Europe and the US might be at the center of the epic war against COVID-19 at this moment but the danger of the deadly virus spreading its wings in South Asia looms large. The sub-continent, home to 21 percent of the world’s population that lives cheek by jowl in thousands of cramped cities, remains most vulnerable because of its tottering healthcare infrastructure and a developing world's socio-economic complexities.  

India, the biggest of the seven South Asian countries with 1.3 billion people, has 425 confirmed cases till March 23 and eight deaths. In a dynamic corona number game-changing rapidly, Pakistan seems to be the worst hit with 804 cases in the region. Sri Lanka, Bangladesh, Nepal, Maldives and Bhutan have fewer cases but that is least comforting as the clock is still ticking, and many of them like Bhutan - with no indigenous cases as yet - is worried about the rising cases in India next door.

Afghanistan, which has Iran (one of the global epicenters) next door, remains in a delicate spot for being in an unending fratricidal conflict and political fragility. 

A swarm of people is not South Asia’s only problem as it is also one of the economically underdeveloped regions in the world where public health infrastructure is not geared up to deal with even basic needs, leave aside a monstrous pandemic that has affected 192 countries.

Declaring lockdown to prevent the spread of the virus is not an easy decision for the governments in the region - as Pakistan Prime Minister Imran Khan found - as it will have huge economic implications for a vast population depending on daily earnings for sustenance.

With a spike in cases in the last three days starting March 20, the Indian government announced the lockdown in major parts of the country, including the capital New Delhi and the commercial hub Mumbai, till March 31. The possibility of an explosion of COVID-19 cases have forced the government to overlook economic constraints, at least for the moment, and focus solely on containing the spread and preventing an explosion of cases.

Pakistan could not even do that. A hapless Prime Minister Khan came on national television on Saturday expressing his inability to take the cruel decision of a lockdown. He said Pakistan, which has reported six deaths, is not the US or China to absorb the cost of a complete shutdown. The provincial governments of Sind, followed by Punjab, the two most prominent states, jumped the line forcing people to remain indoors but the administration is being severely criticised for losing a battle even before entering it.

Experts in India warn that the government can no longer turn the eye away from the fact that the community transfer of the virus has already begun and even though it is yet to be acknowledged officially, the shutdown shows it has been accepted.  

The world over, one of the fundamental approaches in tackling the virus has been testing aggressively and isolating the affected.

But in India, only 11,500 cases were tested till March 18. A study group comprising scholars and data scientists came up with their first report COVID-19 based on the statistics available so far. “The predicted cumulative number of cases in India on March 31 is 379, on April 15 is 4,836 and on May 15 is 58,643. Our current estimates are at best underestimates for India based on early phase data, given the low frequency and scale of testing in India. The upper credible limit to these corresponding count estimates are 2507, 28,925 and approximately 915,000, respectively,” said the report.

The study group makes a strong pitch for draconian measures to stop the spread of infections. A major part of the country is already under lockdown till March 31. The experts want people to be adequately protected against the economic impact of such measures. India enhanced testing by opening it to private labs but there have been reports about shortage of certified kits.

A major worry for the Indian government is to dramatically enhance the hospital bed per patient ratio which is an abysmal 0.5 per 1000 (according to 2011 data). Work on a war footing is required to meet the challenge which is growing by the day. Special hospitals dedicated to treat COVID-19 patients, as China did, are required to be built or earmarked in several states. 

While being involved in its own battle, Indian Prime Minister Narendra Modi held a teleconference with South Asian leaders reviving the South Asian Regional Cooperation Agreement (SAARC) that had gone defunct in wake of the political tensions between New Delhi and Islamabad. Maldives, Bhutan and Nepal have committed contributions in the proposed COVID-19 emergency fund to deal with crises collectively. 

In the South Asian region, only Maldives and Sri Lanka fare relatively better in global rankings of quality of healthcare system. Pakistan, which spends the least on health, has only 0.6 beds per 1000 people compared to 8.5 beds per 1000 people in Germany. What makes matters worse for Pakistan is that apart from lack of health facilities, Pakistan also faces a dearth of doctors.

Bangladesh, which has also declared a holiday from March 26 till April 4 and has reported 33 positive cases and three deaths; has made economic progress in recent years but it has a vast population much of which is beyond the reach of the healthcare system.

The others are smaller countries but not out of the danger zone. Most of them have announced lockdowns, but as a Stanford Graduate School of Business report says that the lockdown of cities and towns are just to “buy time” and “time must not be wasted” to “fight this war” and it should be used to find an “effective treatment” or “complete success in halting viral transmission”.  “We must use it to prepare and fight back.”

In such a scenario, where there could be a sudden explosion of cases, these countries would be looking up to India for help but given the ongoing situation, New Delhi is bogged down with its own problems.

The collective SAARC fund can be used in augmenting capacities of hospitals and procuring more testing kits. The governments need to work on a war footing because South Asia may well be the next hotspot of the dreaded COVID-19.

(The writer specialises in health, education and social issues)