Devastating surge of new infections tears through Indian cities and rural areas, pushing healthcare systems to brink of collapse as credit agency S&P Global warns of impeded economic recovery and virus exposure of unvaccinated regions in South Asia.
India's toll from the coronavirus has surged past 200,000, the country's deadliest day yet, as shortages of oxygen, medical supplies and hospital staff compounded a record number of new infections.
The second wave of infections has seen at least 300,000 people test positive each day for the past week, overwhelming healthcare facilities and crematoriums and driving an increasingly urgent international response.
The last 24 hours brought 360,960 new cases for the world's largest single-day total, taking India's tally of infections to nearly 18 million. It was also the deadliest day so far, with 3,293 fatalities carrying the toll to 201,187.
Experts believe the official tally vastly underestimates the actual toll in a nation of 1.3 billion, however.
The world is entering a critical phase of the pandemic and needs to have vaccinations available for all adults as soon as possible, said Udaya Regmi, South Asia head of the International Federation of Red Cross and Red Crescent Societies (IFRC).
"This is both an ethical and public health imperative," he added. "As variants keep spreading, this pandemic is far from over until the whole world is safe."
Ambulances lined up for hours in the capital, New Delhi, to take Covid-19 victims to makeshift crematorium facilities in parks and parking lots, where bodies burned on rows of funeral pyres.
Patients flock to Sikh temple
Coronavirus sufferers, many struggling for breath, flocked to a Sikh temple on the city's outskirts, hoping to secure some of its limited supplies of oxygen.
Hospitals in and around the capital said oxygen remained scarce, despite commitments to step up supplies.
"We spend the day lowering oxygen levels on our ventilators and other devices as our tanks show alarmingly dipping levels," Dr Devlina Chakravarty, of the Artemis hospital in the suburb of Gurgaon, wrote in the Times of India newspaper.
"We make hundreds of calls and send messages every day to get our daily quota of oxygen. "
The Mayom Hospital nearby has stopped new admissions unless patients brought oxygen cylinders or concentrators with them, its chief executive, Manish Prakash, told television channel NDTV.
Delhi Chief Minister Arvind Kejriwal said people were falling sick more severely and for longer, stacking up the pressure.
"The current wave is particularly dangerous," he said.
"It is supremely contagious and those who are contracting it are not able to recover as swiftly. In these conditions, intensive care wards are in great demand."
Supplies arriving in New Delhi included ventilators and oxygen concentrators from Britain, with more sent from Australia, Germany and Ireland.
"First shipment of oxygen generators from #Taiwan to #India is leaving this week," Kolas Yotaka, a spokeswoman for Taiwan President Tsai Ing-wen, said on Twitter. "We are all in this together."
Canadian Prime Minister Justin Trudeau committed $10 million, adding on Twitter, "We stand ready to donate extra medical supplies, too."
Credit rating agency S&P Global said India's second wave of infections could impede its economic recovery and expose other nations to further waves of outbreaks.
The Asia-Pacific region, in particular, was susceptible to contagion from the highly infectious variants in India, given the region's low ratios of vaccination, it added.
Epidemiologist Bhramar Mukherjee called for much larger lockdowns.
"At this point, lives are so much more important than livelihoods," the University of Michigan professor said on Twitter. "Provide assistance to the poor, but please lockdown and vaccinate."
US President Joe Biden said he had spoken at length with Indian Prime Minister Narendra Modi on issues such as when the United States would be able to ship vaccines to the South Asian nation, and added that it was his clear intention to do so.
"I think we'll be in a position to be able to share, share vaccines, as well as know-how, with other countries who are in real need. That's the hope and expectation," he told reporters at the White House on Tuesday.
The US State Department's coordinator for global Covid-19 response, Gayle Smith, warned that India's challenge called for a sustained effort: "We all need to understand that we are still at the front end of this.
IT companies scramble to handle surge
India's giant IT firms in Bengaluru and other cities have set up Covid-19 "war-rooms" as they scramble to source oxygen, medicine and hospital beds for infected workers and maintain backroom operations for the world's biggest financial firms.
Banks including Goldman Sachs and Standard Chartered, which run much of their global back office operations from large office parks in Bengaluru, Chennai or Hyderabad, have put in place the infrastructure to vaccinate thousands of employees and their families, when age restrictions are lifted on May 1.
Workers at huge technology service providers Accenture and Wipro say teams are working 13-14 hours daily, under growing pressure and struggling to deliver on projects as staff call in sick and take time off to care for friends and relatives.
They play down any threat of a collapse in operations - but at stake if the surge continues is the infrastructure put in place by the world's biggest financial companies in cost-cutting drives that have left them deeply-reliant on the big Indian offices.
"Employees have contracted Covid-19 since the second wave began, causing severe pressure for projects that are nearing deadlines," said one employee at Accenture, asking not to be named because he was not authorised to speak to the media.
Five other sources at Accenture confirmed the growing issues with pressure of work. Accenture said it was providing some medical care and covering the cost of vaccinations for its employees but did not comment on the impact on productivity. Wipro did not immediately respond to requests for comment.
Asia's IT capital Bengaluru, desperate to calm a daily infection rate five times higher than in last year's first wave, on Monday ordered a full lockdown that allows ordinary residents to leave their homes only briefly between 6 a.m. and 10 a.m.
Local IT managers say they struggled to get global chiefs outside India to recognise the seriousness of the outbreak.