MOSCOW (BLOOMBERG, REUTERS) - Russia for the first time reported more than 20,000 Covid-19 cases in the last 24 hours as a surge in some regions is overwhelming local hospitals' ability to care for patients.

There were 20,582 new coronavirus infections in the last day, with two-thirds of them outside of Moscow, the government's virus response centre said on Friday (Nov 6). Russia has reported 1,733,440 total cases, the fourth-most globally.

Moscow Mayor Sergei Sobyanin on Thursday said that infection rates and hospitalisations in the capital resumed their uptrend early this week and extended an order to keep older schoolchildren at home for another two weeks.

The disease's spread in regions beyond Moscow and St Petersburg has highlighted the problems plaguing Russia's underfunded health-care system, with many areas struggling to handle the influx of sick people.

The surge comes as federal authorities resist wider lockdowns, even as European countries from the United Kingdom to Greece have tightened restrictions this week.

The Kremlin said on Friday it was too early to judge how effective coronavirus restrictions in Russia would be without actual lockdowns.

In recent months, Russian authorities have said that harsh restrictions were not needed to contain the surge in Covid-19 cases, stressing that hygiene and safety precautions were key.

The Kremlin has said that targeted measures in certain regions were enough because Russia was better equipped to tackle the virus than earlier in the pandemic, when it imposed lockdowns nationwide.

Speaking to reporters on a conference call, Kremlin spokesman Dmitry Peskov said on Friday that the increase in Covid-19 cases to a daily high of 20,582 was alarming and that authorities would take action depending on how the situation developed.

With 1,733,440 infections, the country of about 145 million has the world's fourth largest number of cases behind the United States, India and Brazil.

Health authorities announced an investigation last month of the deaths of 13 patients in a single Rostov-on-Don hospital due to a lack of oxygen, while social media posts from clinics around the country show patients crowded into corridors due to a lack of facilities.

More than 45,000 people have died of Covid-19 since April, according to government data, which cover only the period April to August.

Deputy Prime Minister Tatyana Golikova said on Oct 28 that the situation was critical in 16 regions, with more than 90 per cent of beds devoted to Covid-19 occupied. That was even after authorities set up more than 25 per cent more emergency places in hospitals for virus patients than during the spring peak.

"We will continue to help regions that don't have capacity on their own, sending teams of doctors to help local medics and deploying additional beds," Prime Minister Mikhail Mishustin said on Monday. "But it is important that the regions do not cover up the problems."

Officials said some regional governments had been slow to enforce measures limiting large gatherings of people and mandating residents wear masks.

Even as colder weather pushes more people indoors, the Kremlin has resisted new restrictions to combat the epidemic's second wave in hopes of reducing the economic fallout from the pandemic. Instead, it issued a nationwide order last week to wear masks in public.

The authorities are placing their hopes on the roll-out of a handful of vaccines - still in the testing phase - to stem the tide of infections.

Moscow will begin offering free public vaccinations in late November or early December, Mayor Sobyanin said on Sunday, though officials have warned that ramping up production is proving difficult.

However, getting people to agree to the inoculations, none of which has completed Phase 3 testing to establish their safety and effectiveness, may be difficult. An October poll by the Levada Centre found that 59 per cent of Russians would not take a free, voluntary Covid-19 vaccine.

The poll of 1,601 Russians showed a growing number of people expect to get sick with Covid-19 and that 61 per cent doubted official statistics on the number of people who have fallen ill.