When Saraswati Tamang Karki became ill with COVID-19 in a small village near Mount Everest, her family had to enlist the assistance of Nepalese soldiers and trekking guides to transport her to the nearest doctor.

On June 11, a group of 13 men took turns carrying the 44-year-old on a stretcher, hurrying up and down the narrow and winding dirt paths that lead from Monju to the Pasang Lhamu Nicole Niquille Hospital in nearby Lukla.

They completed the 15-kilometer (nine-mile) journey in less than four hours, but it was too late. Karki’s death was the fourth confirmed COVID-19 death in the Everest region since late April, when a Norwegian climber attempting to summit the world’s highest peak became the first person to test positive this year.

Residents of the remote region, however, are concerned that many more people will perish as COVID-19 wreaks havoc on the villages along the trails leading to Mount Everest.

Entire families have become ill, but there is a severe shortage of healthcare workers, hospital beds, and testing kits. The region’s 9,000 residents are served by only two rudimentary hospitals and five doctors. Since late April, approximately 400 tests have been performed, with nearly half of them returning positive results.

The worst hit by the latest surge are Lukla, the airport town that serves as the gateway to Mount Everest, and Namche Bazaar, a colorful market town at 3,440 meters where most trekkers stop to acclimate before continuing higher into the mountains.

However, the virus is also wreaking havoc on smaller settlements above the tree line. Pemba Dorjee Sherpa, a mountaineering guide who has climbed Mount Everest nine times, said he tested positive in late May, shortly after returning from the peak’s main campsite.

The virus was passed on to the 47-year-wife old’s and two children, who are now in home isolation in Pangboche, a village five kilometers from Everest Base Camp. Several members of Pemba’s team have also tested positive, and he claims that 15 of Pangboche’s 100 houses now have confirmed cases.

Nepalese authorities, who had cancelled the climbing season last year due to virus concerns, reopened Mount Everest to climbers in February this year, issuing a record 408 permits to those seeking to summit the peak and allowing thousands of tourists into the surrounding Khumbu Valley for multi-day treks.

Residents and trekking guides said they expected some cases in the area due to the influx of climbers and hikers, but it was the Nepalese government’s failure to enforce health protocols that caused the virus to spread throughout the area.

Nationals from India, Nepal’s southern neighbor, were also allowed into the Khumbu Valley without PCR tests, according to Furtenbach, despite a devastating outbreak wreaking havoc on hospitals and crematoriums across the Indian subcontinent.

Seven members of Furtenbach’s team at Everest Base Camp tested positive, prompting him to cancel his company’s expedition in mid-May. “When it became clear that there was a major outbreak in the base camp, the Nepalese government should have called an end to the season,” he said.

Authorities initially denied any reports of cases at the campsite and allowed the season to continue, even as the rest of the country went into a hard lockdown on May 6 due to a surge of infections in the capital, Kathmandu, caused by the Delta variant discovered in India, which was causing oxygen and ICU bed shortages.

While Nepalese authorities did close the Everest Base Camp to all but climbers and support staff following the outbreak, tourists told Al Jazeera that the virus was already spreading – possibly independently – at tea houses catering to hiking groups in the wider Khumbu Valley.

Residents in the Khumbu Valley have complained that the government of caretaker Prime Minister KP Sharma Oli – who recently dissolved parliament amid a bitter power struggle with a faction of his party – is not doing enough to combat the current outbreak.

Following that, he said, the next step would be to increase testing in the Khumbu Valley and vaccinate those most at risk. Otherwise, they might not be able to welcome tourists again in October, he said.