(Bloomberg) — A wave of deaths among Hong Kong’s under-vaccinated elderly has pushed the city’s fatality rate to the highest in the developed world, ramping up pressure on officials to get the outbreak under control as cases continue to surge.

The financial hub averaged eight deaths per 1 million people in the past 10 days, the most among advanced economies, according to Bloomberg calculations based on Johns Hopkins University data. While most major Western countries are past the peak of their latest wave of infections and aren’t reporting a high number of fatalities, Hong Kong’s current ratio is about to surpass the nine deaths per 1 million that the U.S. recorded at the peak of its omicron wave around late January.

The city’s death toll is likely to keep climbing as the outbreak spreads through a growing number of care facilities, a sector which in many places has accounted for a disproportionate share of Covid fatalities. About 580 care homes in Hong Kong are experiencing outbreaks, with 2,900 residents and 860 staff infected. Almost 75,000 elderly and disabled people live in residential facilities in Hong Kong.

Hong Kong is reporting double-digit daily deaths, and more than half of the 87 announced on Monday came from care homes. Most of the fatalities during the current wave have been elderly and 91% hadn’t received two doses of a vaccine, according to government data released Sunday. 

For nearly a year now, experts have warned that the city’s low elderly vaccination rate was a ticking time bomb. Though inoculation jumped after the omicron outbreak started, less than half of the city’s residents aged 80 and older have received a first dose. Rival Asian hub Singapore has vaccinated about 95% of its seniors, and is averaging far fewer deaths — about 5 per day in February.

Read more: Hong Kong Seniors Who Refused Vaccines Are ‘Ticking Time Bomb’

More than two years into the pandemic, scenes reminiscent of the chaotic days of early-2020 are playing out in Hong Kong. The health system is straining, patients are stuck outside hospitals on gurneys, public morgues are overwhelmed, and there’s speculation the city may go into a lockdown.

The situation is at risk of worsening. Authorities announced more than 34,000 cases on Monday, a new daily record. There are 49 patients in critical condition in hospital and 66 in serious condition.

©2022 Bloomberg L.P.