By South Asia correspondent James Oaten and Som Patidar in New Delhi
After suffering fever for several days, Dinesh Singh knew his COVID-19 symptoms were entering deadly territory.
His oxygen saturation was plummeting, and his breathing became increasingly laboured.
The 65-year-old lived in a remote Indian village in Uttar Pradesh and the closest city, where chances of finding spare medical oxygen were best, was three hours away.
"We spent an entire night driving from one hospital to another hospital," his son-in-law Deepak Singh said.
The family sent out an SOS message on social media, like many others during the latest COVID-19 crisis, tagging senior bureaucrats in the city.
But after failing to attract the attention of prominent journalists, politicians or activists, the message went virtually unnoticed.
By the time the family secured an oxygen cylinder on the black market, paying three times the normal price, it was too late.
"My father-in-law should have survived," he said.
"But he died. It's painful."
Politician denies state suffering oxygen shortages
The COVID crisis that has engulfed states like Uttar Pradesh and the capital Delhi has smashed confidence in the country's frail healthcare system.
Countless residents like Dinesh Singh have been left to fend for themselves.
Phone numbers in someone's contacts can be the difference between death and recovery.
"It's impossibly bad," Dr Sumit Ray, the medical superintendent at Holy Family Hospital in Delhi, said.
"It's way beyond even what the media is able to capture. Not because they don't want to. Even doctors don't realise how bad it is."
But the views of those working on the crisis frontline sit in sharp contrast with the chief minister of Uttar Pradesh, Yogi Adityanath.
The monk turned politician for the Hindu nationalist party, the BJP, has repeatedly denied claims from hospitals that the state is suffering a shortage of liquid oxygen.
Instead, he blamed "black marketing and hoarding".
The chief minister went one step further, threatening to use the draconian National Security Act and the Gangster Act to crackdown on "anti-social elements" spreading "rumours and propaganda" about oxygen shortages, Indian newspaper The Hindu reported.
Journalist Arfa K Sherwani from digital publication The Wire said the threat of legal action was clear intimidation against doctors, the public and journalists to play down the overwhelming crisis.
"I think this is going to really intimidate the local media," Ms Sherwani said.
"This looming threat of legal action by the state over just about anything and everything that it doesn't consider the truth will further affect the reporting of the pandemic in the biggest Indian state.
"We've just been able to scratch the surface of what this calamity is doing."
Adding further concern is the national Epidemic Diseases Act, a colonial British law from 1897, which doctors have told the ABC prevents them from speaking out or revealing data over fears they will be accused of "fear mongering" during a time of crisis.
It's already been incited against a man in Uttar Pradesh who tweeted he needed oxygen. The tweet did not mention COVID-19.
Police later revealed the man's relative died from cardiac arrest and did not need oxygen or suffer from coronavirus. Police let the man off with a warning, stating his actions were to "create sensation and fear".
Further alarm was raised about the government silencing critics after Twitter complied with a government directive to remove dozens of tweets critical of the government and populist Prime Minister Narendra Modi, while Facebook blocked the hashtag #ResignModi, a move the company later said was an error.
External Affairs Minister S Jaishankar has asked diplomats to counter the "one-sided" global media narrative, the Indian Express reported.
An article titled "Modi leads India out of lockdown and into a COVID apocalypse", which featured in The Australian but was written by The Times Asia correspondent Philip Sherwell, was publicly slammed by the Deputy High Commissioner to Australia as "slanderous", stating it undermined the government's "universally acclaimed" response to the pandemic.
Journalist Arfa K Sherwani said the "very touchy" government was treating the pandemic as a public relations issue.
"There is a trust deficit," she said.
"A huge trust deficit between the people and the government. The system has collapsed."
Values shown are 5-day averages.
Rate of death could be higher than official toll
India's coronavirus surge has broken records, with Friday's figures adding 386,452 confirmed infections to the tally and 3,398 deaths.
India now accounts for one in four COVID-19 deaths in the world, but the numbers reported are widely believed to be under representative of the actual figures.
Medical consultant Dr Arun N Madhavan said he estimated the real rate of death would be five times higher than the official toll, but that number varied depending on the state.
"There is gross under reporting," Dr Madhavan said.
"It's happening in almost all states of India. More in some states and less in some other states."
In Delhi, one in three tests have come back positive, while in places like Kolkata and Chandrapur, the test positivity rate had almost hit 50 per cent, demonstrating the outbreak had spread far more widely than confirmed cases suggest.
Dr Madhavan said a severe lack of testing meant people were dying at home due to coronavirus but weren't being marked as COVID-19 deaths. The number of daily tests has significantly dropped as facilities buckle due to crippling demand.
Dr Madhavan also said other illnesses were being marked as the cause of death instead of COVID-19, which violates World Health Organization protocol.
In Gujarat, concerns about under reporting were raised this week when medical sources told local media the number of hospital deaths were many times higher than the official toll.
Dr Madhavan said the system was being overwhelmed but politics was also a factor.
"They're asked to do that to reduce the number as much, so the state government looks good compared to other governments," he said.
"It's unfortunate because we need good data to actually see what is happening."
India's Health Minister has said the country has the lowest death rate in the world, and denied the country suffers from an oxygen shortage.
While India's relative death rate has been lower than many western countries, doctors have argued that is most likely due to the average age being younger.
Dr Ray said there was a "political compulsion to underplay" the horrors unfolding, and that the death rate was only likely to increase as the hospitals remain beyond capacity for longer, denying more vulnerable people access.
"We are being overwhelmed by the numbers," he said.
"Even the best healthcare systems in the world cannot deal with these numbers."