Week 17: Covid 19 in the Indian Subcontinent

 As can be seen from the table, two countries stand out as having much lower cases /M and deaths /M: Sri Lanka and Nepal. The other three, India, Pakistan and Bangladesh, have very high rates for both Covid Cases and Covid Deaths, rather similar to 4 major European Countries – Spain, Italy, the UK and France. This blog will deal with the question – how did these two smaller countries do it?  I do not find any common ground between Sri Lanka and Nepal, so I will deal with them separately. 


 

India

Pakistan

Bangladesh

Sri Lanka

Nepal

Population

1,380M

212M

169M

22M

28M

Pop.density/ squ. km       

464

723

1,115

341

291

GINI index         

35.2

36.2

32.4

39.8

32.8

GDP/cap

$2,104

$1,294

$1,456

$4,102

$1,048

 

Covid Cases     

719,655

234,509

154,618

2,078

15,964

Cases/M             

18

14

2.0

0.23

8

Daily cases       

22,252

2,681

3,201

2

180

Covid deaths    

20.160

4,839

2,096

11

35

Deaths ‘M          

14.6

21.9

12.7

0.51

1.2

Daily deaths     

4.67/M

77/M

44/M

0

1

 

Sri Lanka, like New Zealand, has the advantage of being an island, and is able to control entry of virus cases from high prevalence countries.  It is also by far the richest of the 5 countries. The only common factor with Nepal is low population density. The Minister of Health revealed that around 24 hospitals are available ready to tackle the coronavirus emergency.

The general public in Sri Lanka has been heavily criticized for lack of support to combat coronavirus pandemic due to their reckless behaviour. After the first cases of covid-19 were announced, it was followed by a scramble for facemasks, and the panic buying described by Wikipedia.  By 23 March the Army had built 45 quarantine centres across the island, and 3,500 people had been quarantined at them. Lockdowns were imposed and extended between March and April.  Just over 2,000 tests were performed. Sri Lanka has the highest GINI index, indicating a slightly lower level of equality. We must somehow understand how their Deaths /M are so very low, compared with the huge figures in the other 3 large countries.  The low figures for Covid cases/M, Daily Cases and Deaths /M are perhaps explainable in terms of a generally independent population, with adequate money. The low rates for covid could be related to firm handling of the population by the Army.

Nepal is a radically different country, with the lowest wealth of the 5 countries, and the least population density. It is a country that has been through a series of disasters: shortly after their civil war in 2006 there was a dramatic series of earthquakes in 2015 that caused 9,000 deaths and left 208M people displaced from their homes. One possibility is that a people who have become used to adapting to each insult, may have gained degree of resilience. This necessary repairing has by no means been completed, and the country is now in the grip of lockdown, and this may also at present a moment of real opportunity. It seems unlikely that the other features of the Nepalese way of dealing with the crisis - lockdowns, travel restrictions, border controls and so, account for the dramatic escape which somehow occurred from the horrors of the other three, A total of 262K tests were carried out in Nepal.

 

Of the other 3 countries, Pakistan and Bangladesh are almost as poor as Nepal, but India has about double the other two, per capita. India had initial testing only for travellers from high prevalence countries. There was a complete lock-down, which extended to the end of May involving 82 districts in 22 states, and 80 cities.  Schools and colleges were closed. No fewer than 19M tests were carried out.  The first case in Pakistan was identified on 6 March, followed by a group of 26 cases few days later. Partial lockdowns occurred on 24 March. (The Wikipedia account for Pakistan is unusual, in that the word ‘test’ does not occur in it, although 228K ‘confirmed cases’ are described). The report for Bangladesh reports 892K tests, of which 172K were positive. It has a fairly low rate of Cases /M, not as low as Sri Lanka, but better than Nepal. In both India and Pakistan, overcrowded urban areas make a huge contribution to high prevalence, and a huge contribution to high local rates of Covid cases.

 

 

Conclusions

 

How cogent are the putative causes for Sri Lanka?   It could be that I am imagining them, and that the true explanation will be in terms of a gene, or an organic factor like an antibody that has not so far been observed. In the absence of facts that are not yet known, this is as far as I can take things.

 

I am aware that the factors in Nepal that can be thought of as factors indicating stress and psychological pain; alternatively they could be thought of as being related to resilience. On balance, the first seems more likely.

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