As major European countries cheered a drop in coronavirus death rates this week, a top United Nations official warned of a looming crisis in poor countries that could "boomerang" back to rich nations – unless they help contain it.
"No one’s safe until everybody’s safe," said Mark Lowcock, the UN under secretary-general for humanitarian affairs.
He said many low-income countries could see coronavirus infections peak in the next three to six months, and they will need an infusion of emergency aid in the coming weeks to keep the pandemic from decimating their already fragile health systems and struggling economies.
"The countries where we work have the potential to act as kind of reservoirs for the virus if there isn't significant effort to contain it in those places," Lowcock said.
On Thursday, the British accountant and UN humanitarian chief plans to ask rich nations for $6.7 billion in pandemic assistance for as many as 50 developing countries from Latin America to Africa.
The funding plea could be a tough sell as the United States and Europe reckon with the pandemic's crippling effect on their own economies. So far, the COVID-19 outbreak has inspired an every-country-for-itself response, with governments turning inward rather than rallying a coordinated global response.
But Lowcock and other health experts say that go-it-alone approach won't work against Covid-19.
“You have a chance of avoiding what’s currently a one-year problem becoming a ten-year problem with all the consequences we can forecast: instability, migration, space being created for terrorists and so on," Lowcock said.
Lowcock's plea comes as Britain, France, Spain and Italy and other European countries registered their lowest daily death tolls in several months and began cautiously reopening parts of their economies.
Spain is now allowing some adults outside for exercise. On May 11, France will begin a staggered reopening of schools, allow selected business to resume operations, and let people travel within 60 miles of their homes.
In Italy – which became the first country in Europe to apply a national lockdown and where nearly 30,000 people have died of the virus – more than four million people were allowed to return to work on May 4.
“People are happy to be outside but we’re also worried. We’re all scared of losing the gains we’ve made so far (in flattening the infection curve and driving deaths down)," said Domitilla Perri, a Rome clothing shop owner. "My shop won’t open up until May 18 but it’s anybody’s guess what’ll happen then. You see people out now, but they aren’t really buying much."
Italians were also allowed to visit relatives for the first time since March, as long as they did so in small groups and the visit doesn't take them out of the region where they live. Restaurants and coffee bars, previously limited to delivery services, were permitted to offer takeaway options. Parks and public areas reopened. And mourners could attend funerals again, but only up to 15. Social distancing rules remained in force.
Prime Minister Giuseppe Conte's government plans to further loosen Italy's lockdown in two-week increments going forward. But he warned that if the coronavirus infection rates or death toll starts to worsen, that timeline could be pushed back.
Britain will unveil its plan for easing a coronavirus lockdown on Sunday.
Fragile health systems
In other parts of the world, the outbreak is just beginning to take off. From Afghanistan to Yemen, infection and death rates remain relatively low, but officials are bracing for a coronavirus onslaught.
Lowcock said there’s still great uncertainty about how the pandemic will unfold in many poor countries, where the climate and demographics may alter its spread. It’s also not clear, he said, how the virus will interact with malaria, HIV/AIDS, malnutrition and other health challenges.
What is clear: the health systems in many poor countries are ill-equipped to cope with the pandemic.
"On a normal day, we have our constraints and limitations in terms of dealing with the health challenges," said Asad Majeed Khan, Pakistan's ambassador to the U.S.
"Even a resource-rich country like the United States or those in Europe have found their systems overwhelmed by the speed and scale of this disaster," he said. "Our health system in any case is fragile."
Experts say one of the most vulnerable countries is Yemen, which has been ravaged by years of war, starvation and cholera. The first cluster of coronavirus infections was confirmed in Yemen on April 10, and humanitarian officials fear the virus will tear through with unprecedented speed and severity.
"The factors are all here: Low levels of general immunity, high levels of acute vulnerability, and a fragile, overwhelmed health system," Lise Grande, the UN humanitarian coordinator for Yemen, said in a statement last week.
Tom Frieden, former head of the U.S. Centers for Disease Control and Prevention, said public health authorities "need to be careful of dichotomies: open versus closed, us versus them," when trying to tackle a disease that has infected more than 3.7 million people around the world and killed more than 260,000.
"We're all in this together," Frieden said during a May 5 media call organized by the World Economic Forum, a Geneva-based organization known for engaging the business world to help to tackle the world's ills.
Others on the call expressed particular concern about how the virus will unfold across Africa – and the potential for it to circle back to other continents from there.
"We will not be able to eliminate COVID-19 cases everywhere if we still have a lot of cases on a continent with 1.2 billion people," said John Nkengasong, director of the Africa Centers for Disease Control and Prevention, on the same call.
As of May 6, Africa had nearly 50,000 coronavirus infections, according to the Africa Centers for Disease Control and Prevention, which serves 31 of Africa's 54 nations. While that figure is far lower than other regions of the world, the World Health Organization noted in its weekly update ending May 3 that the continent's case totals increased 41%from the previous week.
A stark illustration of Africa's coronavirus preparedness: In Mali, there is an estimated one ventilator per 1 million people – about 20 in all, according to the Africa Centers for Disease Control and Infection.
Still, South Africa has joined several European and other countries, along with some states in the U.S., in easing lockdowns.
The process in South Africa is, however, proving tricky and complex. There are a growing number of cases being found in high-density settlements and shantytowns, where millions are facing growing desperation.
"I heard about food parcels coming to near where I live and went there. I got some food after standing for hours in a very long line, but others did not get (anything)," said Grace Xolo, of Khayelitsha, a sprawling shantytown of 400,000 mostly black South Africans on the lowest economic rung.
"I think of my family and friends and they are hungry. Some are angry. President (Cyril) Ramaphosa must save his people. We are starving,” said a tearful Xolo.
Previously a street vendor, Xolo is part of the informal economy that makes up 20% of South Africa's GDP and employs millions of the working poor. She is now prohibited from making a living and has been trying to register for government aid, without success. The peak of South Africa's coronavirus outbreak is expected to come between late July and September.
'If you don't work, you don't eat'
On the other side of the world, Alejandra Leon is used to crisis.
She runs a medical clinic on the Venezuela border near Cúcuta, Colombia, the heart of the exodus of 5 million Venezuelans from their collapsing country.
They have seen political clashes, a surge in infectious diseases, and a rising number of women and children arriving at their door in increasingly desperate conditions. Since COVID-19 quarantines put the region on lockdown in late March, fear hovers over her clinic, both for medical staff and the migrants they treat.
Many migrant shelters and aid providers have closed their doors, leaving the clinic struggling to treat patients with scarce resources. When the crisis began, Leon said some of her team resigned because they were unable to get basic protective gear or rubbing alcohol.
Meanwhile, informal work sustaining many Venezuelans has dropped off, leaving migrants even more vulnerable.
“We’ve been trying to make it better,” Leon said. “But now we’re regressing because the majority of people who arrive don’t have a way to feed themselves.”
The pandemic has prompted waves of Venezuelans to return to their country, which has been locked in an economic, political and medical crisis for years. But in Venezuela, the coronavirus has only pushed the country further to the brink.
“The situation under the quarantine is critical because if you don't work, you don't eat,” said Yonaimer, whose asked that his last name be withheld for fear of retribution. “We have a son, we have to sustain him somehow. But how we are now, we have our hands tied.”
Yonaimer and his wife fled last year to Peru, traveling more than 2,500 miles to feed their two-year-old son back in rural Venezuela. But they were forced to return after they struggled to survive working on the streets of Lima.
Now, as the former migrants hit two months under quarantine, they and millions others across the region face a brutal question: risk illness or hunger.
"I try to buy arepas and only eat one vegetable a day to survive, so we can give our boy three meals a day," he said. "My biggest fear is getting sick and not being able to do anything. ... we haven’t gone out in the streets. But the fear is that if we stay like this, we’re not going to be able to survive, because now, there’s no aid."
More damaging. For everyone
Niki Popper, a mathematician at Austria's Vienna University of Technology, said that while countries are beginning to open up and thus obsessing over how to keep their coronavirus growth curves "flat," there's good reason to think the infections resemble less of a "curve" and more of a "loop" in which cases will come back endlessly.
"We will face new growth. It depends on different aspects," he said, such as how well populations adhere to ongoing social distancing measures.
Lowcock is convinced that to have a chance at staving off these residual cases, and other destabilizing economic and social spill-overs, wealthier countries must make a sizable emergency increase in foreign aid to the world's poorest countries.
In his pitch, Lowcock has begun telling politicians in rich nations that if they do not help fund poorer countries' coronavirus responses, it will create instability, migration and numerous other problems – from conflicts to famine – that could spiral into a more sweeping global political crisis.
The virus will "boomerang back" to the U.S., Europe and other Western nations if they do not help contain it in low-income countries, he said.
"What we need is extraordinary measures," he said.
Contributing: Eric J. Lyman in Italy, Chris Erasmus in South Africa and Megan Janetsky in Colombia.