Like India, Nepal is experiencing a devastating outbreak of Covid-19 as the virus crosses the porous border between the two nations. While Nepal has fewer cases than its larger southern neighbor, it reports more cases and deaths per million people.

“Nepal is on [a] steeper trajectory in terms of basically all metrics in the Covid outbreak on a per capita basis,” said Andrew Schroeder, Direct Relief’s Vice President of Research and Analysis.

The country is reporting nearly 9,200 cases per day, which translates into a seven-day rolling average of about 296 cases per million, according to the Johns Hopkins Covid-19 Dashboard by the Center for Systems Science and Engineering. In comparison, India is reporting 231 daily cases per million, though the country’s daily case totals have consistently hovered at or above 300,000.

The case burden has taxed Nepal’s already fragile health care system, leading to critical oxygen and medical supplies shortages. According to an announcement by Nepal’s Ministry of Health and Population last week, hospitals in about one-third of the country’s 77 districts are at or near capacity.

Since April, the outbreak in Nepal has followed a steep upwards trajectory, with cases officially peaking at 9,317 per day on May 12. Cases and deaths have since declined, albeit marginally. “There’s some indication that the worst of the indicators are flattening out,” said Schroeder, who pointed to the reproduction rate, or the number of people infected by one Covid-positive individual. At the end of April, that number was 2.1, meaning for every one person infected with Covid-19, two more would contract the virus. Now, the country’s reproduction rate is closer to 1.25.

Still, Schroeder cautioned against drawing concrete conclusions: “Officially speaking [the outbreak] has peaked, and it is declining, but that’s probably not the case.”

Due to a lack of testing, cases are almost certainly missing from official tallies. And because of gaps in health care services, many of those cases are likely hiding in rural areas.

“Although the hardest hit area is the Kathmandu Valley…as you go out from the major city, you’ll now see these waves of Covid hitting areas…that are lower density but have very poor health infrastructure,” said Schroeder.