The COVID-19 paradox in South Asia
It is surprising that the region has far fewer infections and deaths compared with North America and Western Europe
- The oldest and largest democracies in the world are often compared. This time is different.
- The first person tested positive for COVID-19 on January 21 in the United States and on January 30 in India.
- Roughly three months later, on April 20, the total number of infections was 7,23,605 in the U.S. and 17,265 in India, accounting for 31.2% and 0.75% of the world total, while the number of COVID-19 deaths was 34,203 in the U.S. and 543 in India, making up 21.7% and 0.33% of the world total.
- The share of the two countries in world population, by contrast, is about 4% and 18%, respectively.
A puzzling situation
- It is even more surprising that a comparison with South Asia — Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka — yields similar results.
- In Nepal too, it was in late January that the first person tested positive for COVID-19, though it was end-February or early-March in the other countries. On April 20, South Asia, with a share of 23.4% in world population, accounted for 1.25% of infections and 0.5% of COVID-19 deaths in the world.
- Before the pandemic, it would have been impossible to predict, let alone imagine, such a reality. Income per capita in South Asia is just 16% that of the world, and a mere 4% of that in industrialised countries.
- One-third of the world’s poor live in South Asia, so absolute poverty is high and nutrition levels are low. Population density in the subcontinent is among the highest in the world.
- The poor, who live cheek by jowl in urban slums and in cramped spaces in rural areas, are most susceptible to a virus that is contagious. Public health systems and facilities are perhaps the worst in the world.
Two possible explanations
- Past experience of the Spanish influenza in 1918, when India accounted for 18-20 million of the estimated 50 million deaths in the world, or conventional thinking even now, would have led to the opposite conclusion. There are two possible explanations.
- First, the reality might be much worse than the statistics suggest because the total number of infections is almost certainly underestimated, as testing has been nowhere near enough, given the scarcity of testing kits and the massive size of populations. Improved statistics might change the numbers but cannot transform the asymmetry emerging from the above comparisons.
- Second, the lockdowns imposed by governments in India, Bangladesh, Pakistan, Sri Lanka and Nepal, which started in the last week of March and continue until April 27 or longer, have clearly made a difference.
- The lockdown in India, straddling its vast geography, is perhaps among the most stringent in the world. The common purpose was to break the chain of transmission through physical distancing, which has two dimensions.
- This created physical distancing only for the privileged living in homes that have spaces and doors. It was impossible for people in urban slums in mega-cities, where migrant workers lived in cramped spaces, often as many as 10 to a room.
- Migrant workers could not return to their villages, and citizens or foreigners who might carry the virus could not come from abroad. It did strangle potential chains of community transmission, reducing the geographical spread of the virus through contagion, and flattening the curve compared with what it would have been without a lockdown.
A possible hypothesis
- It has been suggested that countries which have mandatory BCG vaccinations against tuberculosis are less susceptible to COVID-19 morbidity and mortality.
- But the BCG vaccine seems to have a stimulating effect on the immune system that goes well beyond tuberculosis.
- Most countries are buying hydroxychloroquine in large quantities from India, as a prophylactic for health workers and for treatment of COVID-19 patients.
- In South Asian countries, universal BCG vaccination is mandatory, while immune systems of people have a lifelong exposure to malaria.
- These could provide possible explanations for the relatively limited spread of COVID-19 in South Asia so far.
Lives and livelihoods
- Obviously, lockdowns have also mitigated the spread. In doing so, they have saved lives, but at the same time, they have also taken away livelihoods.
- In South Asian countries, almost 90% of the workforce is made up of the self-employed, casual labour on daily wages, and informal workers without any social protection.
- The lockdowns have meant that hundreds of millions of people who have lost their jobs, hence incomes, have been deprived of their livelihoods, imposing a disproportionate burden on the poor and those who survive just above the poverty line.
- The problem will not vanish after lockdowns are lifted. Economies that have been shut down for six weeks or longer will be close to collapse. In the short-run, it will be a matter of survival for households and firms and stabilisation for the economy.
- Economic growth will be zero or negative this year. In the medium-term, it will be about recovery.
- Rapid economic growth in the past 25 years had enabled South Asian countries to bring about a significant reduction in absolute poverty, even though it was associated with rising inequality.