India, the world's second-most populous country with 1.4 billion people, has been setting daily records for new cases. It has become a land of misery, countless funeral pyres and urgent calls for its large diaspora to send help. The country accounted for nearly half of new infections recorded worldwide last week. At least 234,000 Indians have died of COVID-19, though the actual number is believed to be much higher because of underreporting.
India's leaders thought they had contained the virus after seeing cases dip at the start of the year. Social restrictions were loosened, sparking a surge in infections in March that led to a near collapse of the country's health care system and a dearth of vaccines.
Doctors and nurses remain overwhelmed and oxygen shortages persist, leaving many patients with little chance of survival even if they reach a hospital.
"Doctors are discharging patients who are stable but not fully recovered to accommodate serious patients," said Smita Kulkarni, a 39-year-old attorney infected with COVID-19 who was recently released from an intensive care unit in Pune and was trying to suppress a violent and persistent cough. "This wave is so much worse than the first."
Countries are closing their borders to travelers from India to blunt the alarming spread of the potentially highly infectious double mutant variant, officially known as B.1.617, which has been detected in at least 17 countries, including the United States, according to the World Health Organization.
Indians are reportedly pooling money and fleeing on private jets to the handful of destinations that will still accept them, including the Maldives and Dubai.
India's opposition party has called for a national lockdown, but Prime Minister Narendra Modi's government, which is facing increasing criticism, has resisted the call over fears of adding more stress to an economy that shrank 8% the last financial year.
Instead, states have been given the authority to issue social restrictions, some of which are in place in Mumbai, Pune and the capital, New Delhi.
The last and only national lockdown, which was imposed in March 2020 with less than four hours' notice, was particularly harsh on the millions of migrant workers who were left stranded far from home after transportation networks were shut down. Many died on their journeys on foot back to their villages.
Attention is again shifting to rural India, where fears are growing that the death toll from COVID-19 could mount because of the chronic absence of decent health care.