s policy to have some hospitals treat only coronavirus patients while others handle only non-infected clients. While that may make treatment inside the coronavirus facility more efficient, it does limit the amount of space available to those suffering from the disease.

Dr. Vasiliy Vlassov, an epidemiologist at the Higher School of Economics in Moscow, told me that the “government continues to open more and more hospitals for Covid-19 patients, and they are filled quickly.” Thus, it seems the amount of patients continues to reach the country’s health care capacity.

But the situation inside Russia’s coronavirus hospitals isn’t great, either.

Experts say a lot of the equipment Russian hospitals have, including ventilators, break down with alarming frequency. Russia is having more produced, but it’s unclear if those who need them will have them in time, especially as the rich hoard them.

Further, Russia generally is short of the equipment that goes with ventilators, like oxygen and anesthetic sedatives. And the country appears to be short of well-trained 24/7 intensive care nurses needed to care for patients on ventilators. Putin himself acknowledged on Tuesday that there is a shortage of protective equipment for health care workers.

Even if medical facilities had all the necessary equipment, it doesn’t appear they would have the requisite space for patients.

The hospital Alikhashkina visited, for example, stopped admitting new patients on April 13 due to overcrowding. That was bound to happen, as a 2017 study from the Moscow-based Center for Economic and Political Reforms found the number of hospitals halved in Russia between 2000 — Putin’s first year in power — and 2015.

If Russia continues to have around 6,000 confirmed coronavirus cases per day, as it has for about the last 10 days, Twigg said hospitals in Moscow and St. Petersburg “will get overwhelmed soon, as it looks like they’re already at capacity.”

Physicians like Irina Sheikina from the capital’s Hospital No. 15 agree. “There are already nearly 1,500 patients, all with pneumonia,” she told the same outlet. “There are not enough beds. They put patients wherever there is free space.”

The lack of beds is a widespread problem.

Earlier this month, experts told me the entire country had about 70,000 hospital beds. That amount clearly wasn’t enough to handle the quick spike in Russia’s coronavirus cases. Now, hospitals in Moscow and elsewhere in the country are desperately seeking extra beds wherever they can. As they struggle to do so, the hope is a makeshift hospital currently under construction outside Moscow might help with the overflow by taking about 500 more patients.

But some medical professionals believe conditions are so bad that it’s no longer worth serving in Russia’s health care system.

Over a dozen members of the nursing staff from Kommunarka hospital, the top coronavirus facility in Moscow, abruptly quit together on Monday because they didn’t have enough protective gear, food to eat, or some of the $132 million in bonuses Putin promised the nation’s physicians.

A video from the Moscow Times shows one of the nurses explaining why she left the hospital. “I worked for two days straight, sometimes three,” the unnamed medical professional said. “They stopped feeding us. They started handing out unsanitary [used] equipment to us.”

“No one paid us for extra shifts,” she continued. “I want people to listen to us finally, and I want us to be paid the money Vladimir Putin has promised us, especially for those working in these conditions.”

From almost every angle, then, Russia’s coronavirus crisis has hit — and hit hard.

“We in Russia are still in doubt about what is going on in the country”

No one can accuse Putin of standing by as the coronavirus swept across the globe.

On January 30, the Kremlin closed its large, far-eastern border with China and suspended the issue of electronic visas to Chinese people. Days later, it evacuated Russians in China on military airplanes and threatened to deport foreigners who tested positive for the disease.

That same month, passengers flying into Moscow from China, Iran, and South Korea — the coronavirus epicenters at the time — had to undergo tests once they stepped off the plane. Meanwhile, citizens returning from Europe would have their temperatures checked and be ordered to quarantine for 14 days at home.

Experts told me those measures, while tough, at best limited the number of infected people in the country and perhaps prevented an even larger outbreak than the one Russia is currently experiencing.

But it’s clear that Putin and his team have gotten more serious as the coronavirus crisis got more serious, too.

In an April 1 videoconference, Putin told government members to start getting serious and tell him truthful information when he needs it. “The results of our work should correspond to what is happening at present,” he said. That, for VCU’s Twigg, was surprising. “It was an implicit admission that what’s been going on until now was everybody lying to each other,” she told me.

Now Putin is extending lockdowns, telling citizens that the worst is yet to come, and having new hospitals built. There’s no question that he’s taking the crisis seriously, but the state of Russia’s health care system looks like it isn’t ready for the moment.

That goes against the kind of bravado Putin’s regime showed earlier in the year. Russian propaganda claimed earlier this month that the country was better prepared than the United States for what was coming, even noting how Putin had offered President Donald Trump assistance. In fact, a Russian plane with medical equipment was dispatched to the US.

And some experts suspect that the country’s official coronavirus statistics aren’t fully transparent, perhaps in an effort to make the situation look better than it is. Pro-Kremlin accounts on social media usually still focus on the low number of deaths, for example, as a way to say Putin has everything under control.

“We in Russia are still in doubt about what is going on in the country,” Vlassov, the epidemiologist, told me. “It’s not only doubt in the state’s statistics, but also in the picture in the social media.”

“The number of lethal cases ascribed to Covid-19 are still low,” he continued. “I think that it is a result of the misclassification of deaths from [the disease] to the other conditions or complications.”

That’s happened before: In 2015, Putin said he wanted to lower the death rate caused by cardiovascular disease in Russia. Almost immediately, hospitals began to report that fewer people were dying from heart conditions. What made that more suspicious is that there was a rise — at about the same rate — of deaths from other causes.

No one in the world, except for maybe Putin, has the full picture of what the crisis really looks like in Russia. But based on what’s already known, Putin has a lot more work to do.