While much of Europe and Asia has relaxed lockdown measures after overcoming the pandemic’s first wave, the United States has moved firmly into its second surge. With more than 4 million confirmed coronavirus cases and upwards of 150,000 deaths, the country that was supposed to be the most prepared to handle a public-health crisis is proving itself to be among the worst at it.
To focus solely on the U.S., however, would be to miss the even more alarming situation occurring in much of the developing world. Brazil, second only to the U.S. in confirmed cases and deaths, has recorded more than 2 million infections. India, the world’s second-most populous country with the third-highest number of cases, is approaching the same grim milestone. Similar increases are occurring in South Africa, Mexico, Peru, Chile, and Colombia. Taken collectively, these countries account for more than a third of the world’s confirmed infections. And such figures only reflect the cases we know about.
While the U.S. can look to the experience of its fellow rich nations to help guide it out of this pandemic, and has relatively more resources to do so, many low-to-middle-income countries do not. The remedies that have proved effective in wealthy nations haven’t necessarily been possible in poorer ones—particularly those with inadequate testing capacity, strained health-care systems, and limited social safety nets.
Perhaps the most worrisome picture is currently in Latin America, which despite being home to less than 10 percent of the global population, claims more than a quarter of known worldwide cases and nearly half of all recently recorded coronavirus deaths. The region’s failure to contain the spread hasn’t been for a lack of trying: While some Latin American leaders, including Brazil’s Jair Bolsonaro and Mexico’s Andrés Manuel López Obrador, opted to downplay the severity of the coronavirus, Peru’s and Argentina’s presidents were lauded for their early efforts to contain it. But the lockdowns and social-distancing measures that worked to curb cases across East Asia and Western Europe haven’t succeeded in the region. In Latin America, “social-distancing measures were effective to reduce the transmission, but they were not effective to bend the curve,” Jarbas Barbosa, the assistant director of the Pan American Health Organization, a regional office of the World Health Organization in Washington, D.C., told me. To put it more visually: Rather than seeing its rate of infection fall, as have other regions whose countries imposed lockdowns, Barbosa said Latin America saw its line “plateau.”
Of course, no country’s context is exactly the same—each nation’s response was affected by a number of underlying factors, including the strength of its health-care system, the age and relative health of its population, and the resilience of its economy. Just as individuals with preexisting conditions are more vulnerable to the virus, so too, it would seem, are countries with underlying instabilities.
Experts I spoke with highlighted two main reasons tried-and-true coronavirus responses that worked in richer nations have failed poorer ones. The first has to do with the fact that lockdowns are more difficult to enforce in developing countries—particularly those with largely informal economies. Nearly 90 percent of India’s workforce is employed informally (in roles as disparate as street vendors, domestic workers, and construction laborers). Informal workers also make up as much as 86 percent of the employed population in sub-Saharan Africa and half of the employed population in Latin America (though the percentage varies from country to country). These jobs are low-paid, and many lack benefits such as sick leave or redundancy pay. Telecommuting isn’t an option: A day’s wage is almost always contingent on leaving one’s house. Enforced lockdowns of the kind declared in India and Peru left most workers jobless and, in the former country, stranded.
Though larger economies such as Britain and the U.S. were able to cushion the financial blow of their shutdowns with hefty stimulus packages, low-and-middle-income countries have been able to offer only relatively modest support. As a result, informal laborers are often faced with the impossible choice of abiding by lockdown rules or feeding their families. “When you ask them to stay home, in many cases you’re asking them to starve,” Benjamin Gedan, the deputy director of the Wilson Center’s Latin American Program and a former South America director on the White House National Security Council, told me.
The second factor has to do with the fact that many of the worst-affected countries in the developing world are also some of the most densely populated. In cities such as São Paulo and Delhi, where swaths of the population reside in multigenerational households within crowded and often unsanitary informal neighborhoods, social distancing is virtually impossible. For some, access to clean water and other basics isn’t a given. Even with the rollout of mass testing and contact tracing seen in some countries, Gedan noted, “if you cannot physically distance, then you cannot contain the spread of this virus.”
If there has been one silver lining, Barbosa said, it’s that the late arrival of the coronavirus to regions such as Latin America meant that many countries had time to shore up their health sectors. With some exceptions, he said, “we didn’t have in Latin America the situation that we saw in the north of Italy or in New York, where the services were totally overrun.” But a head start hasn’t made up for the fact that many health-care systems in the region lack sufficient resources, including life-saving medical equipment—a global issue that is perhaps most acute in Africa, where some countries have only a handful of ICU beds and ventilators. Some have none at all.
These issues weren’t a surprise to Matthew Richmond, a Brazil-based research fellow at the London School of Economics’ Latin America and Caribbean Centre. In mid-April, when Brazil had about 20,000 cases and just over 1,300 deaths, he warned that social and economic inequalities there would only exacerbate the situation. Speaking months later from his home in the southeast of the country, he told me his predictions have largely held up: Efforts to lock down have lapsed, and Brazil regularly records more than 1,000 deaths each day. Meanwhile, the government is pushing to reopen the country even as some of its most senior leaders, including Bolsonaro, have contracted the virus.
In countries and cities around the world, the pandemic has had an outsize impact on people of minority backgrounds and those from poorer communities elsewhere, and Richmond has observed the same dynamic play out in São Paulo. “Even though the cases were quite high in the wealthier areas, the deaths were much lower than in the poor areas,” he said. “And that’s not even taking into account the very high level of undercounting of cases and deaths.”
“There is certainly no sign that the situation is improving,” Richmond told me. “We get so used to seeing these terrible numbers and stories that [we’ve] become a bit desensitized to it.”