Current data suggest that recent pandemics’ origins are associated with a zoonotic mode of transmission from animals to humans . Animal to human transmission was presumed to be the main route of transmission for SARS-CoV-2, since the first reported case of COVID-19 was linked with direct exposure to the Huanan Seafood Market in Wuhan, China. Nevertheless, the subsequent cases that were reported did not follow this mechanism . Therefore, it was concluded that SARS-CoV-2 could also be transmitted through aerosol, human to human (symptomatic/asymptomatic), and surface to human contact .
As of April 21, 2020, there had been over 2.5 million reported cases of COVID-19 in 210 countries across six continents. At the beginning of this pandemic, China (82,758) was affected the most by the disease; however, later the US (792,938), Spain (204,178), Italy (181,228), France (155,383), Turkey (90,980), and Iran (83,505) had the most COVID-19 cases worldwide. The number of reported cases has since started to increase in South Asian countries (India, Pakistan, Sri Lanka, and Bangladesh). The initial cases reported in South Asian countries were thought to be caused by travelers returning from other COVID-19 affected countries. Although, by the date (21st April, 2020), the total number of reported cases in South Asian countries is not as high as it was in the US, Italy, Spain, France, and Iran (Table 1). However, the weekly growth in the number of reported cases (up to the eighth week) in South Asian countries is quite similar to the increase in the number of reported cases in the US, France, and the United Kingdom (UK).
Based on the preparedness index formulated by Greenhill and Oppenheim, which defines the ability of a country to curtail any pandemic , the spread risk of this pandemic is higher in South Asian developing countries than in developed countries . A few of the factors that contribute to a higher spread risk of the pandemic include population density, susceptibility to infection, patterns of movement driven by travel, trade, and migration, the speed and effectiveness of public health surveillance and response measures, and the socioeconomic status of the country . Three out of four countries included in the current study fall under the top ten most populated countries in the world [16-18]. Furthermore, the per km2 population in Bangladesh, India, and Pakistan is more than any country listed in Table 1. In addition, a large number of people in these countries live in slums [16-18], which makes it difficult to maintain social distancing and to adopt preventive measures. Furthermore, poor education and extreme poverty are other factors that make it more difficult to follow social distancing instructions, or early disease identification of symptoms of COVID-19. A report from Pakistan showed an increasing number of cases where people died due to COVID-19 before reaching a hospital .
To date, there has been a total of 2,505,858 reported cases of COVID-19 worldwide, with a lower number of reported cases (31,608) and reported deaths (901) in South Asian countries 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 stronger immunity, warmer weather, childhood BCG vaccinations, and exposure to anti-malaria medications. From the data collected from the worldometer® website, the authors believe that the lower number of reported cases in the South Asian countries could be due to the lower number of diagnostic tests performed for COVID-19 virus compared to countries that have reported a higher number of COVID-19 cases. India (18,658) and Pakistan (9,216) have the most COVID-19 cases in South Asian countries, with 291 and 506 tests performed per million population, respectively. The number of tests (per million) performed in India and Pakistan is significantly lower than in the US (12,167), Spain (19,896), Italy (23,122), France (7,103), and the UK (7,386). Even countries in Asia with the highest number of COVID-19 cases, Turkey (7,991) and Iran (4,203), have a higher number of tests performed per million population. In South Asia, on average, 315.25 tests per million population were performed; this is at least 12 times lower than the number of tests performed in the epicenters of COVID-19.
Accountability for preparedness in these countries is diffuse, and many countries that are at the greatest risk have the most limited capacity to manage and mitigate pandemic risk. In addition, these countries need to perform the virus diagnostic tests in greater numbers to get an accurate picture of the pandemic. Based on the data, one could suggest that the low number of reported cases but with high percentage increases for South Asian countries could be a ticking time bomb waiting to explode, and this region could be the next highlighted region of this current pandemic.