UPDATE 25 May 2020
In Asia, India, Pakistan and Bangladesh are seeing exponential rises in their number of new cases and deaths each day suggesting that all three countries are yet to reach the peak of their outbreaks. (1)
India's strict lockdown has resulted in many factory workers have tried to return to their villages, sometimes walking several hundred miles to do so. Some have died on route. (2)
In South America too, cases and deaths are continuing to increase daily with Brazil now second only to the USA for the total number of cases. Brazil's president, Jair Bolsonaro, continues to attract severe criticism both at home and internationally for his refusal to acknowledge the seriousness of the pandemic. The USA has announced that no non-US citizens will be allowed into the country from Brazil. (3) (4)
UPDATE 18 May 2020
In Bangladesh, the first cases of COVID-19 have been confirmed in the Rohingya refugee camp in Cox's Bazar. Two refugees tested positive on 14 May and are now in hospital.
Refugee camps and city slums provide an ideal environment for the virus to spread and it is highly likely more cases will follow. (1)
Meanwhile the pandemic is tightening its grip on South America.
Brazil has now confirmed just under 250,000 cases and over 16,000 deaths amidst global concern over the chaotic response of its government. The Lancet, one of the world's oldest medical journals, took the unusual step of highlighting their concerns over Brazil in an editorial piece. (2)
Peru has recorded over 92,000 cases and Chile and Mexico have both recorded over 45,000 cases each but case numbers are rising exponentially throughout the whole of South America. (3) (4)
Original Piece 3 April 2020 (figures within article updated on 18 May 2020)
As COVID-19 continues to spread through the Western world people are questioning what will happen when it sweeps through the low income countries of Asia, Africa, and Latin America.
The worst numbers may come from these countries with slums and refugee camps disproportionately affected. Charities working in unstable regions fear civil breakdown may pose a bigger threat than the virus itself in places where volatile relationships between the populace and those in authority are often the norm.
Is it possible that COVID-19 will prove to be a disease of affluence, affecting high income countries with their higher than average levels of international travel and large, busy airports? Somewhat ironically, the good healthcare infrastructures of high income countries may also facilitate the spread of the virus as the risk of transmission of COVID-19 in health and social institutions with large vulnerable populations is considered high.
Or will the lack of healthcare and finance in low income countries mean that COVID-19 eventually becomes yet another disease of poverty, prevalent only in them when the worst of the pandemic is over?
The apparent incidence of Covid-19 in low income countries appears to be low with many countries reporting only a handful of cases. However this probably reflects a lack of diagnosis and testing rather than true low levels of disease.
All but two of Africa's countries have COVID-19 cases according to the head of the Africa Centers for Disease Control and Prevention, Dr. John Nkengasong, who also predicted that Africa will have 10,000 cases by the end of April. Unfortunately that proved to be a severe underestimate as there are currently already 87,000 confirmed cases across the continent on May 18th 2020.
Dr Nkengasong also reported that Cameroon, Ivory Coast and Burkino Faso have already run out of hospital beds and are appealing for tents so they can build makeshift hospitals.
Many African countries are imposing lockdowns but there are concerns that forceful enforcement of them is leading to violence and unrest in many places.
India currently has around 98,000 cases and has recorded 3040 deaths. The country is in strict lockdown but for those in the slums any form of social distancing is impossible. Three cases and one death were confirmed on April 2nd in one of the Mumbai slum populations, a worrying development. I have not been able to find reliable figures for the slums after that date.
Some are theorising that the climate of places such as Sub-Saharan Africa and India are too warm for the virus to thrive, let alone spread, but places such as Florida, with April temperatures of 26 to 28'C, are seeing between 500 and 1000 new cases per day which would infer that higher ambient temperatures do not impede the virus.
Whilst we are still learning about this particular virus, other viruses in the corona family vary widely in their preference, or indeed lack of preference, for certain temperatures and conditions so no assumptions can be made that this one will be influenced by seasonal variations.
The virus has killed a disproportionate number of the elderly across Europe and the USA leading to claims that the higher proportion of younger people in low income countries will have a semi-protective effect and keep the death rate low. However, the younger population are not necessarily a healthy population when malnutrition and diseases such as malaria, combined with a lack of adequate sanitation, are common place. Unfortunately it seems probable that these low income countries are only a few weeks behind the rest of the world and they are simply not equipped to deal with the pandemic.
To provide context, the NHS in the UK had approximately 4000 critical care beds at the beginning of March 2020, a figure which has increased dramatically as hospitals convert existing wards into critical care wards and the Nightingale Hospital in London opens with a potential capacity of a further 4000 beds. The average low income country in sub-Saharan Africa has just 50 critical care beds, according to a report done by the charity Save the Children.
Poorer countries are short of basics such as medical oxygen, not just technical equipment like ventilators. The risk of the pandemic gaining a firm hold in these countries needs to be addressed and quickly but a lack of equipment, both to diagnose and treat COVID-19, and a shortage of health care workers means these at-risk countries do not have the resources they need to respond to the pandemic. An internationally coordinated response is needed involving organisations such as the WHO and the World Bank. This kind of response has been implemented before, for example in 2014 during the Ebola virus disease outbreak in Africa. However, there is a fundamental difference with the COVID-19 pandemic and that is that the richer countries of the world are also dealing with the disease. There is little to suggest that the poorer countries of the world will be spared in this pandemic but the countries that normally sit around the table and spearhead international interventions are already struggling with their own problems back home. One fears that any international aid eventually offered will come too late to make a difference. https://www.ecdc.europa.eu/sites/default/files/documents/RRA-sixth-update-Outbreak-of-novel-coronavirus-disease-2019-COVID-19.pdf
