In Europe and North America, the news is increasingly about lifting lockdown restrictions in place for the Covid-19 pandemic. In many of these nations, daily infection and death rates are declining – the peak has passed. There is a pervading sense that the worst of life under the virus is beginning to pass and that “normal life” is just over the horizon.

In stock markets around the world, there is not just a sense that this is happening, investors clearly believe it to be true, and are actively buying into it. However, many of these nations lack a comprehensive strategy for easing restrictions, and for opening up society and the economy.

To what extent has the data and experience from this, and other epidemics, been deeply analysed and used to develop an evidence-based understanding to underpin an easing strategy? It is likely that the opening up will be at least partly experimental. An increase in infections and a second peak in death rates are likely to accompany such opening up, especially in regions that are still basing national decisions on anything other than expert biological understanding of the disease. If the unco-ordinated (and at times incoherent), response to the pandemic continues in the US, rolling peaks in death rates are almost a certainty as the virus ebbs and flows between cities.

The richer nations of Asia appear to have gotten to grips with the disease. Hopefully, Europe and the US now realise that they ignore the experience of Asian nations at their peril. Despite the spectre of secondary peaks of infection, Europe and North America have probably thwarted the most devastating human and economic potential impacts of the virus. The complacency with which many of these nations initially faced the disease is now, largely, a thing of the past. However, the global impact of the disease is far from thwarted.

Globally, we are not looking at a return to “normal life” over the horizon, but a transition in the pandemic from a rich-nation, northern hemisphere disease, to a poor-nations, southern hemisphere disease. It is a safe prediction that the devastation in human lives will dramatically increase with this transition. What is difficult to predict is the level of complacency that will meet the disease as it transitions, both by the poorer nations themselves, and by the richer nations that are emerging from the worst impacts right now. However, we can outline the worst- and best-case scenarios in each situation. For most nations, the experience will be somewhere between the two extremes.

Rich nations: Scenario 1 – running and reversing

This is the rolling-peaks-of-infection scenario that is likely without a co-ordinated national strategy based on sound scientific understanding. It will be a game of whack-a-mole with infections spiking in one place, then lockdowns being brought to bear, only for a spike to pop up somewhere else. 

The US’s incoherent response to the disease is the template for this scenario, as evidenced by the fact that even now there is no complete and consistent lockdown in place, nor a consistent and rational ban on flights from other countries. In fact, after the much-vaunted banning of flights from China, up to 40,000 people are reported to have entered the USA on flights from that country.

Other examples, like states competing for medical equipment with each other and with the federal government, and the poor availability and accuracy of testing, have been much publicised. Perhaps there is no better demonstration of the lack of emphasis on co-ordination than the fact that basic data on the disease (number of deaths, number of infections, tests performed etc.), is not readily available from any arm of the federal government. It is universities, NGOs and alliances of the traditional press (currently one of the most poorly funded sections of the media), that have stepped into the vacuum to collate the data.

Rich nations: Scenario 2 – tried, tested and determined

This scenario takes place when science has been implemented early and comprehensively by nations. Virtually all these examples are Asian or Australasian, plus a few European nations e.g. Austria and Norway (in stark contrast to their neighbour, Sweden), and perhaps Germany and Belgium, with South Korea being the best example. 

Instituting forms of physical distancing early and co-ordinated widespread testing have been the biggest factors, with the smart use of mobile technology being influential too. Following this path may mean giving up some civil liberties around privacy so that the infection paths of individuals can be tracked using their phone’s GPS and shared with others. One way to prevent future misuse of such information could be to have the laws brought in to permit that such surveillance and sharing last only up until a certain expiry date, after which such measures can no longer be used.

Poor nations: Scenario 1 – running rampant

Unfortunately, this is the most likely scenario for many poor nations. Here we are likely to see an exponential explosion of infections beyond anything witnessed so far. In India alone, and despite the current lockdown, it will not be surprising to see more than a quarter to a half-million fatalities by the end of July. There is simply no opportunity for effective isolation even under lockdown conditions, and economies are too weak to sustain a lockdown for an extended length of time.

In poor countries, where three families live on one small peri-urban stand originally designed for one (working class townships), or three people share a room and often have to use communal taps and sanitation facilities (informal settlements or slums), lockdowns not only border on the inhumane, but are frankly impossible. The International Monetary Fund (IMF) has recognised that in such societies “a lockdown can have devastating effects — for example, on food insecurity — on households which live hand to mouth and have limited access to social safety nets”.

Moreover, many of these countries simply don’t have the necessary health facilities to cope with even a fraction of the population felled by the disease, and that is to say nothing of a co-ordinated national health strategy. It is reported, for instance, that Zimbabwe has a total of seven ventilators and the Central African Republic only three in the entire country.

Much of Africa is at risk of this scenario, as well as India, Bangladesh, and a few nations in South-East Asia, west Asia, central and South America. One possible silver lining is that some of these nations have rural populations that live so far off the grid that the virus is unlikely to have reached them before a vaccine becomes available. The race is then on to see if the vaccine can reach them faster than the virus.

Another is that most of these countries have predominantly young populations who are more likely to survive the disease. In Nigeria, for example, the average age is 18 while Italy’s is 45. However, for nations already facing breakdown, poverty or civil war, the pandemic will just be another way to die, to add to an already long list, e.g. Somalia, Yemen, Central African Republic, South Sudan.

Poor Nations: Scenario 2 – try, test and deter

A few poorer nations are showing signs of being able to get on top of the disease despite incredibly limited resources or opportunities. It seems only to be possible in the richer of the poor nations. South Africa, and perhaps Algeria and the Philippines, are examples that offer hope to other such nations. 

For control of the disease to work in these nations, everything has to come together: very early action, screening and testing, convening epidemiological and medical expertise to thoroughly guide the response, co-ordinated national strategies and constant monitoring. This, plus the innovation of new mechanisms beyond those used in rich nations, but which address the situation prevalent in these poorer nations, will be required.

South Africa, infamous for years of denialism of the HIV pandemic, this time ordered the closure of schools and borders before the number of confirmed infections reached 100. The country was put into one of the most stringent lockdowns on the planet, in which people are permitted to leave their homes only for food and medicine, before the number of infections reached 500. Over 28,000 community health workers go door-to-door in the high-density townships and informal settlements to screen communities for likely hotspots of infection, and to then test to confirm cases.

Data from the screenings are sent directly from the community health workers cellphones to a central command centre that was originally set up to co-ordinate the security and other operations of the 2010 FIFA World Cup. Clear targets for daily infection rates and community screenings have been set, and only when these are reached will the lockdown be eased in a stepwise manner.

There is no doubt that the complacency with which some rich nations (e.g. China, Iran, Italy, the USA and UK), responded to the pandemic in the northern hemisphere, disregarding clear scientific evidence and replacing it with misinformation and denials, has been devastating. 

The tragedy of this response is magnified with each day that the disease was left unchecked after the rate of infection and fatality became clear in cities in China. It is therefore astonishing that even now, the leaders of some nations, like Brazil, Nicaragua and Belarus, continue with this denialism.

At the start of this pandemic, scientists sprang into action exploring a range of aspects of this disease, sharing information freely, and combining to create an understanding of the disease at the start of a pandemic, that is unprecedented in human history. 

Will we now see a rise in nationalism and isolation, limiting collaboration and communication by scientists? Will we see complacency in rich nations lead to a change in global co-operation and supply, just as the pandemic takes off in poor nations?

What we need is a global response where nations freely and openly collaborate to help each other through this crisis. Once it becomes available, getting a vaccine to everyone on the planet is not just an act of humanity, it’s the only way to control rolling waves of reinfection between the northern and southern hemisphere nations. DM

Dr Peter Carrick is an adjunct ecologist at the University of Cape Town, South Africa. He has a PhD from the University of Cambridge and is currently sheltering in place in the US, after starting a sabbatical at the University of Colorado at Boulder before the pandemic. He has explored parts of all six continents, mostly on foot, and explores thinking on the intersection of ecology with humans, their society and economies. He writes in his personal capacity.