Is South Asia a Ticking Time Bomb for the Coronavirus?
WHY YOU SHOULD CARE
The world's most densely populated region has so far reported the fewest COVID-19 cases. But the reality might be far more grim.
The third-year medical student at Wuhan University thought she had “escaped hell by just a whisker.” A day before the Chinese government imposed a lockdown on Wuhan, ground zero of the COVID-19 pandemic, the 20-year-old woman packed her bags and left for her home in the southern Indian state of Kerala. But a few days later, the aspiring doctor would be diagnosed as India’s first patient infected by the new coronavirus and placed under quarantine — first in a hospital for 25 days, and then at home for another 10 days.
Now recovered, the young woman who requests anonymity, recalls the horrors of her time in isolation. “I would keep reading about the deaths on my smartphone and only hope to survive,” she says. Her emotional rollercoaster of a ride — from relief at escaping Wuhan to the fear of death — mimics the shifting fortunes of India and its neighborhood, a region that could prove central to global efforts to combat the coronavirus.
The world’s most densely populated region, South Asia is home to a quarter of the planet’s people, yet has so far reported just 169 cases, or a little more than one in every thousand of the total 156,000 patients globally. India has reported 102 cases, Pakistan 31, Afghanistan 11, Maldives 10, Sri Lanka 10, Bangladesh 3 and one each in Bhutan and Nepal. Two people — both in India — have died.
But growing evidence suggests that the virus is far more widespread in the region, sparking concerns among leading public health experts and virologists that South Asia might be a time bomb waiting to explode. The region’s countries have focused their prevention strategy on scrutiny of incoming travelers at their international airports. India, for instance, said in early March it had screened 650,000 arriving passengers over the previous five weeks. But it was watching the vast majority for visible symptoms, and fewer than 1 percent actually underwent tests. And several cases appear to have slipped past, coming to notice only later, after they had been in contact with dozens of people.
On March 8, the Kerala government declared three confirmed cases of the virus — people who had returned from Italy more than a week earlier. A 76-year-old American tourist was diagnosed with COVID-19 in Bhutan, after he had spent several days previously in India, traveling up the Brahmaputra river on a houseboat. Bangladesh’s first three cases of the coronavirus were all people who had recently returned from Italy but weren’t identified as positive at the airport. The cases in Pakistan too — all involving recent travel to Iran or Italy — weren’t detected at airports.
India saw the signals of a tsunami but is staying on the seashore hoping and even believing it will not come.
T Jacob John, virologist, Christian Medical College, Vellore
Last week, the Indian government suspended most visas for foreigners until April 15, a drastic step that appeared to acknowledge its failure in screening visitors at airports. It has also banned passengers and crew from all foreign cruise ships until March 31. And on Friday, Indian Prime Minister Narendra Modi called on his other South Asian counterparts to prepare a joint regional strategy to combat the virus.
But that delay on the part of India and the region in shifting focus to the possibility of community spread means they’re now struggling to track all those who were in contact with patients, say experts. An unmatched population density makes social distancing harder than anywhere else in the world. Limited and overstretched medical resources make any response to a crisis more challenging: India has only 52 testing centers for a population of 1.3 billion people. And a wave of false and dubious information — including some peddled by governments — makes the task of the medical community even harder.
“India saw the signals of a tsunami but is staying on the seashore hoping and even believing it will not come,” says T. Jacob John, emeritus professor of virology at Christian Medical College, Vellore, one of India’s top medical schools. “In all likelihood, India will have a national disaster in a few weeks to months. The South Asian nations have fragile and skimpy health management capacity in the best of times — what about the worst of times?”
Meanwhile, the low number of cases shown means South Asian nations aren’t on the blacklist of other countries. Does that mean that a greater spread in India, Pakistan or Bangladesh than reported could lead to people unknowingly carrying the virus elsewhere too?
“Of course,” says John.
Holes in the airport screening approach remain a part of the problem. It doesn’t help that many travelers are likely “people who show such mild symptoms that no one can tell,” says Dr. Amesh Adalja of the Johns Hopkins Center for Health Security.
But while community spread through people with few visible symptoms is a global phenomenon, it’s particularly worrying in South Asia. “More the density of the population, the faster the virus spreads,” says John. “So South Asia will have [an] avalanche sooner than later — and other small land-slides, later but for sure.”
What makes the challenge even more acute in the region is the lack of adequate basic facilities such as personal protective equipment, ventilators or intensive care units, says John. That makes any move to random testing among communities, as a strategy, difficult for countries like those in South Asia. It also means that death rates among vulnerable populations — such as patients who also have pneumonia or acute respiratory distress syndrome — could eventually prove higher in India than in the West, he adds.
A flood of misinformation over claimed cures that has swept the region is also worrying doctors and scientists. In India, some legislators have claimed cow urine and cow dung could heal you from the coronavirus — assertions with no scientific basis. India’s government has suggested that a cocktail of six herbs could help treat the virus. Meanwhile, in Sri Lanka, a misleading Facebook post suggested an incorrect way of wearing face masks.
The spread of misinformation, on top of the coronavirus, is a scenario South Asia — and the world — can ill afford.
(Correction: An earlier version of this story referred to comments made to other publications by Oommen Kurian, a senior fellow with the Observer Research Foundation. OZY recognizes that it might not have been fully clear who Kurian made those comments to. Kurian’s comments have been withdrawn.)