HONG KONG — With medical workers and volunteers strained by the novel coronavirus, Myanmar's de facto leader Aung San Suu Kyi asked for forgiveness in a televised speech this week, acknowledging that surging cases and deaths had led to a shortage of hospital beds.

Yet in the same speech, Suu Kyi vowed to go ahead with elections on Nov. 8, despite the anxieties over public health in one of the world’s least-developed countries.

“At this time, all of us should unite our strength to overcome covid and also conduct the elections successfully,” said Suu Kyi, describing voting as a duty equal to fighting the virus.

The election result is hardly in doubt — Suu Kyi’s National League for Democracy (NLD) remains wildly popular — but the specter of millions flocking to polling booths during a virus outbreak has unnerved some voters, echoing fears in the United States as the presidential election nears.

Meanwhile, the outbreak has highlighted Myanmar’s weak health system, its inequalities and its sluggish development several years after a transition from military rule.

“With cases rising every day, I think they should postpone the election,” said Htain Linn, a 31-year-old Yangon resident who voted for the ruling party in 2012 by-elections and again in the last election, in 2015. “If they still refuse to do that, it only shows how poor the management of this NLD government is.”

Myanmar until recently had largely avoided the worst of the coronavirus, even as the pandemic wreaked havoc elsewhere in Southeast Asia.

Outbreaks are raging in Indonesia and the Philippines, while Malaysia this week reported its largest single-day increase. Malaysian Prime Minister Muhyiddin Yassin, who is in quarantine after one of his ministers tested positive, said an election in the state of Sabah last month was partly responsible for spreading the virus.

And while Myanmar’s covid-19 mortality rate is comparatively low, at around 1 per 100,000 population vs. 65 in the United States, its outbreak is spiraling. Deaths doubled over the past weekend and have since surpassed 530, from just seven a month ago. On Wednesday, a record 1,400 new cases were confirmed; the total has since risen above 22,000.

Officials partly attribute the surge to expanded testing, with about 11 percent of those tested found to be positive.

'A big imbalance'

The epicenter of the outbreak shifted in September from the western state of Rakhine — home to the Rohingya Muslim minority, the target of a 2017 military campaign that spurred allegations of genocide — to the heavily populated region around Yangon, the country’s largest city.

Now, workers are racing to prevent the virus from overwhelming Myanmar’s health infrastructure, consistently ranked among the world’s worst.

Across Yangon and elsewhere, officials have established hundreds of quarantine centers where those with even mild symptoms can be placed in isolation. Makeshift hospitals have been fashioned out of football stadiums, and volunteers have been deployed to quarantine and treatment facilities.

“There is a big imbalance between medical workers and the number of patients in the covid facilities,” said a doctor volunteering at a coronavirus center in Yangon, who declined to give her name for fear of retribution. “All the hospitals are absolutely struggling to balance the needs of the coronavirus and non-coronavirus patients.”

Myanmar spends only 2 percent of gross domestic product on health care. Yet the coronavirus has not changed the government’s social spending; there have been few subsidies or assistance packages.

And as the election nears, the virus has stalled campaigning in Yangon. The city has been under partial lockdown for weeks, forcing businesses to close and threatening livelihoods. At least 10 NLD officials have been forced into quarantine in Pathein, 120 miles west of Yangon.

Suu Kyi and other officials this week participated in a test run to see how voting could be made safer with measures such as social distancing, providing masks for voters who show up without them, and offering advice on hand-washing techniques. Yet parties have held campaign events with thousands of attendees, breaking rules that prohibit gatherings of more than 50 people.

System failure

The NLD, synonymous with Myanmar’s democracy movement, came to power with high hopes that it would kick-start development after six decades of military rule. In the 2015 vote, the first contested national election since the end of direct junta rule, the party won in a landslide.

But the pandemic has accentuated bleak economic circumstances.

Gerard McCarthy, a postdoctoral fellow at the National University of Singapore’s Asia Research Institute who studies inequality in Myanmar, said that more than 80 percent of households are skipping meals and that others are taking on new debt to pay for food.

The wave of coronavirus infections “has really challenged the perception that the competency of the government was the reason that covid-19 hadn’t caught on,” McCarthy said. “There isn’t an apparatus to distribute social services here. The government simply hasn’t figured out how to feed 80 percent of people in the Yangon region.”

Still, on the streets of Yangon, tea shops and taxis are adorned with the NLD’s yellow-and-red flags. The party is seen by many as the only counterweight to the military, which retains a powerful role in the economy and is guaranteed a quarter of parliamentary seats.

Suu Kyi’s near-divine status among voters is almost certain to propel her to victory. But it underscores a disconnect between politics and economic circumstances, said writer and historian Thant Myint-U.

Politics in Myanmar “is about personality,” he said. “The incredibly unfair economic system, fast-rising inequality, massive unemployment and loss of income due to the pandemic — these issues see almost no reflection in Myanmar politics.”

Diamond reported from Yangon.