All across Asia, countries are bracing for a devastating second COVID-19 wave like the one killing thousands of people a day across India.

In 2020, the region moved quickly to implement strong public health measures as early cases began to surface. That allowed it to fare relatively well against the pandemic. But now, many countries are facing exponential increases in case numbers—and the situation may get worse.

“What we are seeing in Southeast Asia are the initial symptoms—that cases are increasing in a similar manner to what we were seeing four weeks ago in South Asia,” he says. “The second wave is really creeping across Asia, spreading from South Asia to Southeast Asia,” said Abhishek Rimal, the Asia Pacific emergency health coordinator at the International Federation of Red Cross and Red Crescent Societies (IFRC).

In Jan. 2020, Thailand became the first country outside of China to confirm a case of the disease that became known as COVID-19—but it successfully fought off the pandemic for most of the year, recording less than 5,000 cases in a population of 70 million by mid-December. Now the total has skyrocketed 18-fold to more than 90,000 cases as this onetime COVID success story battles a worrying new surge.

“We don’t have enough beds, we don’t have enough ventilators,” Anucha Apisarnthanarak, the chief of the infectious diseases division at Thammasat University Hospital, about 20 miles north of Bangkok, told TIME.

Thailand’s neighbour Cambodia avoided the worst effects of the pandemic, moving quickly to shut down schools and entertainment venues, ban domestic travel and close borders. By mid-February, less than 500 total cases had been reported in a country of 16.5 million people. Now it is recording that many cases each day. For a poor nation with an underfunded health system, this is a potential catastrophe, prompting Prime Minister Hun Sen to warn that the country was “on the brink of death.”

Across the border in Laos, officials have reported less than 1,500 cases, but the caseload has increased almost tenfold in the last three weeks—and the landlocked country reported its first COVID-19 related death on May 9. On May 12, Malaysia reported 39 coronavirus-related deaths—the biggest daily tally of fatalities the country has seen since the pandemic began.

Infections are meanwhile spiking in Vietnam. It has notched just 3,740 cases since the start of the pandemic, but community transmissions began climbing sharply in mid-April and health workers have been told to prepare for 30,000 patients. Prime Minister Pham Minh Chinh said the new outbreak would threaten political stability in the communist-ruled state if not brought under control.

In the wealthy city-state of Singapore, the number of cases of community transmission increased to 71 in the past week, up from 48 the previous week, and the number of cases without a link to known cases has risen to 15 over the past 7 days.

The world’s most populous Muslim-majority nation, Indonesia, is braced for a COVID wave in the wake of the recently concluded Ramadan, which saw authorities struggle to enforce a domestic travel ban. And the Philippines is battling a stubborn coronavirus surge despite having subjected its people to one of the world’s longest and strictest lockdowns.

The causes of the outbreaks across Southeast Asia vary, but Meru Sheel, an infectious disease epidemiologist at Australian National University, says that the devastating surge on the subcontinent may be having knock-on effects. India is recording more than 350,000 official cases a day—a number that experts believe is an undercount.

In Malaysia, the prime minister announced that a nationwide lockdown in place for about a month already will continue, and he gave no date for the lifting of restrictions.

His government had previously said the strict curbs would be eased in stages, as long as there was a drop in infections, intensive care bed use and a rise in vaccination rates.

Bangladesh also said it would impose a new national lockdown, with offices shut for a week and only medical-related transport allowed.

The announcement prompted tens of thousands of migrant workers to desert the capital Dhaka, where the lockdown will cut off their revenue sources.

The most serious surges have been seen in Taiwan and Vietnam - places which are only now experiencing the full brunt of a Covid wave.

In Taiwan, a slight easing of quarantine rules for airline pilots led to a rapid cluster, while in Vietnam, a fast-moving new variant has seen multiple clusters spring up, exacerbated by community gatherings.

South Korea and Japan hit new heights in Covid waves a few months back - prompting alarm, particularly in Japan where many are concerned about the upcoming Olympic Games.

With Covid-19 likely to become an endemic disease, the only way out for countries is through vaccination.

The Philippines, a country of 109 million people was already struggling to contain one of the region’s worst outbreaks when numbers began to climb sharply upwards in March this year. Typical daily caseloads have ranged from 3,000 to 7,000 in the past three months, but have been as high as 10,000 or 11,000, and hit an official peak of 15,310 on Apr. 2—a figure that is almost certainly an undercount. Less than 5.5% of the population has been vaccinated, according to WHO figures.

– Agencies