Since its original outbreak in Wuhan we have seen the epicentre of the COVID-19 pandemic move from the Far East to Europe and the US and, as wealthier countries vaccinate their way out of their own crises, the epicentre has swung back to hit less developed nations in South Asia.

India

Why does India have so many COVID cases?
India has seen a rapid and well-publicised increase in COVID cases. After a stepwise easing of restrictions across the country throughout 2020, India’s leader, President Narendra Modi, declared the country was in the “end game” of the pandemic. Soon after this bold statement, large religious and political gatherings were allowed to take place with little regard for social distancing and, inevitably, cases began to soar. On May 3, India hit the grim milestone of 20 million COVID cases, though the true number is thought to be much higher.

The brunt of the cases in India are thought to be due to the B1.1.7 variant, which originated in the UK. It is a variant we know is more infectious and able to spread more rapidly and, sadly, India has provided the virus with a large reservoir of people to infect and more importantly, enabled it to mutate again.

The resulting new Indian “double mutant” variant has caused worldwide concern because it is thought to be even more infectious and it may well be able to evade some of the protection offered by vaccinations and previous infections.

To add to India’s woes, despite an issue with vaccine hesitancy among some parts of the population, India had a promising start to its vaccination programme. However, as supply of raw materials from the US, needed to manufacture vaccines, came under pressure, India has struggled to keep up with demand.

This has left huge swathes of the population exposed; hospitals have quickly become overwhelmed amid chaotic scenes where people have been unable to access basic health care. As oxygen and drugs used to limit the severity of the disease have become a luxury, the Indian black market has flourished with opportunists preying on the vulnerable, selling medical supplies at premium prices.

Countries around the world have recognised it is in their interests to send medical aid to India to help stem the spread of the virus, but not before India hit record daily death rates.

Pakistan

As tragic as the situation is in India, other South Asian countries are now beginning to see increases in COVID-19 infections as well. Across the border, Pakistan has experienced a sharp rise in cases and reported more than 140,000 new infections of COVID and more than 3,000 deaths in April alone.

Pakistan, which has a population of 217 million compared to India’s 1.37 billion, recorded its highest daily death rate on April 28 with 201 reported deaths.

With ICU beds in high demand, there is now concern that Pakistan may suffer a similar fate to neighbouring India. Pakistan appeared to escape the initial two waves of the coronavirus pandemic relatively unscathed. With its densely packed population and areas of deep poverty, scientists remain puzzled as to why the country did not suffer higher infection and death rates during 2020.

However, the arrival of the UK variant, as well as apathy from Pakistanis about the virus have led to a recent surge in cases.

Social distancing measures are now being encouraged by Pakistan’s prime minister, Imran Khan, who addressed the nation after a meeting of the National Coordination Committee on April 23. He said: “I am appealing to you to follow SOPs (standard operating procedures) so that we don’t have to take steps that India is taking which means imposing lockdowns. Half the problem is solved when you wear face masks.” He has also enlisted the help of the Pakistani army to aid the police force in ensuring standard operating procedures are adhered to by the public. These include: Schools in districts with a higher than 5 percent positivity rate remaining closed until Eid; markets being closed at 6pm (excluding essential shops and pharmacies); indoor and outdoor collective dining being banned until Eid (with only takeaways and deliveries allowed); offices closing at 2pm and operating at 50 percent staff capacity; and all flights to India banned.

The approach of Eid al-Fitr in May, when people typically do more shopping and socialising, has raised concerns, and citizens are being encouraged to enjoy simpler and smaller festivities this year.

Pakistan’s vaccination programme is also progressing slowly, due to issues with vaccine hesitancy and some indifference from the Pakistani public because of relatively low numbers of deaths in the initial waves of the pandemic. The country has approved the Chinese Sinopharm vaccine for use as well as Russia’s Sputnik V vaccine. It is also expected to receive millions of doses of the Oxford Astra Zeneca vaccine through the global COVAX scheme. So far, only 1 percent of the population has been vaccinated either through the government’s free scheme or the private sector, for those who can afford it.

Ramadan, a month that involves fasting through the day but an increase in indoor mixing either in homes or places of worship in the evenings, coupled with the run-up to and arrival of the Eid festivities, will prove a testing time for Pakistan. If the authorities are unable to get the public on their side with social distancing measures, it may suffer the same fate as neighbouring India.

Bangladesh

Over to the east of India lies Bangladesh. It, too, was relatively unscathed during the 2020 waves of the pandemic, but this has led to people becoming complacent about the virus and not adhering to social distancing measures. March and April saw a resulting rise in COVID cases in Bangladesh (population, 163 million) which prompted the government to impose new restrictions across the country. On April 19, Bangladesh recorded its highest daily death rate at 112 deaths. A full lockdown was implemented on April 14.

Since cases began to rise, the government has imposed restrictions following the lockdown, including a ban on public gatherings in areas where infection rates are high and a travel ban to and from countries the government considers high risk. Planned elections for some areas have also been postponed. Vaccinations are underway but progressing slowly, with only 2.81 million having received both doses of the vaccine and about 8 million doses given in total. The key for Bangladesh is to hope that India’s troubles do not spill over the border and wreak havoc on the healthcare system. The government and health officials must now work hard to convince the population that this virus must be taken seriously and that restrictions need to be adhered to.

Nepal, Afghanistan and Sri Lanka

In the surrounding areas, Nepal, Afghanistan and Sri Lanka have seen more modest rises in cases over March and have received vaccines through a number of donation routes, but it remains to be seen if what we see playing out in India will be repeated there.

Many countries have been sending aid to India and will be watching the developments in this part of the world with interest. We have seen how containing the pandemic in one part of the world is impossible; movement of people and goods, coupled with the fact that one in three people who have coronavirus exhibit no symptoms, means the virus will cross borders.

What local governments do to stem the spread of the disease will be crucial to us all. This is a global pandemic which will not be over until it is over everywhere and that might mean countries putting their own immediate interests aside to help others