With the remote eastern corner of India struck by COVID-19, Dr Deepak Kumar worked double shifts to treat those who could not be admitted to government hospitals.

But as the state of Bihar’s poor health infrastructure became overwhelmed with patients, his wife, Neetu Devi, began to worry about him.

“I was worried because we have young children at home,” Ms Devi told the ABC.

“I shared my concerns with him many times, but he used to tell me that it was his duty.

“He was very dedicated and worked hard during this time of pandemic.”

Those fears were realised when the father of two young children contracted the virus from a patient and died shortly after.

“My children are missing their father lot,” Ms Devi said.

The family’s experience is far from the only one to emerge after the region experienced a surge in cases in July and August.

Just last month, the local medical association raised the alarm about the dangers facing healthcare workers after calculating doctors in Bihar were dying at nine times the national average.

The region, which is one of the country’s poorest and most populous states, has become one of India’s worst affected areas after the country’s aggressive six-week nationwide lockdown failed to snuff the infection.

Doctors put under huge strain during pandemic

Now, with more than 90,000 daily cases over the past week, India’s coronavirus count is showing no signs of slowing down.

India’s Government has consistently pointed out that the country’s mortality rate is significantly lower than Brazil, the United States and many European nations.

But Monday marked a small milestone, with India passing Brazil’s total. If current trends continue, it’s only a matter of time before it catches up with the United States, provided the latter keeps its cases trending downward.

A second wave of COVID-19 infections is already well underway in the country’s capital, Delhi, while the worst hit state of Maharashtra has simply been unable to contain the spread.

But it is the number of deaths among healthcare professionals which is creating the most concern amid fears it is putting a further strain on the country’s underfunded healthcare system.

Nowhere has this issue become more apparent than in Bihar.

It was always primed for disaster. The state had fewer than 40 doctors per 100,000 people, compared with 90 for India overall and 250 in the United States.

Hospital beds per capita were also a faction of the national average.

As well as a shortage of doctors, personal protective equipment was in such short supply in the initial months that one doctor the ABC spoke with made her own using a plastic car cover.

Doctors have also been concerned about inadequate training for frontline staff, and a poor testing system.

And they also fear they are being overworked, especially given all leave for medical professionals has been cancelled since March.

Armed guards surround some doctors as relatives get desperate

Doctor Dipali Singh, who treats coronavirus patients in the state capital, Patna, returned to work only a week after giving birth.

“When you come home, you just don’t shut your door and it’s over,” she said.

“I have a very little kid. So constantly there is a war going on with your emotions and your dutifulness as next day you will have to go on duty.”

Dr Singh said the fear of contracting the virus and spreading it to family members has become emotionally draining.

“You see on TV that this doctor has died or that doctor has died,” she said.

“Also, you come to know about your relatives who got infected.

“So, on duty you go with baggage. It is very difficult, very difficult.”

The situation facing healthcare workers has escalated to such a point that in at least one town, a doctor now has an armed guard to protect him from desperate relatives of patients.

Dr Kumar Gaurev says relatives kept barging into the wards, even the ICU, to stroke and feed their loved ones.

“If we stop them, they get angry,” Dr Gaurev told Reuters news agency.

“They just barge into our ICUs … and they are taking the infections from our ICUs to other people in society.”

There has also been concern about what happens to the families of healthcare workers who have died.

“My husband did his duty,” she said.

“He wanted to groom both his sons to be good doctors. [But] how will they become doctors? We do not have money. I do not have a job.”

Bihar is now back in lockdown until the end of September, and the growing case numbers appear to have tapered off, for now at least.

What’s going on in India?

India’s record-breaking daily infections coincide with an increase in testing, with more than a million people tested a day in recent weeks.

Epidemiologist Tanmay Mahapatra said current projections show India’s daily caseload will peak between 100,000 and 150,000.

But despite the record setting numbers, and more than 4.3 million confirmed cases, experts believe the spread of the virus has been far higher than the official numbers show.

A serological survey in Delhi suggested 29 per cent of the population had been infected due to the presence of coronavirus antibodies.

That would extrapolate to around six million cases in the capital alone, which is thirty times the official data.

In Pune, which has the highest number of infections in the country, a serological survey suggested half the population had been infected.

It’s for these reasons experts believe health professionals who are not even treating coronavirus patients have unknowingly been exposed at such high rates.

“The system is being flooded with cases,” Dr Mahaptra said.

“It’s really tough for having a clear demarcation between doctors who are supposed to work in the COVID facility, and doctors who are not.”

Makeshift hospitals have sprouted up across India. But concern is emerging about how the facilities will be adequately run, given the shortage of medical professionals, proper equipment and training.

Dr Mahapatra said the high rate of asymptomatic and mild-symptom infections meant early detection was needed to filter those who could quarantine at home, from those who may need specialist or hospital treatment.

This would ease pressure on the country’s hospitals.

Dr Mahapatra said despite the grim projections of 150,000 cases a day, India should not resign itself that such numbers are inevitable.

“Now we have to learn how to live with it,” he said.

“How not to underestimate its danger but deal with it as a health hazard.

“And then continue to work on the data indicatively. Not in an absolute number.”