COVID-19's Spread is Accelerating in the Developing World
While many nations have been protected so far, it seems their luck may have run out.
COVID-19 is not ending, in fact it has barely started.
America and western Europe have begun to adjust to a new normal. Case numbers are flat or declining, stores are starting to open up, and politicians are working to clean up some of the economic damage. While there is still a feeling of unease concerning a second wave of coronavirus, attention has moved to more immediate issues. Unfortunately, other areas of the world are only beginning to see the worst of coronavirus.
During the opening months of the COVID-19 pandemic many noted the conspicuous lack of cases in the developing world. Countries like India, Brazil, South Africa, and Bangladesh seemed underprepared for this pandemic, given the high population density, weak government institutions, and under-resourced health care systems. But, for whatever reason, coronavirus didn’t take off. Some speculated that the warmer weather or the younger populations might offer some protection. Others suggested that case numbers were artificially suppressed due to low testing, or deliberately doctored data. Whatever the case, things have started to change, and the numbers have started to climb.
On Saturday May 30th, there were 124,103 new cases of coronavirus reported worldwide according to Worldmeter (all statistics from this article are sourced from Worldmeter as of May 30/31 unless otherwise specified). This was the second highest single day batch of cases that has been reported. May 29th had 125,473 new cases — the most of any single day in the pandemic. 116,304 cases were reported May 28th – the day with the third highest load of new cases. Numbers are starting to climb again after almost a month of relative stasis.
It is impossible to capture what is happening across the entire globe, as every country and community is dealing with the crisis differently. Looking at a handful of countries may give an impression into what is occurring across the developing world. This article examines a few countries that offer warning signs for what the coming months may look like.
Brazil has had one of the worst COVID-19 responses of anywhere in the world. President Bolsonaro has continually downplayed the threat of the virus. He even joked that Brazilians might have some special resistance to the virus, saying “They can jump in raw sewage and nothing happens”. In reality, Brazil’s has quickly become the country with the second most reported infections, with over half a million confirmed cases. Worse, the rate of spread is accelerating. 30,102 new cases were reported May 30th, which is almost twice as many as was reported the week before. An exponential trend can be seen in the new cases being reported.
As worrying as these numbers are, they are certainly a massive undercount. Brazil has conducted only 930,013 tests, with a rate of 4,378 per million citizens. For comparison, the United States has conducted over 15 million tests, and has performed about 52,000 tests per million people. Over 50% of Brazil’s tests are positive — compared to a 10% positive test rate in the U.S. — which strongly suggests that there are a tremendous number of COVID-19 infected individuals who have not been tested.
News from inside Brazil is deeply concerning. The Rio Times reported that ICU bed occupancy is exceeding 91% in São Paulo as of May 25, and the Brazilian Report has noted that meat production may drop by 35% as a result of infections in slaughterhouses. Neighbouring countries like Chile are reporting overwhelmed hospitals, while Peru has reported over 164,000 cases. Given current conditions, there is a no reason to believe that the spread should slow in the coming weeks.
Initially, there was hope that India might avoid the scourge of coronavirus. The country instituted a strict 21-day lockdown starting March 24. At the time, India had reported only 534 confirmed cases in a country of 1.3 billion people. This intervention appeared to slow the spread. By the end of April, the country had under 35,000 confirmed cases — about the same number as Florida.
May has been a different story. As the lockdowns have eased, and testing rates increased, the COVID case number has begun to climb. By the end of May over 180,000 cases have been confirmed. The rate of spread is also continuing to accelerate — May 27, 28, 29 and 30 were each record breaking days for new case reports. While the overall infection rate in the country remains low (as far as we can tell) it is possible that a month or two from now that India will be leading the world in total case numbers. Similar trends are playing out in India’s neighbors Pakistan and Bangladesh.
Inside the country, it appears that Indians — or at least the Indian government — has lost patience with the lockdowns. The national government has announced phase 1 (known as “Unlock 1”) of their reopening process for June 8th, which allows malls, hotels, and places of worship to operate. State governments have been granted some autonomy in managing the virus, given that different regions have been affected unevenly, but since travel is not strictly regulated between states, there is a concern that the disease will spread between regions.
Iran was one of the first countries outside of China to be hit with COVID-19. By March 1st, they were already reporting almost 1,000 cases, while the U.S was still under 100. What was particularly striking about Iran’s statistics was the mortality rate, which climbed as high as 14% on some days. While early months were very difficult, by the end of April it seemed that the worst was over. New cases and deaths had been dropping. There was hope that the month of May would continue the trend, and the disease would be under defeated.
Unfortunately, Iran has been hit by a second wave. Case numbers that had dropped to under 1,000 per day by the end of April, have now returned to over 2,000 per day. This is unlike the “second wave” that was reported in East Asian countries in mid-March, which was largely over-hyped. Iran’s second wave has been a sustained increase in case numbers over the last month. Deaths in this second wave has remained mercifully low, with the overall mortality rate settling to approximately 5.2%, but it is always possible for this trend to reverse as well.
So far, Africa has been spared from the worst of COVID-19. The entire content, with its population of 1.2 billion people, still has less cases of coronavirus than New Jersey. Testing in Africa has not been great, but given the relatively low caseloads, it is not out-of-step with the rest of the world (source). Still, there is reason to be concerned that their luck may be running out.
South Africa had the highest case load of any African nation at present, with just under 31,000 cases as of May 30. While this number is low, it is twice the number of cases that were reported on May 16, and more than 4-times the amount reported on May 2. COVID-19 appears to be doubling every two weeks — a much slower doubling rate than was seen in the U.S. and Europe during the worst of the pandemic, but still a deeply concerning trend if it were to continue.
Egypt’s doubling rate is almost identical. There were 6,193 on May 2; 11,719 on May 16; and 23,449 cases as of May 30. As of yet, Egypt has not implemented a strict lockdown, so it is possible that government intervention will reverse this trend. Of course, this will require the leadership taking the pandemic more seriously, which so far, they have been unwilling to do.
While the statistics in South Africa and Egypt are worrying, it is far better to have the data than not have the data. Tanzania’s President has been accused of suppressing COVID-19 testing. The government has not released new test results for the last month, and the opposition party has claimed that there are 10,000–20,000 undisclosed cases in the country. According to some observers, life in the country is continuing more-or-less as normal, meaning minimal social distancing.
While this is the most flagrant case of dishonest reporting, there are concerns that several other countries are not being transparent with testing numbers. For example, Sudan has reported only 401 tests, but says there are 4,800 cases in the country. It is likely the case that wealthier nations will need to provide resources to develop robust testing capacity along with trustworthy reporting systems. Without these measures in place, COVID’s gradual spread could continue, overwhelming medical facilities, and leading to a rise in mortality.
These outbreaks are not simply a concern for those inside these countries. As long as COVID-19 is circling the globe the world economy will continue to be in a deep-freeze, and the risk of a second wave will remain high. This is aside from concern for the suffering and loss of human life. President Trump also severed all connection to the WHO, meaning they will have few resources to address this growing pandemic. This may leave these impoverished nations to take on this horrible disease on their own.