India's COVID-19 outbreak has stabilised in parts of the country but deaths rose by 4,194 on Saturday as infections spread in rural areas where public health services are scarce and overstretched.
India reported more than 400,000 infections a day in early May but the numbers have gradually eased. On Saturday, government data showed 257,299 new cases.
Active cases in the richest state of Maharashtra and Karnataka, home to the tech hub of Bengaluru, and the coastal state of Kerala had fallen in the last two weeks, health ministry official Lav Agarwal told reporters.
Daily numbers in states including West Bengal, which recently concluded state elections, and the southern states of Andhra Pradesh and Tamil Nadu were on the rise, he said.
With hospitals overflowing, the health system overwhelmed in the cities and a shortage of vaccines, experts have warned India could face a third wave of infections in coming months.
"While it (spread of coronavirus) has stabilised in many parts of the country, and overall the burden has been lessened, we have a long way to go with this wave," Dr V.K. Paul, part of a federal government panel on COVID-19 management, told a news conference.
"For the first time, we have seen that rural areas have been affected in this pandemic."
Total infections in the country stood at 26.3 million, the second highest in the world after the United States, while the country's total death toll was 295,525.
Prime Minister Narendra Modi and state authorities have faced widespread criticism for failing to counter the pandemic as many officials gear up for another surge.
The slow pace of vaccination in the country is another major concern.
New Delhi's chief minister said city authorities had been forced to halt vaccinations for those aged between 18 and 44 as supplies had run out.
The chief minister of Andhra Pradesh urged Mr Modi to help with supplies as the state had no stocks to vaccinate those aged below 45.
Case numbers also rose in neighbouring Nepal, which on Saturday said it had added 8,591 infections in 24 hours to take its total count above the half-million mark.
Pfizer vaccine effective against Indian variant
The Pfizer coronavirus vaccine is 88 per cent effective against the Indian variant after two doses, a study by Public Health England has found.
Both the Pfizer and AstraZeneca jabs were found to be almost as effective against symptomatic disease from the B1617.2 strain as they are against the Kent variant after the second dose.
However, they were only 33 per cent effective three weeks after the first dose.
UK Health Secretary Matt Hancock described the outcome as "groundbreaking", while PHE said it expected to see even higher levels of effectiveness against hospital admission and death.
The study, which took place between 5 April and 16 May, found that the Pfizer vaccine was 88 per cent effective against symptomatic disease from the Indian variant two weeks after the second dose, compared with 93 per cent effectiveness against the Kent strain.
Meanwhile, the AstraZeneca jab was 60 per cent effective, compared with 66 per cent against the Kent variant over the same period.
Both vaccines were 33 per cent effective against symptomatic disease from the Indian variant three weeks after the first dose, compared with about 50 per cent against the Kent strain.
Some 12,675 genome-sequenced cases were included in the analysis, but only 1054 were of the Indian variant.
The study included data for all age groups from 5 April to cover the period since the strain emerged.
Dr Jamie Lopez Bernal, consultant medical epidemiologist at PHE and the study's lead author, said there was more confidence in the data from the first vaccine dose compared with that from the second.
He told journalists on Saturday: "There are bigger numbers that have been vaccinated with one dose. So I think we classify that as moderate certainty around the first dose, but low levels of confidence around the second dose."
However, Professor Susan Hopkins, PHE's COVID-19 strategic response director, said the data trend was "quite clear" and was heading in the "right direction".
PHE said the difference in the effectiveness between the vaccines may be due to the AstraZeneca second dose being rolled out later than the Pfizer vaccine.
Data also shows it takes longer for the AstraZeneca jab to reach maximum effectiveness.
There were insufficient cases and follow-up periods to estimate vaccine effectiveness against severe outcomes from the Indian variant but this would be evaluated in the coming weeks, PHE said.
