KATHMANDU, Nepal – Ram Singh Karki escaped the first wave of the Indian pandemic by boarding a crowded bus and crossing the border into Nepal. Months later, as the rate of new infections declined, he returned to his job at a printing house in New Delhi, which had supported his family for two decades and helped pay for school fees for his three children.

Then India was swept away by a second wave, and Mr. Karki was not so lucky.

He was infected last month. New Delhi hospitals have been overwhelmed. When his oxygen level dropped, his manager organized an ambulance to bring him back to the border. He entered Nepal, taking with him just the clothes on his back – and the virus.

Nepal is now considering declaring a health emergency as the virus rages virtually unchecked in the poor country of 30 million people. Carried by returning migrant workers and others, a vicious second wave has stretched the country’s medical system beyond its meager limits.

Nepal has recorded half a million Covid cases and 6,000 deaths, figures which experts say deeply underestimate the toll. Testing remains limited. One number could indicate the real severity: For weeks now, around 40% of tests have been positive.

A government in disarray has compounded the problems. Besieged Nepalese Prime Minister KP Sharma Oli pushed for an election in November after the country’s parliament was dissolved last week, an event that could worsen the spread.

Earlier this week, Hridyesh Tripathi, Nepal’s Minister of Health and Population, said the government was considering declaring a health emergency as infections rose.

But such a statement could be taken into politics. The move would allow officials to curb popular movements – a level of control opposition groups fear could be used to quell dissent.

In the meantime, officials in the capital Kathmandu have urged people to store food for at least a week and stay home.

The impact spreads beyond those infected. Remittances from migrant workers have slowed. Tourism and the economy have been damaged.

“Millions of people continue to feel the growing pressure not only with the direct health impact of Covid-19, but also with food, jobs, medical bills, out-of-school children, repayment loans, mental pressure and much more, ”said Ayshanie Medagangoda Labe, United Nations Development Program Resident Representative in Nepal.

Nepal’s close relationship with India has helped make it vulnerable. India has long been its main trading and transit partner. The two nations share a deep cultural bond across a porous 1,100 mile border. Nepal’s devastation mirrors that of its big neighbor – from patients spilling into hospital corridors and onto lawns, to long lines at oxygen filling facilities, to an unprepared government to the crisis.

Officials say workers like Mr. Karki who were forced to return home by the second wave brought the virus with them. The villages along the border are among the most affected. Nepal’s health ministry said about 97% of cases sent for genome sequencing show the B.1.617.2 variant found in India, which the World Health Organization has classified as a “variant of concern.” world ”.

Nepalese leaders were not prepared. During India’s first wave last year, when a million Nepalese migrant workers returned home, Nepal instituted tests and quarantine measures at border crossings.

But in the second wave of this spring, these measures were too little too late. By the time Nepal closed two-thirds of its border crossings in early May, hundreds of thousands of workers had returned, entering their villages without proper testing and quarantine. Thousands keep coming back every day.

The government’s attention had shifted elsewhere. In February, as the virus appeared to be receding, Mr Oli organized rallies of thousands of supporters in Kathmandu and other cities. Opposition parties have organized their own rallies. Last year, Mr Oli said the health of the Nepalese people would deter the disease.

Government advocates say the pandemic is a global problem and officials are doing their best with few resources or vaccines.

Mr. Oli called for international help, although it will not be enough to meet Nepal’s needs. China has donated 800,000 doses of vaccine, 20,000 bottles of oxygen and 100 ventilators. The United States and Spain sent planes loaded with medical supplies, including oxygen concentrators, antigen tests, face masks and surgical gloves. The United States provided $ 15 million this month to step up Covid testing in Nepal. Nepalese migrant workers from the Gulf countries arranged for oxygen cylinders to be returned home.

But Nepal cannot fight the pandemic without India’s help. Already, an Indian vaccine maker has told Nepal it cannot deliver the promised million doses.

Nepal also depends on India for half of its medical equipment needs, according to the Nepal Chemical and Medical Suppliers Association, but the latter country is keeping pretty much everything for its own urgent national needs. Equipment from China, already expensive, has become more difficult to obtain due to restrictions from the Chinese pandemic.

“For a month now, India has stopped the supply of medical equipment and drugs as well, not just vaccines,” said Suresh Ghimirey, the association’s president.

In some provinces that have seen large numbers of migrant workers returning to India, hospitals are running out of beds. In Surkhet district, the main provincial hospital said it could not admit more patients. The small outlying villages quietly mourn their dead. The tests were slow.

“With the exception of a few villagers, many are unable to go out and do the daily farm chores,” said Jhupa Ram Lamsal, neighborhood chief in Gauri village, where nine people have died from Covid more than 10 days earlier. this month. “What is worrying is that even symptomatic people are not ready for Covid testing.”

Mr Lamsal said he had recently reached Gauri, who is in isolation and has no health facilities, with a team of medics performing antigen testing. Residents have rejected healthcare professionals’ request for Covid testing, he said, arguing that they would be discouraged if they found out they were positive.

“The situation is out of control,” Lamsal said. “We are hopeless, helpless.”

Mr. Kakri, the printing worker, was from a village in Bhimdatta Municipality in the western corner of Nepal. The area of ​​110,000 people has officially registered 3,600 infections, according to health chief Narendra Joshi. But the lack of border metrics means the data may not fully measure severity.

“More than 38,000 people have returned from one of the two border points in the district since the start of the second wave in India,” Joshi said. “It is difficult to manage them.

Mr Karki was a high school dropout who went to India to work as a laborer when he was still a teenager, said his wife, Harena Devi Karki. When he visited the house twice a year, he was the life of gatherings – making jokes, making fun. The $ 350 a month he sent home covered his family’s household expenses as well as private school fees for their two teenage daughters and a 12-year-old son.

Even when last year’s lockdown meant Mr Karki had been stranded at home for months with no income, he insisted the children continue to private school. He would pay off the debts once the printing press reopened. He dreamed of seeing his eldest daughter – “she is the most talented” – to become a doctor.

“I couldn’t finish my studies,” Ms. Karki remembers, telling her husband. “Let me eat less, but we should send them to a better school for their education.”

When Mr. Karki received her husband at the border around 2:30 a.m. on April 29, she said, he was frail and didn’t even have the energy to get up. He was taken to a nearby hospital, where he died.

“’Everything is fine. Go home,” her husband told her, Ms. Karki said. “But he never came home.