The Covid-19 outbreak that has overwhelmed hospitals in New Delhi and Mumbai is spreading to states across India, as the world’s fastest-growing Covid-19 surge shows no signs of slowing.

The country hit a new global high for the pandemic on Wednesday reporting more than 360,000 new daily cases. It recorded 3,293 deaths, the highest single-day toll for the country.

New Delhi and Maharashtra, the state that is home to the country’s financial capital of Mumbai, account for about a quarter of India’s three million active cases. But cases are now rising fast elsewhere—in some of India’s largest and most populous states, including Uttar Pradesh, West Bengal, Tamil Nadu, Karnataka and Kerala. Those five states, with a combined population of over 500 million, now account for about 35% of the country’s active cases.

In the southern state of Kerala, the number of new cases being reported has risen to more than 30,000 a day, from around 13,000 two weeks ago. Hospitals there are beginning to see some of the same strains as those in New Delhi and Mumbai.

Since last week, there have been long lines at the KIMS hospital, a private facility in the state capital of Thiruvananthapuram, said Dr. A. Rajalakshmi, senior consultant of infectious diseases at the hospital.

“We don’t have infinite resources. We have to say no to patients. We have no option but to send some back,” Dr. Rajalakshmi said. “The hospital has already stretched its general wards to treat coronavirus patients, as Covid numbers are expected to rise steeply in the near future.”

The rapid increase in cases across India has been fueled by a combination of factors. As cases dropped in recent months, the public and governments got more relaxed about pandemic safety measures such as wearing masks and social distancing. Public gatherings, small and large, resumed. Highly infectious new variants are also potentially playing a role.

We don’t have infinite resources. We have to say no to patients. We have no option but to send some back.

— Dr. A. Rajalakshmi, senior consultant of infectious diseases at KIMS hospital in Thiruvananthapuram.

The Hindu Kumbh Mela festival drew more than 3.5 million people from across the country to the Himalayan state of Uttarakhand in April, according to state data. On March 31, the day before the festival began, the state reported 293 cases. On Wednesday, the daily number had shot up to more than 6,000.

The state government has imposed a weeklong lockdown. On Tuesday, the first day of the lockdown, most areas of the state were quiet, with markets and shops closed. The city of Haridwar, where Hindu pilgrims had flocked to the banks of the Ganges River earlier this month, was mostly deserted. Even the temples were silent. The sound of an occasional ambulance broke the silence, and the only signs of activity were the lines forming outside of pharmacies.