So far, the coronavirus has hit hardest in wealthy countries. But the pandemic now appears poised to explode in many parts of the developing world — which has far fewer resources to combat the virus.
The virus initially traveled outward from China to places that had the most interaction with China. These are the richer parts of East Asia — South Korea, Japan, Taiwan, Singapore — along with Europe and the United States. All these places had lots of flights, business dealings and tourism with China.
Of the 24 countries with the most coronavirus cases, all but a couple are from the developed world, according to a comprehensive chart maintained by Johns Hopkins University.
But now, several months after the virus first appeared, it appears poised to explode in many lower-income parts of the world — areas that have far fewer resources to combat the virus.
"There are a lot of other countries at lower-income levels that already have significant coronavirus outbreaks," said Mira Rapp-Hooper of the Council on Foreign Relations. Because of limited testing, the overall scope is "very likely going undetected or underdetected while the pandemic continues to spread in those countries."
Analysts caution that it's impossible to predict with certainty which countries will be hit hardest and which may be able to mount an effective defense.
But a list of vulnerable nations includes countries with huge populations and widespread poverty, such as Brazil, India, Indonesia, Nigeria and Pakistan.
So far, few cases
To date, the number of confirmed cases in these countries has been relatively low, ranging from fewer than 5,000 in Brazil to just over 100 in Nigeria.
But all these nations have lagged behind wealthier countries in responding to the threat, and their options are far more limited.
In India, the world's second most populous nation with 1.3 billion people, Prime Minister Narendra Modi imposed a 21-day lockdown last week. By Sunday, he was on nationwide radio acknowledging the hardships.
"I would firstly like to seek forgiveness from all my countrymen," Modi said. Impoverished Indians will "definitely be thinking what kind of prime minister is this, who has put us into so much trouble."
But Modi said there was no other option. The number of confirmed cases in India has just passed 1,000, though in the absence of widespread testing the actual number is likely much higher.
The measures imposed in wealthier countries may not be realistic in poorer ones, says Jennifer Nuzzo, an epidemiologist and director of the Outbreak Observatory at Johns Hopkins University's Center for Health Security.
"It's one thing for us here in the United States to sit at home and telework for weeks or months," she says. "But it's another thing to ask people in countries where their sole income may be from going out into the streets and selling things, to tell them to stay home for weeks and months and potentially not earn an income to feed their families."
Indians head to villages
Modi's moves in India sparked a mass migration, with millions of the urban poor fleeing for their home villages.
Nuzzo sees this as extremely dangerous.
"The last thing you want in these circumstances is to increase the geographic footprint of your epidemic," she says. "I do really worry that when governments announce an intention to implement lockdowns, it winds up scattering cases and it becomes much harder to control when you don't know where everyone went."
Experts say there are no easy, low-cost solutions that poorer countries could adopt. Like wealthier countries, they need more tests, more protective equipment for doctors and nurses, more hospital beds — and have no clear way to get them.
As many wealthier countries struggle to contain their own coronavirus cases, it's not clear if the U.S. and other developed countries will be able to help orchestrate a strong response, as they have done for previous international health crises, like the 2014 Ebola outbreak in West Africa.
Nuzzo did cite one glimmer of hope. She was part of a study, published just last October, on how well countries were prepared for a pandemic. The results did not track strictly along national income levels. Past experience mattered, she said, citing two examples from Africa.
Nigeria did much better than expected when hit by Ebola in 2014, Nuzzo says. The health system functioned, and the disease was brought under control.
"They were able to contain it quickly and it didn't become the nightmare scenario that we predicted," she says.
In East Africa, Uganda and neighboring countries were the first countries ravaged by HIV/AIDS back in the 1980s. As a result, they've built public health systems that perform well above what their income levels would suggest, she notes.
Greg Myre is a national security correspondent. Follow him @gregmyre1.
RACHEL MARTIN, HOST:
So far, countries in the developing world haven't been hit as hard by the coronavirus as wealthier nations in Asia, Europe and North America. But the pandemic now appears ready to explode in those countries, which have far fewer resources to combat the virus. NPR national security correspondent Greg Myre has been studying the global trends, and he joins us now. Good morning, Greg.
GREG MYRE, BYLINE: Hey, Rachel.
MARTIN: So could you start by just explaining this phenomenon? I mean, why richer countries were hit first by the coronavirus?
MYRE: Well, simply put, the virus traveled from China to the countries that had the most contact with China. So these were initially the rich countries of East Asia. We're talking South Korea, Japan, Taiwan, Singapore - then on to Europe and the U.S. All of these countries had lots of flights, lots of business, lots of tourism with China. So Johns Hopkins University has the most detailed chart of coronavirus cases in the world, and it's quite striking. Almost all of the top 25 countries with the most cases of the virus - with just a couple exceptions - are these wealthier countries. And it's important to note that the U.S. and others are really preoccupied with their own struggle. And they haven't really been in position to orchestrate any kind of global response.
MARTIN: Right. So we're now several months into this outbreak and it keeps spreading - right? - around the world. What are we seeing right now in developing countries?
MYRE: Well, this next tier of countries sort of - you can think of them as large, developing countries - appear to be at a real tipping point. And it's ominous because they have nowhere near the resources of these wealthier countries. We're talking about India, Indonesia, Pakistan, Nigeria, Brazil. Relatively low numbers so far in these countries - maybe from a few thousand to just a few hundred, but it's starting to accelerate. A lot of them are getting their biggest daily counts ever. And so I spoke about this with Mira Rapp-Hooper, who's at the Council on Foreign Relations.
MIRA RAPP-HOOPER: There are a lot of other countries at lower income levels that already have significant coronavirus outbreaks. They are very likely going undetected or underdetected while the pandemic continues to spread in those countries.
MARTIN: So what can they do? I mean, what options do these countries have?
MYRE: Well, they're starting late and their options are limited. Let's look at India with 1.3 billion people - second-most-populous country in the world. Prime Minister Modi imposed a 21-day lockdown last week. And within days, he went on nationwide radio and he asked forgiveness for the extreme hardship this was imposing. You have so many people living at the margins, so much crowding there. Social distancing is really almost an impossibility in these megacities, like New Delhi and Mumbai. And these measures used in rich countries may not be realistic in poor countries. And so I called Jennifer Nuzzo, who's at Johns Hopkins University.
JENNIFER NUZZO: It's one thing for us here in the United States to sit at home and telework for, you know, weeks or months. But it's another thing to ask people in countries where their sole income may be from going out into the streets and selling things to tell them to stay home for weeks and months and potentially not earn an income to feed their families.
MYRE: One of the most dramatic effects in India has been this mass migration. Literally millions and millions of the urban poor are fleeing the cities - and often on foot because a lot of transportation has shut down - and they're heading back to their homes in the villages. And clearly, this can spread the virus on these trips and is not something that the government wanted or intended.
MARTIN: Right. So is anyone daring to make a prognosis for these developing countries right now?
MYRE: Well, it's really tough. There's no obvious, easy solutions. Jennifer Nuzzo at Johns Hopkins did cite a potential silver lining. She was part of a global study published last October on how countries were prepared for pandemics. It didn't entirely follow income levels. But one good example was Nigeria, which did much better than expected during the Ebola outbreak in 2014. Its health system functioned, and it came in much better than predictions.
MARTIN: All right. NPR's Greg Myre for us. Thank you, Greg.
MYRE: My pleasure. Transcript provided by NPR, Copyright NPR.