In recent times, one of the greatest challenges for any nation or the world is the threat of a world-wide disease outbreak commonly referred to as a pandemic. Even though the world is better prepared to face any health crisis than before, still the world is not fully prepared to handle a pandemic. Preparing for global health crisis like a pandemic disease has become ever challenging owing to myriad of elements, many of these factors are unique among natural disasters. Generally, pandemics occur very rarely and mostly they influenced by the anthropogenic changes to the ecological systems. Current data suggest the recent pandemics have their origins associated with the zoonotic mode of transmission that is from animal to humans . Animal to human transmission was presumed to be the man route of transmission for COVID-19, since the first reported case of COVID-19 was linked with direct exposure to Huanan Seafood Market in Wuhan, China. Nevertheless, the subsequent cases that were reported did not follow this mechanism . Therefore, it was concluded corona virus can be transmitted through aerosol, human to human (symptomatic/asymptomatic) and surface to human contact .
As of April 21st, 2020, there had been over 2.5 million reported cases of COVID-19 around 210 countries across 6 continents. At the beginning of this pandemic China (82,758) was impacted the most by the disease, however later the United States (792,938), Spain (204,178), Italy (181,228), France (155,383), Turkey (90,980) and Iran (83,505) have the most COVID-19 cases worldwide. In the past few weeks number of reported cases have started to increase in South Asian countries (India, Pakistan, Sri Lanka and Bangladesh). The initial cases reported in South Asian countries was thought to be brought by travellers returning back from other COVID-19 affected countries. Although as of now the total number of reported cases from South Asian countries was not as high as it was in USA, Italy, Spain, France, Iran etc (Table 1). However, weekly growth in number of reported cases (up to 8th week) in South Asian countries is quite similar to the increase in number of reported cases in USA, France and UK.
Based on preparedness index formulated by Oppenheim and other (2017) that defines the ability of a country to curtail any pandemic the spread risk of this pandemic is higher in South Asian developing countries as compared to other developed countries [14, 15]. Few of the factors that lead to higher spread risk of the pandemic include density of the population, susceptibility to infection; patterns of movement driven by travel, trade, and migration; and speed and effectiveness of public health surveillance and response measures; and socio-economic status of the country.15 Three out of four countries included in the current study fall under the top 10 most populated countries in the world [16–18]. Furthermore, per km2 population in Bangladesh, India and Pakistan is more than any country listed in table (Table 1). In addition, large number of people live in slums in these countries that makes it difficult to maintain social distancing and adapt preventive measures. Furthermore, less education and more poverty are other factors which makes it more difficult to follow social distancing instructions or early disease identification of symptoms of COVID-19 [16–18]. A report from Pakistan showed increasing number of those cases which died due to COVID-19 before reaching to hospital .
As of this time, there has been a total of 2,505,858 reported cases of COVID-19 worldwide, with a low number of reported cases (31,608) and reported deaths (901) in South Asian countries as compared to other regions of the world. There have been many hypotheses related to this lower reported COVID-19 cases and deaths. Some of the theories included strong immunity, warm weather, childhood BCG vaccination and exposure to malaria/malarial drugs. From the data collected from worldometers® website, the authors believe that the lower number of reported cases in the South Asian countries could be as a result of lower number of diagnostic tests performed for COVID-19 virus as compared to other countries that have report higher corona cases. India (18,658) and Pakistan (9,216) have the leading corona virus cases in South Asian countries with 291 and 506 number of tests performed per million population respectively. The number of tests (per million) performed in India and Pakistan are significantly lower when compared to US (12167), Spain (19896), Italy (23122), France (7103) and UK (7386). Even the countries in Asia with highest corona cases Turkey (7991) and Iran (4203) have higher number of tests performed per million population. On average, in south Asia there were 315.25 tests/million were performed which were at least 12 times lower than per million tests performed in the epicenters of COVID-19.
Accountability for preparedness for these countries is diffuse and many of the countries are at greatest risk of having the most limited capacity to manage and mitigate pandemic risk. In addition, these countries need to perform the corona virus diagnostic test in greater number to confirm the presence of the real picture of this pandemic. Based on this data, one can suggest that low number of reported cases but high percentage rise for South Asian countries can be a ticking time bomb waiting to explode and this region could be the next highlighted region of this current pandemic.