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Published on Mar 20, 2020
COVID-19: A South Asia Update

On 11 March, WHO officially declared COVID-19 a global pandemic, with growing cases getting detected in over 100 locations internationally. The director-general had repeatedly stressed on the vulnerabilities faced by ill-prepared “weak” countries, in a conference on 23 January, that the virus poses a serious threat to South Asian counties owing to their poor public health systems.

On 17 March ,WHO pushed to take “aggressive” action, fearing that some countries may be moving towards community transmission. Although more than 200,000 cases of COVID-19 and more than 8,000 deaths are reported globally, South Asia has seen a total of 427 cases as of 18 March, with three deaths, all in India.

The first Covid-19 case reported in India was on 30 January in Thrissur district of Kerala. The diseased was a student, who returned from a University in Wuhan. On 3 February, Kerala reported its third confirmed case, leading the government to declare a state of emergency; A month later, India reported six new cases of COVID-19 from Maharashtra and Karnataka - four had a travel history to the USA or Dubai. The 50th COVID-19 case in India was reported on 11 March; 39 of these 50 cases in India had a foreign travel history, while the rest contracted the infection through the local transmission.

India reported its first Covid-19 death of a 76-year-old man in Karnataka on 12 March; India touched 166 confirmed cases with 3 deaths, according to the latest official update from the Ministry of Health and Family Welfare on the morning of 19 March.   Schools, colleges and cinema halls in Delhi have been shut to prevent the spread until 31 March. The state government declared an epidemic in the national capital, invoking provisions of the Epidemic Diseases Act, 1897. On 16 March,  the capital had shut all night clubs, gyms, swimming pools and gatherings above 50. A total of 12,29,363 passengers were screened at 30 designated airports. Tihar Jail has set up an isolation ward. The Indian government has decided to quarantine itself from the rest of the world until 15 April suspending all visas except for diplomats, UN or international bodies, official and employment purposes.

Similarly, Afghanistan identified its first case of COVID-19 on 24 February 2020. The Ministry of Public Health stated that one suspected case was tested positive. The patient, a 35-year-old man, was a resident of Herat and had returned from Iran. On 7 March, three additional people confirmed positive in Herat; two among them had a travel history to Iran. MoPH confirmed one positive case on 9 March in Samangan. By 18th March, there was a total of 22 confirmed cases with no casualties. Steps taken by Afghanistan include contact tracing, shutting all schools in Herat and banning public gatherings indefinitely. The country has restricted all air and land movement to and from its neighbour Iran. Local authorities in Herat has made arrangements to use Paediatric Hospital facilities as isolation wards.

Within five days, across the Durand line, Pakistan, confirmed two cases of COVID-19, both citizens who travelled to Iran. On 10 March, nine new cases of coronavirus had emerged in Karachi. The number rose rapidly in the next week with 187 positive cases on 18 March with no recorded deaths. To contain the virus, screenings of international travellers at all points of entry to Pakistan have been set-up at airports. World Health Organisation (WHO) has been supporting health care providers and facilities for building capacity for preparedness and response, including training health care providers on contact tracing suspected and confirmed cases, managing case, and distributing Information Education and Communications materials to raise public awareness. Pakistan imposed a ban on all public gatherings till 31st March, wherein all public gatherings, open-air religious meetings, marriage gatherings and all events having large public attendance will remain suspended. Twelve isolation centres have been set up across the Sindh province.

On 7 March, Maldives reported two confirmed cases. The infected patients are employees at a resort and caught the virus from an Italian tourist who tested positive upon his return to Italy. Both patients have been quarantined. As of 16 March, 13 people have tested positive, all being foreign nationals. There have been no deaths to date. Since 8 March, Maldives has curbed movement on several resort islands. On the same day, banned passengers originating from/who had travelled through Italy in the preceding 14 days. On 12 March, the Maldivian government declared a state of a public health emergency due to COVID-19 outbreak in the country effective nationwide for 30 days. Schools are shut down till further notice; public gatherings are banned for a specific duration in specific locations. The Maldives’ government built the world’s first Covid-19 resort to quarantine patients.

The last country to join the list was Sri Lanka, reporting its first coronavirus case on 11 March. Director-General of Health Services said that the infected 52-year-old tour guide had come in contact with Italian tourists and has been isolated in Colombo. The following day, Sri Lanka reported its second case. As of 18 March, the total confirmed cases have risen rapidly to 29 with no reported cases of deaths. Sri Lanka has been quarantining returnees from Italy, South Korea, and Iran, the countries experiencing major outbreaks of the coronavirus. On 9 March, Sri Lanka suspended Buddhist pilgrimage tours to India. On 14 March, On-arrival visa facility for foreigners arriving in Sri Lanka through Ordinary Passports was temporarily suspended.

On 8 March, Bangladesh announced three cases of COVID-19. These confirmed cases included two people who recently returned from Italy. The trio has been isolated and treated in a local hospital. As of 17 March, three new cases were confirmed in Bangladesh, bringing the total to 8. To contain the virus, passengers from four countries: Italy, South Korea, Japan, and Kuwait are restricted to enter the country borders without “Coronavirus-free” medical certificates. Residential hotels across the country have been warned about the virus and advised about their responsibilities.

Nepal saw its first case of COVID-19 on 25 January. The infected was a Nepalese student, studying in Wuhan, with symptom-onset on 3 January. He visited the Hospital in Kathmandu on 13 January . He was discharged within four days of isolation, and follow up tests on 29 and 31 January showed negative results. Measures taken by the government include a 24-hour-operating health desk has been established at the International Airport in Kathmandu to screen incoming persons. The country suspended visas upon arrival for nationals from eight countries from 10 March  until further notice. It further, announced the suspension of visas upon arrival for nationals from any country from midnight on 14 March until 30 April.

The first positive case in Bhutan of COVID-19 was confirmed on 5 March , who is a 76-year-old person from the USA, who had come to Bhutan as a tourist. Adhering to the National Preparedness and Response Plan (3rd Edition), all follow-up actions were initiated immediately. The disease was isolated and health officials and relevant agencies carried out primary disease management and contact tracing. The case’s close contacts were his partner; the driver and the guide who has been quarantined at the designated COVID-19 hospital. As per the National Preparedness and Response Plan, the government announced the closure of schools and institutes in Thimphu, Paro and Punakha for two weeks with effect from 6 March. On 6 March, the government announced a two weeks restriction on all incoming tourist

The steady rise of COVID-19 cases in South Asia causes huge concern. In countries with poor infrastructure and lack of professionals, a virus as contagious as COVID19 can strike a crisis of very high magnitude. Over the last week, numbers have risen from 127 to 427 in South Asia, which is approximately a 236% increase in the number of cases. A week prior, the rise was from 56 to 127, causing a 126.7% rise in cases. Thus, the numbers may look small in relation to other countries like Italy & Korea, but the relative rise is significant. The number of tests conducted in comparison to the massive population is very low, often questioning the real spread of the virus. While prompt actions taken by governments are appreciated and welcome, one cannot simply accept the numbers at face value. Self-isolation, is the only way to move forward and contain the virus as social distancing in poor infrastructural areas like the crowded slums of India is an intractable problem.

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