VATICAN CITY: Catholic cardinals in Rome marked the start of the Lent religious season on Wednesday without Pope Francis, as the 88-year-old spent his 20th day in hospital seriously ill with pneumonia.

The Argentine pontiff, head of the worldwide Catholic Church, usually leads the Ash Wednesday celebrations marking the start of 40 days of prayer and sacrifice before Easter, the holiest period in the Christian calendar.

Instead Italian Cardinal Angelo De Donatis read out the pope’s homily at the mass at Rome’s Santa Sabina basilica, which was preceded by a procession joined by around 20 red-clad cardinals.

“We feel deeply united with him at this moment and we thank him for the offering of his prayers and his sufferings for the good of the entire Church, and the whole world,” De Donatis said of the pontiff at the start.

Francis, leader of the world’s almost 1.4 billion Catholics, was admitted to Rome’s Gemelli hospital on February 14 with bronchitis, which then developed into pneumonia in both lungs.

He has since suffered a worrying series of crises, including “two episodes of acute respiratory failure” on Monday, which have sparked widespread alarm.