The Philippines is battling the worst Covid-19 surge in southeast Asia, a pummeling that is overwhelming some hospitals and could cause a humanitarian crisis.

The situation is so dire in the nation of more than 7,000 islands that even one of the country’s former presidents had to spend the night in an emergency room because there were no regular beds available. Ex-President Joseph Estrada was rushed to the hospital in Manila on March 28 as his infection worsened, and he was later admitted to the intensive- care unit and put on a ventilator.

Others aren’t making it into the hospital at all, instead dying inside tents set up outside as they wait to be admitted, at home or in ambulances. Nearly 1 in 5 Covid tests are coming back positive, indicating that the infection continues to spread undetected in many areas.

Vaccination rates in the Philippines, meanwhile, lag behind many of its neighbors. The problem, the country’s health leaders say, is the arrival of novel variants that are more virulent and dangerous.

“It’s not that we aren’t prepared,” Health Undersecretary Maria Rosario Vergeire said. “The increase in the number of cases was something not expected. Unfortunately, the variants have spread faster, and the increase has been tremendous.”

The country is doing what it can, with President Rodrigo Duterte putting the Manila metropolitan area and nearby provinces in lockdown until Sunday. Still, new infections are hitting record levels, with an average rate of more than 10,000 new cases diagnosed every day, and deaths that have topped 13,000.

Local residents, afraid the health-care system will collapse entirely, are buying equipment like oxygen tanks and unproven medications to prepare for a potential infection. Already more than 80% of ICU beds in Manila are filled, and 60% of the nation’s ventilators are in use.

More than a year after the virus emerged, its continuing to cause the same problems—just in different locations.—

Michelle Fay Cortez