The devastating second wave in India is the result of a perfect storm: a failure to plan for a second wave; premature relaxation of public health measures; large gatherings; insufficient vaccination coverage; and newer variants such as B.1.1.7 and B.1.617 that are highly transmissible and potentially more severe. India has 95,000 intensive care beds and 48,000 ventilators. By mid-May, it is projected that the country will need 340,000 beds and more than 700,000 ventilators. Rural India has few of these and is already hit hard. India needs the global community’s support to survive this crisis. Even as India struggles to get the second wave under control, cases are surging among India’s neighbors, including Nepal, Pakistan, Bangladesh and Sri Lanka. While the exact variant driving the new surges among India’s neighbors is unclear, the B.1.617 variant has already spread to more than 18 countries.