COVID-19 is going to kill more people in 2021 than it did last year. If you want to see why, look at what’s happening in India.

Cases have been surging in the country of 1.37 billion people. On Sunday alone, 261,500 new infections were recorded. That’s as bad as the U.S. during all but the worst five days of the pandemic in December and early January.

Case counts are rising far more quickly, too. Average infection numbers over the past seven days have run at nearly three times the level two weeks ago, a pace of growth that the U.S. last saw in the early days of the outbreak a year ago.

The real numbers may be yet higher. The city of Bhopal used COVID-19 protocols to cremate or bury 84 people April 13, according to the Hindustan Times, while declaring only five COVID-19 deaths. The B.1.617 variant, which isn’t well understood yet, has features associated with higher infection rates and lower antibody resistance. It’s turning up in more than half of viral samples taken in India.

As caseloads push medical facilities toward capacity, the health system itself is starting to crack. Vaccine stocks, hospital beds and even oxygen supplies are running short, leading to bitter arguments between the states and the federal government.

In some places, the dead are being transported by truck because cities have run out of hearses. Elsewhere, crematoria have started to break down because of the sheer number of bodies being burned. The government Monday promised to open up vaccines to all people over the age of 18.

If things don’t change soon, the country will be facing 3,000 deaths a day — twice its current level, and 10 times what was being seen through most of this year — wrote Bhramar Mukherjee, a biostatistician at the University of Michigan, last week.

As my colleague Mihir Sharma has written, arrogance, hypernationalism and incompetence helped foster a fatal sense of complacency amid India’s apparent success against the outbreak earlier this year. Until a few weeks ago, lockdown restrictions had been progressively loosening for months. Cinemas were allowed to open to full capacity Feb. 1. Health Minister Harsh Vardhan declared the country “in the endgame of the COVID-19 pandemic” in early March, at almost precisely the point that cases started to surge again.

Worryingly, the clear signs of a second wave haven’t prompted much course correction since.

Worse may be to come. The Kumbh Mela, a Hindu pilgrimage festival that’s normally the largest mass gathering on earth, is underway on the banks of the Ganges, attended by an estimated 3.5 million people. That’s well down on the numbers in a normal year. Still, it’s far above the mere thousands allowed to other mass events, such as last year’s Hajj in Saudi Arabia and Arbaeen pilgrimage in Iraq.

Even held outdoors, such events carry a profound risk of spreading the most infectious variants to every corner of the country. Close to 10% of people returning to Gujarat’s largest city, Ahmedabad, from the festival tested positive for COVID-19 over the weekend, the Press Trust of India reported Monday. Hitherto, the coronavirus has mostly hit the relatively affluent, urbanized parts of the country that are best able to cope with it. If the Kumbh Mela seeds it in rural districts, where the majority of India’s population lives, the death toll could be higher still.

Vaccine supplies for the richest and, thanks to global initiatives, poorest countries are relatively ample. Yet those for middle-income nations, where the majority of the planet’s population lives, are grossly inadequate, blocked by restrictive patent rules. India, with one of the world’s largest pharmaceutical industries, is far better placed than most midsize economies to cope, but even it is crumbling under the strain.

The more people infected in emerging countries, the more opportunities COVID-19 will have to develop into fresh strains and prolong this death and misery.

David Fickling is a Bloomberg Opinion columnist covering commodities, as well as industrial and consumer companies.