India reported over 4,000 COVID-19 fatalities for a second straight day on Thursday, while infections stayed below 400,000 for a 4th day, though the virus has become dominant in rural regions where cases can go unreported because of a lack of testing.

This comes as concern is growing about the transmissibility of the variant that is driving infections in India and spreading worldwide.

The World Health Organization on Monday classified a COVID-19 variant first spotted in India as a global “variant of concern,” saying preliminary studies showed it may be more transmissible than some other variants.

There is a particularly dire situation in rural regions of Uttar Pradesh, India’s most populous state with a population of more than 230 million. Television pictures have depicted families weeping over the deceased in rural hospitals or camping in wards to tend the sick.

Bodies have washed up in the Ganges, the river that flows through the state, as crematoriums are overwhelmed and wood for funeral pyres is in short supply.

Well-known opposition politician and activist Yogendra Yadav wrote in The Print that “official statistics give you no idea of the devastating pandemic that is raging through rural UP.”

“Widespread ignorance, lack of nearby or adequate testing facilities, official and unofficial cap on testing and inordinate delays in test reports have meant that in village after village, virtually no one has been tested, while scores of people complain of a ‘strange fever’”.

India had 362,727 new coronavirus infections over the last 24 hours while fatalities rose by 4,120, according to health ministry data.