Unimaginable and Unmanageable: COVID-19 in Developing Countries

Covid-19 Graffiti

The number of COVID-19 cases worldwide crept to over three million this week. More than two billion of the world’s population are living in lockdown. The disease is now present in over two hundred countries. The term ‘gone viral’ has taken on a much darker meaning; and its meaning manifests differently depending on where you live. To date, COVID-19’s effects have mostly been recognised in richer countries, but the virus is tightening its grip on the most impoverished parts of the world: parts of the world that are poorly-equipped to cope with its impact or its after-effects.

Developed countries are understandably proud of their  health and social care systems; however, Coronavirus has laid bare their limitations, exposing weaknesses in healthcare infrastructure everywhere – from the UK’s long-suffering treasure of a National Health Service to the United States’ plethora of private hospitals. In Italy, doctors have had to make brutal decisions on the allocation of healthcare resources based simply on patients’ likelihood of survival.  In the UK, the Prime Minister himself has been hospitalised.  Meanwhile in the US, where the cost of treatment for COVID-19 reaches $35,000 per person – tens of millions are set to lose their health insurance. Economically well-developed nations are becoming desperate as their institutions begin to buckle under the pressure. But developing countries are even less prepared for this; their weak healthcare systems and even weaker economies will not bend – only break.

Most developing countries have far fewer doctors and far fewer hospital beds per capita than developed countries. For example, Sweden has more than five times as many doctors per 1000 people than any country  in Africa.  The differences in equipment are even starker.  Uganda has one intensive care unit (ICU) bed per million people, where the US has 347. Somalia has fifteen ICU beds for the whole country. Some system of testing is vital in managing the spread of the disease: South Korea has already carried out over half-a-million tests. This scale of engagement requires testing kits and testing labs which simply don’t exist in many places.  Masks, gloves and other personal protective equipment (PPE) are also needed in huge quantities in short supply in the West, but virtually unobtainable in the developing world.  The stark truth is this: the health system in developing countries is simply in no position to cope with a tsunami of COVID-19 patients.

These numbers have pretty predictable consequences.  Every factor and phrase we have seen and read in the wealthy West will be magnified. For example ‘underlying health conditions’ have accompanied many deaths, so consider the effects of adding malnutrition, malaria, and tuberculosis to that mix.  In the US, mortality rates from COVID-19 have frequently been co-related with ‘levels of air pollution’, and ‘social distancing’ has played a vital role in limiting the pandemic’s spread. We can foresee the consequences for the world’s most polluted and crowded cities (of the twenty worst-polluted cities by air quality, seventeen are on the Indian sub-continent). In developing countries, almost a billion people live in slums with inadequate access to running water to wash their hands. These housing projects are frequently bursting at the seams, crowding 10 to 12 people in poorly reinforced shacks stacked directly alongside and even on top of one another. This makes social distancing not a difficulty, but a physical impossibility. Dharavi, for example, one of the biggest slums in India, is a ticking bomb for Coronavirus with almost 1.5 million people packed in into just over two square kilometres.

A condiment seller in India. Photo by Urip Dankar

Whilst rich countries are announcing historic rescue packages to stimulate their economies, the policymakers in developing countries lack either the fiscal or monetary tools to fight the economic impact of the virus. Whereas governments in European countries have offered a stimulus of around 20 percent of their GDP, the Indian government’s rescue package accounts for only 1 percent. Poor welfare benefits in developing nations will exacerbate the  economic devastation. The fact that a large segment of the population in developing countries works in the informal sector will make it especially hard to target relief interventions.  And, of course, the majority of the developing world relies heavily on foreign income from exporting natural resources, tourism, development aid and remittances from workers abroad. These income streams are all set to collapse; leaving these vulnerable countries in an even more precarious situation.

The pandemic is also an infodemic of misinformation. This is not limited to the developing world only; the difference is that people in these countries are more prone to fake news distributed via WhatsApp and Facebook, with numerous unscientific cures and conspiracy theories being wrongly circulated by communities as cornerstones of truth. Claims include a few of the following: that the virus can be cured by garlic, Vitamin-C, bleach and silver solution – remedies that have been peddled with limited traction. In the Congo, the virus is described as a disease for white people, providing populations with a fall sense of security. Meanwhile in other countries, misinformation germinates within the government itself: Tanzania’s president claims that the church should not be closed because the Coronavirus is “satanic” and “cannot survive in the body of Christ.”

COVID-19 represents an unprecedented and possibly unmanageable economic challenge for developing countries. The damage from the virus will result not only from the disease itself and the death it brings, but from how this interweaves with other factors: political instability, disruptions to travel and trade; and long interruptions in the struggle against hunger, illiteracy, and climate change. According to Oxfam, Coronavirus could drive over half a billion people into poverty. We are dealing with a global shock to the global economy which demands a global response. This gives an illustration of the scale of thinking and the level of co-operation which is needed: immediate debt relief, immediate commitment to vaccine availability, and immediate planning for massive financial aid. As the pandemic takes its toll on the world’s poorest countries, developed nations need to step forward, not back; and they need to work together.  The fight is just beginning.

Words by Navjot Sangwan and Alex Durham

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