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A Coronavirus Mystery: Why Are There So Few Cases in South Asia?
India, Pakistan, and Bangladesh are home to nearly a quarter of the world’s population but account for only 2 percent of confirmed cases of COVID-19.
BY RAVI AGRAWAL | APRIL 30, 2020, 4:52 PM
Residents of a slum in Kolkata, India, line up to receive relief packages on April 30. DIBYANGSHU SARKAR/AFP VIA GETTY IMAGES
Welcome to Foreign Policy’s weekly South Asia Brief. Today, we attempt to explain why there are so few coronavirus cases across the region. Plus: Another deadly attack rocks Afghanistan, a constitutional crisis brews in Sri Lanka, and the death of two Bollywood legends.
If you would like to receive South Asia Brief in your inbox every Thursday, please sign up here.
Why Aren’t There More Coronavirus Cases in South Asia?
Let’s face it: Everyone expected worse. More than three months after the first recorded case of the coronavirus in South Asia, the region has only around 60,000 confirmed infections. By comparison, the United States has more than 1 million, while Spain and Italy both have confirmed more than 200,000. Put another way, South Asia’s countries account for one-quarter of the world’s population but only 2 percent of its coronavirus infections. Why?
Parsing the numbers. South Asia’s relatively low case numbers are a bit of a puzzle, especially given high population density and poor health care systems across the region. An immediate reaction is to call into question its testing capacity. India has so far conducted only 830,201 tests, or 614 for every 1 million people—among the lowest rates of testing in the world. But if India’s low rate of testing were hiding a massive outbreak, it would show up in other ways. Only 4 percent of India’s coronavirus tests have returned positive, compared with around 17 percent in the United States, implying that the virus is less widespread in India.
Another indicator of a larger outbreak would be the number of deaths. But here the data also shows South Asia in a favorable light. While the United States has recorded more than 60,000 deaths from COVID-19, India counts only 1,079 so far. Those numbers are likely higher—only one-fifth of deaths in India tend to be medically certified—but it is not as if there has been a massive surge in hospital admissions.
Using India’s data as a proxy for the region, the likely takeaway would be that South Asian countries have either succeeded in flattening their curves for now or that they are still in the early stages of their outbreaks. If it’s the latter, then the current state of lockdown ensures the coronavirus won’t spread too rapidly.
Successful approach? Has South Asia succeeded where Western countries have failed? Countries such as India and Bangladesh have imposed stricter lockdowns than the West—and earlier in their respective outbreaks. In that sense, South Asian economies should be commended for moving quickly in response to the shutdowns in other countries. With the exception of Pakistan, which for a while allowed flights to China, most of the region’s countries imposed strict restrictions on international and domestic travel.
Even that doesn’t completely explain the low number of cases. After all, even after closing the borders, the number of cases rose internally. And many South Asian countries made vital errors. India announced its nationwide lockdown with no prior notice, leaving millions of migrant workers displaced and vulnerable. Across the region, gatherings of religious groups took place in early March, leading to coronavirus clusters.
To their credit, authorities seem to have had some success in contact tracing and imposing quarantines. One theory goes that the region’s youthful demographics give it an advantage. India, for example, has a median age of 28, compared with 38 in the United States. (The median ages in Afghanistan, Bangladesh, and Pakistan are 18, 26, and 24, respectively.) But even here, if there are many asymptomatic cases among young people, then those may eventually show up in infections among elderly populations—and that has yet to be recorded.
Other theories are more tenuous. For example, the World Health Organization says there is no evidence that the Bacillus Calmette-Guérin vaccine—widely deployed in South Asia to fight tuberculosis—provides protection from the coronavirus. Nor is there proof that warmer weather slows the spread of the coronavirus.
Summer strategy. There is no real end to the pandemic unless the world can develop a vaccine. That means it’s too soon to declare any country’s approach a success. And there lies the real problem for South Asia. Countries are already easing some of their early restrictions. India’s government has allowed the opening of neighborhood shops, as well as some work in construction, agriculture, and manufacturing. Pakistan has allowed mosques to open for Ramadan prayers. Bangladesh is reopening some of its garment factories, a vital part of its economy. These reversals could lead to spikes in rates of infections.
Lawmakers will have to weigh the dangers of further outbreaks against a growing restlessness among their populations. In Surat, India, a crowd of migrant workers turned violent, throwing stones at glass windows at a construction site and damaging vehicles. They want to work or go home to their villages, and something has to give. But there are no perfect choices.
India, Pakistan, and Bangladesh are home to nearly a quarter of the world’s population but account for only 2 percent of confirmed cases of COVID-19.
BY RAVI AGRAWAL | APRIL 30, 2020, 4:52 PM
Residents of a slum in Kolkata, India, line up to receive relief packages on April 30. DIBYANGSHU SARKAR/AFP VIA GETTY IMAGES
Welcome to Foreign Policy’s weekly South Asia Brief. Today, we attempt to explain why there are so few coronavirus cases across the region. Plus: Another deadly attack rocks Afghanistan, a constitutional crisis brews in Sri Lanka, and the death of two Bollywood legends.
If you would like to receive South Asia Brief in your inbox every Thursday, please sign up here.
Why Aren’t There More Coronavirus Cases in South Asia?
Let’s face it: Everyone expected worse. More than three months after the first recorded case of the coronavirus in South Asia, the region has only around 60,000 confirmed infections. By comparison, the United States has more than 1 million, while Spain and Italy both have confirmed more than 200,000. Put another way, South Asia’s countries account for one-quarter of the world’s population but only 2 percent of its coronavirus infections. Why?
Parsing the numbers. South Asia’s relatively low case numbers are a bit of a puzzle, especially given high population density and poor health care systems across the region. An immediate reaction is to call into question its testing capacity. India has so far conducted only 830,201 tests, or 614 for every 1 million people—among the lowest rates of testing in the world. But if India’s low rate of testing were hiding a massive outbreak, it would show up in other ways. Only 4 percent of India’s coronavirus tests have returned positive, compared with around 17 percent in the United States, implying that the virus is less widespread in India.
Another indicator of a larger outbreak would be the number of deaths. But here the data also shows South Asia in a favorable light. While the United States has recorded more than 60,000 deaths from COVID-19, India counts only 1,079 so far. Those numbers are likely higher—only one-fifth of deaths in India tend to be medically certified—but it is not as if there has been a massive surge in hospital admissions.
Using India’s data as a proxy for the region, the likely takeaway would be that South Asian countries have either succeeded in flattening their curves for now or that they are still in the early stages of their outbreaks. If it’s the latter, then the current state of lockdown ensures the coronavirus won’t spread too rapidly.
Successful approach? Has South Asia succeeded where Western countries have failed? Countries such as India and Bangladesh have imposed stricter lockdowns than the West—and earlier in their respective outbreaks. In that sense, South Asian economies should be commended for moving quickly in response to the shutdowns in other countries. With the exception of Pakistan, which for a while allowed flights to China, most of the region’s countries imposed strict restrictions on international and domestic travel.
Even that doesn’t completely explain the low number of cases. After all, even after closing the borders, the number of cases rose internally. And many South Asian countries made vital errors. India announced its nationwide lockdown with no prior notice, leaving millions of migrant workers displaced and vulnerable. Across the region, gatherings of religious groups took place in early March, leading to coronavirus clusters.
To their credit, authorities seem to have had some success in contact tracing and imposing quarantines. One theory goes that the region’s youthful demographics give it an advantage. India, for example, has a median age of 28, compared with 38 in the United States. (The median ages in Afghanistan, Bangladesh, and Pakistan are 18, 26, and 24, respectively.) But even here, if there are many asymptomatic cases among young people, then those may eventually show up in infections among elderly populations—and that has yet to be recorded.
Other theories are more tenuous. For example, the World Health Organization says there is no evidence that the Bacillus Calmette-Guérin vaccine—widely deployed in South Asia to fight tuberculosis—provides protection from the coronavirus. Nor is there proof that warmer weather slows the spread of the coronavirus.
Summer strategy. There is no real end to the pandemic unless the world can develop a vaccine. That means it’s too soon to declare any country’s approach a success. And there lies the real problem for South Asia. Countries are already easing some of their early restrictions. India’s government has allowed the opening of neighborhood shops, as well as some work in construction, agriculture, and manufacturing. Pakistan has allowed mosques to open for Ramadan prayers. Bangladesh is reopening some of its garment factories, a vital part of its economy. These reversals could lead to spikes in rates of infections.
Lawmakers will have to weigh the dangers of further outbreaks against a growing restlessness among their populations. In Surat, India, a crowd of migrant workers turned violent, throwing stones at glass windows at a construction site and damaging vehicles. They want to work or go home to their villages, and something has to give. But there are no perfect choices.
