Despairing of finding enough beds for patients stricken with the coronavirus, a nurse in the Siberian city of Irkutsk has been forced to begin taking people to a village hospital more than 100 miles away. And the worst is yet to come, said the nurse, Valentina M. Monkhoroeva, adding, “the number of confirmed cases in the Irkutsk region grows every day.”

As Ms. Monkhoroeva’s predicament illustrates, the pandemic is now advancing, not receding, across much of Russia’s vast hinterland. But that has not dimmed the Kremlin’s determination to hold a nationwide vote on constitutional amendments that, among other things, would enable President Vladimir V. Putin to stay in power until 2036.

With Moscow, some 2,600 miles to the west of Irkutsk, seemingly over the worst of the outbreak, Mr. Putin has declared victory over the coronavirus and mobilized huge resources to make sure the referendum, already put off once, now goes ahead no matter what. Voting officially started last Thursday but the big day is Wednesday, which has been declared a national holiday in the hope that more people will vote.