Globally, about one in every four people lives in one of South Asia’s three most populous countries, India, Pakistan and Bangladesh, which collectively occupy just 3% of the world’s total land area. The fast-moving Covid-19 pandemic has already entered this giant, concentrated population center, with an increasing number of reported deaths.
Worst-case estimations of the ultimate fatalities due to the coronavirus in South Asia may dwarf anything likely to be seen in the United States, Iran, China, Italy or anywhere else in the world.
Despite the obvious risk, South Asia, because of its unique social, economic and political realities, may not be able to continue for long some of the common measures taken in more advanced economies to stem the spread of the coronavirus that causes Covid-19.
Take for example the concept of “flattening the curve,” where the key premise is that as long as any country can keep the level of stress on its health-care system to a manageable level, it can provide treatment to even a large number of the infected, over a long period of time, without any systemic collapse. However, a flattened curve may not mean much if a country already has an inadequate health-care infrastructure able to withstand only a modicum level of system-wide shock.
The numbers of hospital beds per thousand people in Italy, Iran and China are 3.4, 1.5 and 4.2 respectively. Compare that against India’s, Pakistan’s and Bangladesh’s 0.7, 0.6 and 0.8. The number of physicians per thousand people stands at 4.09, 1.14 and 1.79 in Italy, Iran and China vis-à-vis 0.78, 0.98 and 0.53 of India, Pakistan and Bangladesh.
Statistics on intensive care units is imprecise but their numbers in the three major South Asian countries are estimated to be significantly less than in Italy or even Iran. In the entire country of Bangladesh for example, there are reportedly only 29 ICU beds that can adequately treat a Covid-19 patient, whereas the ideal ratio should one ICU unit per every 10 regular hospital beds. Madhya Pradesh, one of India’s larger states in terms of population, which is similar to Italy’s, has only 0.17 ICU unit per hundred thousand people.
South Asia also has the world’s most densely populated cities, making social distancing, the necessary component of a flattened curve, difficult to achieve.
South Asia is also home to some of the world’s largest slums. The Dharavi Slum of Mumbai houses a million dwellers, while Orangi Town in Karachi houses 2.5 million. Bangladesh, on top of its numerous slums around the capital Dhaka, houses close to 1 million Rohingya refugees from Myanmar in slum-like conditions. Social distancing is impossible under such circumstances.
Restricting unnecessary international travel, refusing entry to foreign travelers from affected countries, and shutting down borders are some of the measures being undertaken in South Asia in tune with other parts of the world. However, these options have already posed unique challenges, given that India, Pakistan and Bangladesh are world leaders for sending expatriate workers abroad – mostly to the Middle East, but many to Europe and North America.
For example, more than 300,000 South Asians work in Italy, and hundreds of them returned home over just a few weeks in March. Because of a lack of testing and enforced quarantining, many of the returnees went back to their everyday lives in densely populated South Asia.
Targeted quarantining of recently returned expatriate workers hit snags in Bangladesh, where news of forcefully held travelers inside quarantine centers with less than ideal conditions caused media outrage. Bangladesh handed over the job of managing quarantine facilities to the country’s military.
South Asian countries fare poorly in the Corruption Perception Index managed by Transparency International, where India, Pakistan and Bangladesh rank 80, 120 and 146 out of 180 countries monitored. These three countries also fare poorly in the global competitiveness index as measured by the World Bank, ranking 68, 105 and 110 respectively, as against China’s, Italy’s and Iran’s rankings of 12, 30 and 99 out of 141 countries.
The existence of rampant corruption and inefficient governments may explain why patients are fleeing from quarantine facilities in India and Bangladesh, perhaps fearing government-enforced isolation more than the coronavirus itself.
And it’s not just the patients – even some health professionals are now hesitant to provide care for their patients because of a lack protective gear. Reports from Bangladesh suggest many patients were denied treatment by doctors who were too scared to get near them.
Social and religious sentiments are complicating matters too. India, Pakistan and Bangladesh are home to more than 550 million of the world’s billion-plus Muslim population. Five-times-daily prayer congregations and massive religious gatherings are integral parts of the lives of South Asian Muslims.
Bangladesh has only succeeded in halfhearted disbandment of large gatherings including prayer congregations, following similar restrictions imposed in countries such as Saudi Arabia and Iran. Pakistan, despite its increasing death toll from the virus, is yet to prohibit mass prayers in any meaningful way, as of this writing.
Religious zeal has also given birth to misinformation tailored for the poor and the vulnerable in South Asia. Some religious Hindus were led to believe that drinking cow urine can fend off the coronavirus, since cows are held sacred in Hinduism.
South Asia’s political climate and sensitivities contributed to delays in decisive actions at the onset of the Covid-19 pandemic. Bangladesh was busy with the festivities surrounding the centennial birthday celebration of the country’s founder, who happened to be the late father of the current prime minister. Although much grander celebrations involving foreign dignitaries were postponed, government-funded concerts and fireworks involving large public gatherings continued as recently as late March.
India, under its nationalist Prime Minister Narendra Modi, is experiencing the worst economy in several decades, making it difficult for the country to continue the ongoing business shutdowns and social distancing for too long.
Pakistan’s maverick Prime Minister Imran Khan, who hails neither from the country’s powerful military nor from one of the established dynasties, is still new to power, with a ton of unfulfilled economic promises. Busy tackling the country’s already dire economic conditions, Khan at one point candidly admitted that Pakistan simply could not shut down its cities, as doing so would be a choice between death from the virus and death from hunger. Pakistan eventually went for partial shutdowns of several cities and businesses, some of which are now already reopening.
South Asia has been densely populated for millennia, and this region has experienced colossal pandemics before. During the 1918 Spanish flu outbreaks, the South Asian death toll was more than 17 million. Although no one yet expects the current pandemic to be remotely as lethal as that, the extremely contagious nature of this coronavirus among the South Asian population could still cause great distress, particularly given that the region is home one of the largest minority populations of all the major economies of the world, including those in Europe, the Middle East and North America.