India’s nightmare: Record high cases, vaccine shortages, hospital fires.

It was supposed to be a day when India made a bold step forward in its fight against Covid-19, when everyone 18 and older in its vast population became eligible to be inoculated. Instead, several states reported that vaccine shortages had forced them to delay expanding access, and the country’s latest report of cases remained higher than any other has ever reached.

India’s long, nightmarish day began with a hospital fire in the western state of Gujarat that killed at least 16 Covid-19 patients and two health care workers, the latest in a series of deadly accidents to strike the country’s overwhelmed health system.

As families of the sick fill social media with pleas for oxygen and cremation grounds burn thousands of bodies daily, India has gone from declaring victory over Covid to suffering its gravest emergency in decades.

India has pushed the world record for daily new cases higher and higher, reporting 401,993 new cases and then 392,488 over the weekend. It is averaging over 3,000 Covid deaths each day, with more than 200,000 dead in total. And evidence suggests the official numbers vastly understate the toll.

While it is a global power in vaccine production, India didn’t purchase enough doses to protect itself. When its cases were relatively low, it exported more than 60 million shots; now exports have essentially been shut down. The chief executive of Serum Institute of India, the world’s largest vaccine manufacturer, is in Britain, having come under increasingly intense pressure at home.

Less than 2 percent of India’s 940 million adults have been fully vaccinated, according to data compiled from government sources by the Our World in Data project at the University of Oxford. Officials in Delhi, the capital, and big states like West Bengal and Karnataka have announced that the planned expansion of vaccine eligibility to everyone 18 and older is on hold because of shortages.

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“As soon as vaccines arrive, we will let you know, then you can come for shots,” said Delhi’s chief minister, Arvind Kejriwal, the BBC reported. “We appeal to you not to crowd vaccine centers in the next few days.”

As long as vaccines are in short supply and the virus is running rampant, experts warn that dangerous variants will evolve, spread and possibly evade vaccines. That could eventually pose a threat even for countries like the United States, where 40 percent of the population is fully vaccinated. Michael Diamond, a viral immunologist at Washington University in St. Louis, said that the only way to break the cycle is to ensure countries like India get enough vaccines.

“In order to stop this pandemic, we have to vaccinate the whole world,” Dr. Diamond said. “There will be new waves of infection over and over again unless we vaccinate at a global scale.”

India has a homegrown variant called B.1.617, which some in the news media and medical industry have concluded is responsible for the ferocious second wave.

Researchers outside of India, however, say the limited data so far suggests that a better-known variant may be more to blame: the highly contagious B.1.1.7 variant that was first found in Britain and is now the most common source of new infection in the United States. All of the major vaccines in use have been shown to be effective against B.1.1.7.

Dr. Anthony Fauci, President Biden’s Covid adviser and the top U.S. infectious disease expert, said in an interview with The Indian Express that to get a clearer picture, genetic materials could be sent from India to Britain and the United States to be sequenced, though U.S. efforts only recently ramped up.

Dr. Fauci also said India should consider another lockdown, a politically charged subject in a country that shut down early in the pandemic, some say prematurely. In recent weeks, a Hindu festival with millions of worshipers was allowed to take place and Prime Minister Narendra Modi appeared maskless at campaign rallies with thousands of supporters who also weren’t wearing masks.

“No one likes to lock down the country,” Dr. Fauci said.

“But if you do it just for a few weeks,” he added, “you could have a significant impact on the dynamics of the outbreak.”

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