Dr Georgy Arbolishvili doesn't need to see government statistics or hear about the records being broken every day for infections and deaths to know that Russia is struggling through a particularly alarming phase of the coronavirus pandemic.
He simply looks around his filled-to-capacity intensive care unit at Moscow's Hospital No. 52.
With only about a third of Russia's 146 million people vaccinated against Covid-19, the country has hovered near 1000 reported deaths per day for weeks and surpassed it on Saturday — a situation that Arbolishvili says "causes despair".
"The majority of ICU patients in grave condition are unvaccinated," he told AP. These illnesses "could have been very easily avoided if a person had been vaccinated".
With a record 1015 deaths reported Tuesday, the country's death toll is now 225,325 — by far the highest in Europe, even though most experts agree even that figure is an undercount.
Those statistics "are directly linked to vaccinations". Arbolishvili said. "The countries with a high share of those vaccinated don't have such bad mortality numbers."
Even though vaccines are plentiful, Russians have shown hesitancy and skepticism when it comes to getting vaccinated, which has been blamed on conflicting signals sent by authorities since the pandemic began last year.
Even as ICUs have filled in recent weeks, life in Moscow has continued as usual, with restaurants and movie theaters brimming with people, crowds swarming nightclubs and karaoke bars and commuters widely ignoring mask mandates on public transportation.
That makes medical workers like Dr Natavan Ibragimova shudder.
"I think about sleepless nights when we get a huge number of patients who didn't even bother to use banal protective means," the internist at Hospital No. 52 said.
Patients who have had the vaccine usually don't have serious symptoms, Ibragimova added, while the unvaccinated come to regret it.
"Patients who survive after a grave course of illness tell us when they are discharged, 'Doctor, you were right and I will tell everyone that it's necessary to get the vaccine,'" she said.
Until now, the Kremlin has ruled out a new nationwide lockdown like the one imposed early in the pandemic that dealt a heavy blow to the economy and sapped President Vladimir Putin's popularity. The surging infections have raised the pressure on Russia's health care system and prompted Cabinet officials to suggest that most public sector workers take a week off.
Deputy Prime Minister Tatyana Golikova, who heads the coronavirus task force, suggested Tuesday that such a nonworking period start Oct. 30 and last through the following week, when four of seven days already are state holidays. The Cabinet will ask Putin to authorize the move, which would still keep many businesses in the service sector open.
Authorities also have raised the pressure on medical workers, teachers and public servants to get vaccinated, but the pace has stayed sluggish. Putin has underlined the importance of vaccinations but has emphasised that it should be voluntary.
Kremlin spokesman Dmitry Peskov admitted that while the government has done everything to make vaccinations easily available, it should have been more proactive in encouraging them.
"Obviously, more should have been done to explain the lack of alternative to vaccination," Peskov told reporters.
Authorities have set up vaccination sites in shopping malls and other facilities at clinics where shots are offered without any advance booking. They also have used lotteries, bonuses and other incentives to encourage people to get vaccinated, without much success.
Russia is the only place "where you can easily come and get the shot while passing by," said Dr. Irina Beloglazova, a pulmonary specialist at Hospital No. 52. "A vaccine offers a clear chance to survive. I wonder why people don't take that chance."
In August 2020, Russia boasted of being the first country in the world to authorize a coronavirus vaccine even though it was only tested on a few dozen people at the time, proudly naming the shot Sputnik V in honor of its pioneering space program.
While extolling Sputnik V and three other domestic vaccines developed later, state-controlled media derided Western-made vaccine shots, a controversial message that many saw as feeding public doubts about vaccines in general.
Asked if authorising imports of foreign vaccines would help, Peskov said the skepticism isn't limited to domestic shots. So far, the World Health Organization and the European Union have not authorized the use of Sputnik V, and Peskov emphasised that the issue should be resolved on an equal basis.
While resisting a nationwide lockdown, the Kremlin empowered regional authorities across the country to decide on local restrictions, depending on their situation.
Many of Russia's 85 regions already have restricted attendance at large public events and limited access to theaters, restaurants and other venues. Some have made vaccinations compulsory for certain public servants and people over 60.
Golikova urged the regions to move quickly on using digital codes for access to public areas.
Russia's second-largest city of St. Petersburg joined others Monday in ordering digital codes so people can prove their vaccination or their recovery from infection to access conferences and sports events beginning Nov. 1. As of Nov. 15, those codes will also be required at movies, theaters, museums and gyms, and on Dec. 1, they will be mandatory at restaurants, cafes and some stores.
The city reported the second-largest number of new infections after Moscow, where authorities so far have refrained from tightening restrictions despite the mounting caseload. Moscow this week moved to tighten mask mandates on public transportation.
On Tuesday, Moscow Mayor Sergei Sobyanin said unvaccinated people over 60 will be required to stay home. He also told businesses to keep at least a third of their employees working remotely for three months starting Oct. 25.
Michael Head, a senior research fellow in global health at Britain's University of Southampton, said the almost daily record-breaking virus numbers in Russia are hardly surprising, given the lack of restrictions and the highly contagious Delta variant.
"We have seen time and again that if you let susceptible people mix, the Delta variant is very, very adept at spreading in communities," he said.
Experts at the WHO and elsewhere estimate that might require more than 80% of a population to be immunised.
The government's task force has registered more than 8 million infections and ranks Russia as having the fifth-most Covid-19 deaths in the world after the United States, Brazil, India and Mexico.
However, state statistics agency Rosstat, which also counts deaths in which the virus wasn't considered the main cause, has reported a much higher death toll — about 418,000 as of August. Based on that number, Russia would be the fourth hardest-hit nation.
Martin McKee, a professor of European public health at the London School of Hygiene and Tropical Medicine, said the situation was extremely worrying for Russia and the rest of the world. Even high rates of vaccination elsewhere in Europe won't prevent the virus from being reimported from Russia, particularly if worrisome new variants emerge, he said.
"Until we have control of the virus everywhere, there's a risk of importation and the pandemic will not be under control," he said.