As she stood in the courtyard of the morgue holding the body of her grandmother who died of Covid-19, Ramilya Shigalturina had a message for anyone still resisting vaccinations.
"I'm begging all Russians: Please get vaccinated, because it's really dreadful and dangerous," said the resident of Nizhny Novgorod, the country's fifth-largest city.
Shigalturina said her 83-year-old grandmother "died right away after catching it. She wasn't vaccinated."
When Russia last year became the first country to launch a coronavirus vaccine, called Sputnik V, it was hailed as a matter of national pride and a sign of its scientific know-how. But since the free immunisation programme began in December 2020, only about a third of the country's 146 million people have been fully vaccinated.
The low vaccine acceptance is of increasing concern as Russia suffers a sharp rise in cases, setting records for infections and deaths nearly every day this month. On Thursday, the national coronavirus task force reported 1036 deaths and more than 36,000 new infections over the past 24 hours.
"I can't understand what's going on," President Vladimir Putin said, a rare admission of bewilderment from the steely leader. "We have a reliable and efficient vaccine. The vaccine really reduces the risks of illness, grave complications and death."
At Nizhny Novgorod's Infectious Hospital No 23, where the seriously ill patients lie in wards with little space between their beds, Dr Natalia Soloshenko is battered by the onslaught.
"I can tell you that out of every 50 admitted, only one or two of them are vaccinated," the chief doctor told the Associated Press. "The whole ICU is full of highly critical patients; all of those patients are unvaccinated.
"To be honest, we're not even outraged any more; we just feel sorry for these people," she said.
Nina Pugacheva is still in the hospital, but is one of the lucky ones — she is recovering.
"Tell everyone to get vaccinated," she said.
Soloshenko said widespread misinformation appears to be driving the vaccine hesitancy.
"It's a very sensitive issue, a burning issue for all healthcare workers. We read what's on social media and see the most negative information coming from the citizens of our country regarding vaccination," she said.
Many Russians are suspicious of vaccines as a whole because of a distrust of authorities dating to the Soviet era. With Sputnik V, there was widespread concern that it was approved for use before the completion of full clinical trials.
Some critics also have blamed conflicting signals from authorities. While extolling Sputnik V and three other domestic vaccines, state-controlled media often criticised Western-made shots, a message that many saw as feeding doubts about vaccines in general.
The vaccination rate in the Nizhny Novgorod region, about 400km east of Moscow, is 44 per cent higher than the national average, but it is seeing a high death rate. The coronavirus task force reported 40 new deaths in the past day — about twice the death rate recorded in Moscow.
As deaths spiked, regional governor Gleb Nikitin said new measures would be taken to curb the spread of the infections, but they haven't been announced yet.
Putin on Wednesday ordered Russians to stay away from work from October 30 to November 7, a period that includes a four-day national holiday.
Moscow and St Petersburg, the two most populous Russian cities and the country's key political, business and cultural centres, have gone further, announcing new restrictions after months of inaction.
In Moscow, gyms, cinemas, entertainment venues and most stores are to be closed from October 28 to November 7; and restaurants will be open only for takeout or delivery.
The authorities in St Petersburg on Monday introduced digital codes for proving vaccination that must be shown, beginning November 1, to enter conferences and sports events. Starting on November 15, those codes will be required at movies, theatres, museums and gyms, and on December 1 they will be mandatory at restaurants, cafes and some stores.
A similar code system was tried in Moscow over the summer but was abandoned after a few weeks amid complaints from restaurant owners about tanking revenue.