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Rich nations struggle but poorer countries will be overwhelmed

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Life on the margins: People wait outside of a gate to receive relief supplies provided by local police authorities amid the Covid-19 outbreak in Dhaka, Bangladesh. Photo: REUTERS

Life on the margins: People wait outside of a gate to receive relief supplies provided by local police authorities amid the Covid-19 outbreak in Dhaka, Bangladesh. Photo: REUTERS

REUTERS

Life on the margins: People wait outside of a gate to receive relief supplies provided by local police authorities amid the Covid-19 outbreak in Dhaka, Bangladesh. Photo: REUTERS

Peru tried to do everything right. Officials declared an early lockdown - and backed it up with 16,000 arrests. Yet cases of coronavirus are surging, up nearly 60pc since last weekend.

In Egypt, observers say a repressive government is vastly undercounting the infected. In Brazil, where the president has dubbed Latin America's largest outbreak a "fantasy", numbers are skyrocketing.

New York hospitals and Italian villages are the current front lines of the global pandemic. But epidemiologists and other public health experts say coronavirus is poised to spread dangerously south, engulfing developing nations already plagued by fraying health-care systems, fragile governments and impoverished populations for whom social distancing can be practically impossible.

"In three to six weeks, Europe and America will continue in the throes of this - but there is no doubt the centre will move to places like Mumbai, Rio de Janeiro and Monrovia," said Ashish Jha, director of the Harvard Global Health Institute. "We need to be very worried."

There's rising concern the epidemic will continue to build and spread in the Southern Hemisphere winter, raising the potential for retransmission to North America, Europe and Asia.

"There is certainly a significant risk," said Stephen Morisson, director of the Global Health Policy Centre at the Centre for Strategic and International Studies. "It is a highly fast-moving, highly transmissible virus that is expected to continue its circulation around the planet.

"Downstream, as we approach the next wave - winter 2020-2021 - we have to be worried about importation of the virus from the Southern Hemisphere."

The pandemic is already confronting some of the world's poorest nations with their greatest economic challenge in decades. Income losses in the developing world are expected to exceed €202bn, the United Nations has warned. Nearly half of all jobs in Africa could be lost.

European governments are paying furloughed workers the majority of their salaries, and millions of Americans who lose their jobs will have access to unemployment benefits. But billions of people in Africa, South Asia and parts of Latin America and the Caribbean live life on the margins with little or no social safety net.

They are street vendors, house cleaners, motorcycle-taxi drivers. They live off what they earn for the day. They frequently lack property, or savings. Running water. Refrigerators. They're being told to distance themselves socially while they sleep in rooms crammed in some cases with a dozen or more people.

Umm Muhammad, a single mother in Alexandria, Egypt, has lived without her €69 salary since the outbreak forced the clothing factory where she worked to close three weeks ago.

"We are the people who are below rock bottom," she said. "Now we are perishing."

In Egypt, experts fear the number of infected could be at least 10 times greater than the 609 confirmed by the authoritarian government.

Analysts say the health system would not be equipped to deal with larger numbers. The country has 0.5 hospital beds for every 1,000 people, according to the Organisation for Economic Co-operation and Development. The US has 2.8. South Korea has 12.3.

Experts say there's no official count of intensive-care beds or ventilators.

Mumbai anesthesiologist Atul Kulkarni, editor of the 'Indian Journal of Critical Care Medicine', has estimated there are about 67,000 intensive-care beds in the country of 1.3 billion. State-level resources paint a grimmer picture: One study found that Madhya Pradesh, home to more than 70 million people, had just 1,816 intensive-care beds.

A spike in infections would quickly overwhelm those resources. In a worst-case scenario, a group of epidemiologists and biostatisticians predicted, India could have 915,000 infections by May 15.

To prepare, India has banned the export of goods that could be crucial in the fight against the coronavirus, including ventilators, surgical masks and the anti-malaria drug hydroxychloroquine, now being studied as a possible treatment for Covid-19 - a decision that could complicate the ability of other developing nations to obtain them.

Ibrahima Soce Fall, the World Health Organisation's assistant director general for emergency response, said the extent to which the virus spreads in a country depends on how authorities manage their first clusters - "and a lot of countries are not responding well".

One silver lining, he said, is that outbreaks of diseases such as Ebola have trained some developing countries to closely follow WHO advice - something many are now rigorously doing.

The IMF and World Bank are moving to offer billions of dollars in emergency loans to poor and middle-income nations. But they have warned it's unlikely to be enough, and some developing nations will require substantial debt relief.

Citizens of poor nations living under weak or repressive governments are at particular risk of finding themselves cast toward the bottom of the global scrum for scarce medicines and ventilators. (© Washington Post)