She’s exaggerating, but only just. The country recorded — no typo — 386,452 cases of COVID today, a figure universally seen as a gross underestimate of the true number of infections due to the lack of testing in certain areas. The health-care system there is so crushed that retired medical professionals are being asked to come back to work to help India cope. Crematoriums and cemeteries are overwhelmed. Supplemental oxygen is scarce. Hospitals don’t have empty beds. Vaccines are so hard to come by that India is actually *closing* vax centers in the midst of a national emergency because there are no doses to deliver.

As horrendous as it is right now, the real terror lies in the fact that no one seems to have any sense of how much worse it might get. As Jonathan Last notes, the fact that India’s hospitals are overrun means that some unknown number of people who would have survived if they had received good medical care will end up dying, further ballooning the death toll.

One doctor in charge of a COVID unit at a hospital in New Delhi spoke to CNN about the situation today, describing it as apocalyptic. She’s had the virus itself, as have her kids, as have her parents. At one point she says that hardly any households have been completely untouched. That’s how it feels when you read the news accounts, as if literally the entire country has been infected all at once. Watch, then read on.

“What we are seeing is nothing short of an apocalypse,” says Dr. Farah Husain on the Covid surge gripping India.

“The second wave is extremely contagious, extremely aggressive, and it is affecting the younger population in a significantly different way that we had not expected.” pic.twitter.com/aFs2sal0M0

— CNN (@CNN) April 30, 2021

India’s problem is increasingly a global problem. Cases in neighboring countries have begun to tick upward, leading scientists to speculate that the outbreak is spilling over and might soon cause a regional crisis. India’s desperate demand for vaccines also means that its considerable manufacturing capacity has been repurposed to serve its own needs, leaving other countries in the lurch and vulnerable:

India promised to supply 200 million COVAX doses that are being distributed to 92 poor countries. But its own rapidly worsening situation has prompted Delhi to shift focus from COVAX to prioritizing India’s own citizens.

The Serum Institute of India (SII) had already delivered 28 million doses of the AstraZeneca vaccine, COVAX said in a statement in March, but was due to ship another 90 million doses in March and April.

Those deliveries would be delayed, it warned, due to rising demand within India…

The moment India is short on vaccines and keeps its supplies for domestic purposes, it means other countries like South Africa and Brazil have to wait, she said. “You’re delaying the world getting vaccinated by many months,” Shruti added.

The domestic political fallout is uncertain but the country’s nationalist prime minister, Narendra Modi, has taken the brunt of the public outrage over the spiraling epidemic. Some have accused him of hiding COVID data for fear that the true numbers would embarrass India and damage him politically. Others have focused on his insistence on holding large unmasked rallies even as case counts surged, something he has in common with other strongman leaders like Trump and Bolsonaro:

Modi’s own lapses and missteps are an increasing source of anger. As coronavirus cases skyrocketed, Modi continued to hold huge election rallies and declined to cancel a Hindu religious festival that drew millions to the banks of the Ganges River, despite pleas from health experts.

Rather than making urgent preparations for a second wave of cases in an already weak health-care system, the government put much of its focus on vaccinations — a campaign too limited to blunt the oncoming disaster. The government repeatedly chose self-congratulation over caution, publicly stating that the pandemic was in its “end game” in India as recently as last month.

So arrogant was Modi’s government in believing that India had conquered COVID that it continued to export millions of vaccine doses to other countries all the way into March instead of stockpiling for a potential second wave. He may survive the disease but whether his government survives the crisis is another matter.

The great mystery at the heart of the terrifying surge in cases is whether it’s being driven by a familiar strain of the virus or something new and more sinister. “The current wave of Covid has a different clinical behavior,” said one Indian doctor to the NYT a few days ago. “It’s affecting young adults. It’s affecting families. It’s a new thing altogether. Two-month-old babies are getting infected.” The doctor in the CNN clip above seems to agree, citing the country’s unusual “double mutant” variant at one point and noting how it seems to spreading more quickly and aggressively than common COVID. But is that based on any hard data or just a vague impression that “this outbreak is unusually bad, therefore the cause must be unusually bad too”?

“Researchers outside of India say the limited data so far suggests instead that the variant called B.1.1.7, which has affected Britain and the United States, is more likely to blame” than India’s “double mutant,” the Times noted today. B.1.1.7 is the British variant, which is known to be highly contagious. Maybe that fact plus Indians’ willingness to let down their guards and hold large gatherings in the belief that they were “immune” from COVID somehow was all it took to seed the current mega-outbreak. Even if it is the “double mutant” variant that’s driving it, though, the good news is that the vaccines appear to work against that strain. BioNTech, which designed Pfizer’s vaccine, said a few days ago that it’s “confident” the antibodies generated by its product will be able to cope with the Indian variant. And new data out of Israel, where a few dozen cases of the Indian variant have been detected, seems to bear that out:

I'll just do point estimates.

Assume the 5 children were <16 and thus unvaccinated.

That gives us 32 cases among unvaccinated adults, and 4 cases among vaccinated adults.

The basic calculation for effectiveness then gives us a remarkable 98% against B.1.617. pic.twitter.com/efZQiQVvR1

— Carl T. Bergstrom (@CT_Bergstrom) April 30, 2021

Now—even with these worst-case assumptions—we estimate 92% effectiveness for the vaccine using the same calculation.

( 9/0.15-4/0.85) / (9/0.15) = 0.92.

Worst case point estimates is that the Pfizer vaccine is as effective against B.1.617 as it is against wild type.

— Carl T. Bergstrom (@CT_Bergstrom) April 30, 2021

India’s outbreak may yet produce a variant that threatens the immunity conferred by the vaccines but B.1.617 probably isn’t it.

I’ll leave you with this, which succinctly captures the magnitude of the problem and the fear the feds feel about someone importing a dangerous new strain here.

WASHINGTON (AP) — White House: On advice of CDC, US to restrict travel from India starting May 4 due to COVID-19 surge.

— Zeke Miller (@ZekeJMiller) April 30, 2021