Covid-19 could test the overstretched health system of two of South Asia’s largest countries.
While the Spanish flu pandemic of the early 20th century originated from Europe and killed at least 50 million globally, India paid the heaviest price.
The virus, brought on ships by infected people, spread like wildfire as ill-prepared doctors in the then-British colony struggled to contain it.
The influenza spread from the ports of Bombay (now Mumbai) into the crowded city streets in a matter of days after first appearing in May, 1918. From there, sick people carried it via trains to rural towns and villages. In the end, an estimated 18 million were dead, leaving India to account for one-fifth of Spanish flu deaths.
The outbreak of the Covid-19 pandemic has resurfaced fears that India and other densely populated South Asian countries are ill-prepared to handle the crisis when even developed nations like Italy are struggling to halt mounting casualties.
India has reported only eight deaths from the coronavirus with 425 confirmed cases at the time of writing. Some experts say that many cases have gone unreported in the country of 1.3 billion and there could be far more community spread.
If the situation gets out of control, New Delhi could be dealing with as many as 300 million potential cases of coronavirus.
So far, only 20,000 people have been tested with most of them having a travel history to countries where the outbreak has occurred.
Dr Randeep Guleria of the All India Institute of Medical Sciences says that Covid-19 tests are being ramped up.
“We will now test every patient with severe respiratory infections in the ICUs, so that even those who don't have any travel history or contact with the infected do not get missed - that is a change in policy that is coming soon,” he told TRT World.
While New Delhi has taken a number of steps to curb its spread, there are concerns that tests have been carried out on just a fraction of the potential virus carriers.
Guleria says that previously officials felt that screening for Covid-19 wasn’t turning up enough clusters of acute respiratory cases to warrant an increase in tests.
“Now that numbers have been gradually increasing over the last few days, there is a feeling that we should start testing more.”
Over the weekend, India moved aggressively to counter the spread. Schools, markets and cinemas have been shut and inter-city transport services suspended.
However, the lockdowns to maintain social distancing don’t seem to be working. Videos shared on Twitter showed crowds of hundreds gathered on Sunday to sing and dance for doctors.
Over the years, India has created an affordable health infrastructure. It earns more than $3 billion in medical tourism from patients seeking cheaper heart surgeries or cancer treatment. But the best hospitals cater to the rich.
Overall, India’s health spending as a percentage of GDP is a meagre 1.3 percent and it has only 0.5 hospital beds per 1000 people.
Densely populated cities, pollution, poor sanitation, and millions of people who live in slums make it a breeding ground for diseases such as tuberculosis.
“Infection, not heart disease, diabetes, or cancer, is the leading cause of death in India,” Professor Pranatharthi Chandrasekar wrote in the Lancet general medicine journal a few years ago.
The Hindu nationalist government of Prime Minister Narendra Modi hasn’t helped matters. In January, the Ministry of AYUSH, which promotes herbal medicines, drew ridicule for publishing a questionable homoeopathic remedy to fight the coronavirus.
Trouble next door
In neighbouring Pakistan, things are equally bleak with doctors already warning that hospitals in the country of more than 200 million people aren’t equipped to deal with a pandemic.
So far, there have been 6 reported deaths and around 800 confirmed cases of Covid-19. And there are concerns that these numbers can spike.
“We are not prepared. Our hospitals are not prepared to handle normal diseases so you can imagine what can happen with this,” says Dr Altaf Ahmed, a Lahore-based infectious disease expert.
Most of the coronavirus cases in Pakistan have been linked to Shia Muslim pilgrims returning from Iran, where more than 1,800 people have died.
The government faces criticism for not being able to stop infected people from escaping isolation facilities.
Islamabad has shut borders and suspended international flights but Prime Minister Imran Khan didn’t order a complete lockdown, saying it could badly affect daily wagers.
Nevertheless, the provincial Sindh government has enforced strict measures, deploying police and soldiers to keep markets shut and people inside their homes.
A big worry is that there’s no mechanism in place to track people who might have come into contact with an infected person, says Ahmed.
The government has set up testing facilities at its hospitals but they are not enough to check the potential carriers of the coronavirus, he says.
“In the whole of Punjab (Pakistan’s largest province) they have the capacity to test 1000 to 1,200 people a day and that too in private labs and they are charging 8,000 rupees ($50) for one test.”
Both countries have a lot to worry about especially as religious fanatics are asking people to find cures in pigeon nests in Pakistan and cow dung and urine in India.
As experts encourage people to repeatedly wash their hands, millions of people on both sides of the border don’t have access to water or proper toilets. Both lack hospital beds and ventilators.
A couple of days ago it became apparent that the coronavirus had become a pandemic, someone in India shared a rather disturbing video: a vegetable vendor was washing tomatoes, green chillies and other farm produce in a gutter’s black smudge. Such a scene is not uncommon in Pakistani cities.
It quickly turned into a meme with people on both sides of the border wondering if the coronavirus would be more infectious than pathogens that lurk in a gutter. Apparently, it is.