There are fears worrying numbers of health workers in Russia are becoming infected with the coronavirus amid a shortage of protective gear and alleged failure by local administrators to take appropriate quarantine measures.

After an apparent lag with European countries, the epidemic has surged in Russia. This week, the country became fifth in the world for total recorded cases, overtaking France and Germany and now behind only the U.K., Spain, Italy and the United States. Russia’s number of new cases grew by over 10,000 a day most of last week, a rate of infection second only to the U.S.

That wave of infections has crashed into health workers. Medics in Moscow and other cities across Russia have been reporting many of their colleagues falling ill. In the regions outside the capital — where the health system is much less resourced and often crumbling — medical staff have described feeling unprotected, sometimes posting desperate pleas on social media demanding action from officials.

In Saint Petersburg’s primary coronavirus hospital almost 200 medics are being treated, according to local health officials. In Moscow around 2,000 medics have been infected, its mayor has said. In Ufa, 700 miles east of Moscow, doctors have demanded a criminal inquiry be opened after dozens of patients and staff tested positive in a single hospital.

As the epidemic worsens, however, some health workers have expressed fears that if the rate of infection among their colleagues continues it will lead to a shortage of staff, as many have to go into self-isolation or are hospitalized. In Moscow, authorities have already started bringing in medical students as reinforcements.

“We are on the threshold simply of a collapse in health personnel,” said Andrey Konoval, who heads the independent union, Dyeistviye, which represents around 4,000 health workers across 49 Russian regions. “It’s no coincidence” Moscow has been calling up students, he said.

To avoid that, Konoval said, he thought authorities would likely have to abandon the policy of sending health workers exposed to the virus into quarantine, if they didn’t have severe symptoms.

There are signs Moscow is now bracing for a possible wave of critically ill patients. Authorities this week converted a pavilion at a Soviet-era exhibition park as well as a suburban mall to create around 4,000 more coronavirus beds. This is in addition to a large temporary hospital built from scratch in March outside the city. Moscow’s mayor Sergey Sobyanin on Thursday also extended the city’s lockdown until May 31.

Until now, Moscow has seemed to largely cope with the influx of virus patients, except for a day early-on when dozens of ambulances carrying patients became backed-up in miles-long lines for hours trying to deliver them to two hospitals. The city has been able to learn from the experience in Northern Italy, several doctors said, where the health system was overwhelmed, and has used the delay before its own epidemic to increase bed capacity.

Doctors in the capital have told ABC News the situation in their hospitals has been harrowing but so far manageable. But they were concerned by the number of their staff getting sick.

Ira Apraksina, a doctor in the diagnostic imaging department at the War Veterans Hospital No 3, one of Moscow’s primary coronavirus hospitals, said in the first two weeks of the outbreak virtually her entire department had fallen ill. The majority have now recovered, she said, although one doctor has died. The number of new staff getting ill now has shrunk she said because so many have already had the virus.

Apraksina’s hospital had been one of those where a backlog of ambulances had occurred. She said that had not happened again and that the hospital had not been overwhelmed yet.

A doctor at her hospital said on Saturday that 505 of its 800 beds were occupied after a substantial number of patients were signed out. But it’s three intensive care units with 60-person capacity was completely full they said. “Every centimeter is occupied,” they said.

Alexander Erlich, a cardiologist at Moscow’s City Clinical Hospital No. 29, said in mid-April his hospital had been due to be reclassified to take only coronavirus patients but the decision was reversed at the last minute, a sign — he believed — that Moscow still had enough beds. Two weeks on though, his hospital has now been made a coronavirus center and he himself had become infected, spending two weeks in quarantine.

Despite that, Erlich said he still hoped Moscow would manage to avoid Italy’s scenario.

So far Russia’s official death toll has remained low, at just 1,915, far less than in other countries with similar numbers of infections, something that has puzzled experts. And as cases have grown, Russian health workers have started recording deaths among their own colleagues, in the absence of what they feel is proper counting by authorities.

They have produced a “list of memory” on a webpage with the names of those who have died. On Sunday the page had 158 names.

That number raises questions about Russia’s official death toll for the virus. The number of medics killed is a higher proportion of the total deaths in the wider population compared to other countries with similar numbers of infections. It suggests either Russian health workers are dying at a higher rate than elsewhere or Russia’s death toll in reality is much higher — or both.

In the U.K., between 150 and 200 health workers are estimated to have died when the country has recorded a total 31,000 coronavirus deaths. As the Guardian newspaper noted this week, when Italy reported that 100 medical workers had died, the country’s death toll had just surpassed 18,200.

“If we take the statistics in Britain, or Italy, the U.S., it’s 20 times, 30 times higher than in Russia,” he said. “Of course, everyone looks at that and understands that it cannot be that way,” said Erlich, one of the doctors behind the list.

Doctors have suggested many coronavirus deaths may be being recorded under other causes, such as heart failure or pneumonia.

Official data published on Sunday showed the total number of deaths registered in Moscow in April was 18% higher than the same period last year, up by around 2,000 more. Other countries have suggested such “excess deaths” will likely give a better idea of the real toll of the virus.

But it is the regions outside Moscow where health workers are facing the virus with the fewest defenses. For weeks, videos and posts have been appearing from medical staff across Russia pleading for proper protective gear and saying they were afraid their leadership would punish them for speaking out.

In St. Petersburg, a doctor at a veteran’s hospital last month resigned in protest over a lack of gear and said a second hospital she had been moved to had no “clean zones” set up. A nurse at another hospital in the city this week appealed in a post online for help, saying they had only single-use masks. “It’s frightening to go to work,” the nurse wrote, saying staff had been threatened with firing if they spoke publicly. “We’re like cockroaches for the leadership.”

Dmitry Seryogin, who leads a paramedic union in Oryol, about 250 miles southwest of Moscow, said for a month he and his colleagues had been attending most calls wearing only ordinary surgical masks and gloves, despite requests for hazmat suits.

At the end of April, two of his team tested positive he said but officials refused to quarantine their paramedic station. After they began complaining to regulators, he said, the administration finally closed the station and sent 40 paramedics into quarantine.

Andrey Konoval, whose union includes Seryogin’s, said he was receiving reports from doctors that some hospitals were deliberately limiting testing of their staff to avoid sending them to quarantine. He said the situation with protective gear had begun to improve as federal authorities began to make it more available for local administrations, but he feared it was too late.

“There is serious progress, but the time has been lost,” Andrey Konoval, whose union includes Seryogin’s . “And already, in some sense, that battle so that medical facilities don’t turn into hotspots for spreading the infection and that the staff are preserved for work, that situation it seems me is already lost.”