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Why India, Pakistan Have Lower Number Of COVID-19 Cases Compared To The US, Europe?

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South Asia, home to India, Pakistan, Afghanistan, Bangladesh, Bhutan, Maldives, Nepal and Sri Lanka account for almost 20% of the total world population. All of SAARC nations including India and Pakistan have registered only about 1.5 per cent of total COVID-19 cases so far, confusing many health experts. 

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South Asia’s disproportionately lower cases of COVID-19 despite being home to one-fifth of the world’s population have perplexed health experts’ that have put forth various reasons explaining the ‘low figures’.

The country-wise COVID-19 infected number people in South Asia as of April 27 morning IST stand as follows: India – 27,890 cases, Pakistan – 13,328, Bangladesh – 5416 Afghanistan – 1531 Sri Lanka – 523, Maldives – 214, Nepal – 53 and Bhutan – 7. These numbers are astonishingly very low as compared to Europe and North America.

Health Experts have put forward various reasons in trying to explain this disparity with some attributing the lower number of cases to warmer and humid weather and protection offered by the tuberculosis vaccine bacillus Calmette-Guérin (BCG) that is prevalent in the Indian subcontinent.

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Other medics have attributed the lower number of cases to the better immune system among those in the Indian subcontinent while some have argued that South Asian countries implemented better physical distancing measures.

The lower testing record of SAARC nations may not fully explain the fewer cases. India conducted just 335 tests per million as compared to Bhutan and Maldives that conducted around 11,000 tests and 6,871 tests per million and yet all of them had fewer positive COVID-19 cases as against France, Germany and the US which conducted 7103, 20,629 and 12,659 tests per million.

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Another reason attributed to the lower number of cases of COVID-19 in South Asia is the early lockdown implemented by the respective Governments.

India, Pakistan, Bangladesh and Sri Lanka began implementation of the lockdown around the same time around late march soon after the first few cases of the infections were reported. India extended the measure till May 3.

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By contrast, the US, one of the worst-affected countries, enforced stay-at-home orders around late March and early April even though the country was in the grip of the pandemic.

India also fared better in the lockdown stringency score than the UK and US. India’s scored 100 as against 64.5 for UK and 76.1 for the US, according to an analysis by researchers from the University of Oxford.

India’s Union Health Ministry said that the doubling rate was reduced to 7.5 days from an earlier period of 3.4 days since the lockdown was implemented. Bhutan and the Maldives had their first positive COVID-19 case only in the first week of March while Sri Lanka confirmed the first positive case in March.

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Another factor contributing to the lower number of cases in South Asia despite having almost 1/5 of the world’s population is believed to be its demographics. Evidence has already shown that older people are more susceptible to COVID-19.

The average age in India is 26.8 years while it is below 25 years in Bangladesh, Nepal and Pakistan. The average for Italy is 45 while it is above 40 for Germany, France and the United Kingdom. India has just 7.4 per cent senior citizens while Italy has 25 per cent population above 60 years.

Another possible reason behind the lower number of cases in the subcontinent is believed to better immune system of South Asians. Indians and other South Asians are exposed to more germs and infections as compared to European and American population making their natural immune response better, according to experts.

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However, some experts disagreed with the theory pointing out to the fact that India has the highest burden of tuberculosisKala-azar and the fourth-highest malaria incidence in the world to make this hypothesis unreliable.

According to health experts, India and European countries reported the first infected case in nearly the same time frame but the number of cases in Europe exploded in April (after starting steadily in March) and this pattern could repeat in India and other SAARC nations if measures are eased.

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