WARNING: This story contains a graphic image.
When COVID-19 was ravaging densely populated parts of the U.S., Europe and India throughout the spring and summer, many in Russia hoped the country's vast emptiness would act as a kind of natural physical distancing and slow the spread of the coronavirus.
But that optimism has evaporated this fall as poorly funded and ill-equipped hospitals in rural towns and cities struggle under an avalanche of new COVID-19 cases.
Russia set yet another record for daily new infections on Friday, recording 18,283 — well beyond the spring's daily peak of 15,000. While the highest concentration of positive tests is in Moscow, the spread of COVID-19 is intensifying most dangerously in remote regions beyond the capital.
Some of the worst stories have come from the city of Barnaul in the Altai Krai region of Siberia.
Social media video that circulated last week showed the basement of Hospital No. 12 packed with more than 30 corpses in black body bags lining corridors and storage rooms.
Artemy Panchenko said that when he saw the video, he knew his aunt, Ludmilla, had to be one of those lying on the hospital floor.
Her family learned that the 69-year-old had died from COVID-19 but overwhelmed hospital staff could not find her remains.
"We did not believe [her] body could disappear forever. But we had no hope," said Panchenko.
Three days later, he said the family was told she had been found but that they would have to wait another seven days to claim her body because there were not enough doctors who could perform an autopsy.
"We were hoping it would be more civilized — that her body was refrigerated somewhere, not just left like this on the floor."
By the time her remains were released, Panchenko said, she was bloated beyond recognition.
Conditions in many other rural Russian hospitals appear equally grim.
In the city of Rostov-on-Don, near the border with Ukraine, two hospital administrators were fired this week after 13 patients died when the ventilators they were hooked up to ran out of oxygen.
And in Omsk, a similar tragedy was barely averted after ambulances carrying two patients on ventilators were forced to drive around the city for 10 hours because every hospital was full.
With their oxygen about to run out, the attendants drove to the local offices of the Ministry of Health to plead with officials there and eventually the patients were admitted.
In Volgograd, known locally as the Hero City, which, as Stalingrad, witnessed what Russians consider the most ferocious battle of the Second World War, an 87-year-old veteran with COVID-19 was discharged and left unconscious on the hospital steps in a wheelchair.
Staff apparently wanted him moved to a psychiatric facility, according to local media reports, but his distraught daughter, Galina Kurapova, posted a video of her pleading for them to take him back into intensive care.
The man died a few hours later.
This week, President Vladimir Putin acknowledged shortfalls and ordered military doctors be sent to several hospitals in the Urals. He also allocated the equivalent of $131 million US to cope with the surge of cases.
That the pandemic is tearing into the rural Russia hospital system is unfortunate but predictable, said Dr. Vasily Vlassov, a professor of health-care administration and economics at Moscow's HSE University.
"The infrastructure of Russian health care was never rich and after the so-called optimization of the system [in 2011], the quality of the hospitals … increased, but the number of beds decreased.
"In general, things will get worse, but on what scale it is difficult to estimate," Vlassov told CBC News in an interview.
On Friday, the independent newspaper Novaya Gazeta published what it said was an internal government assessment of how bad the pandemic might become in Russia.
Compiled by the Center for Monitoring Biological Risks of the Federal Medical and Biological Agency, it forecasts as many as 25,000 new infections a day by December, with six million Russian eventually contracting the virus — a four-fold increase from today.
The report says deaths will almost double from the official number of 27,000 to 52,000 by the end of the year.
However, demographers inside and outside the country believe the actual number of people who've already died from the coronavirus is far higher than official figures suggest.
The Moscow Times reports Russia's state statistics agency, Rosstat, puts the real number of coronavirus deaths at 45,663 between April and August, a death rate that would exceed some of the hardest-hit countries in Europe.
Vaccine production bottlenecks
For months, Russians have been told their country is leading the global race to develop the world's first coronavirus vaccine and that its highly touted "Sputnik V" is out in front.
Kirill Dmitriev, the head of the Russia Direct Investment Fund, which is bankrolling its production, promised in July that 30 million doses would be available by the end of 2020.
But on Thursday, the government confirmed only two million doses of vaccine would likely be ready, citing lack of equipment and production bottlenecks.
Nonetheless, the head of the Gamaleya Institute, the vaccine maker, said plans for a countrywide inoculation campaign remain on schedule to start in early 2021 and that the virus will be "vaccine-manageable" by next summer.
Vlassov, the Moscow university epidemiologist, is not convinced.
"We don't know anything about the efficacy of the vaccine," he said, noting that so far the only data published has come from Phase 1 trials involving a tiny sample of 76 people.
"Now it is in [a] Phase 3 three trial, but actually it is very slow in these trials. Two western vaccines, Oxford and another one [Moderna], are better — they have finished the process of immunizing participants in trial."
Gamalyea said this week that so far only 9,000 of 40,000 eventual trial volunteers have received both shots of the two-shot vaccine.
The Putin government has framed the push to develop a vaccine for COVID-19 as a 21st-century version of the Space Race and has been highly sensitive to criticism of the vaccine and its overall coronavirus response.
This week, after the rash of complaints from the hospitals in Siberia, Russia's Health Ministry issued what some critics complain is a "gag order" on doctors or other hospital staff from talking publicly — or posting videos — about conditions inside.