34 Alla
~detectingonlycaseswithforeignorigins. "I
suspect that if we did 20 times more tests
we might find 20 times more cases,· says
Ramanan Lamlinarayan of Princeton Uni-
veISity. "I persoilillly think we are already
in the thouSilllds if not tens of thousands.•
Should the virus have indeed slipped
past India's banien, there is little reason to
think it will follow a different course from
elsewhere. That would put India's epidem-
ic about two weeks behind America's and
perhaps a month behind Italy's. That is
alarming, given bow poorly prepared India
is. Decades of under-investment in publichealth-recent budgets have aveiaged a
meagreL3%of GDP-baveleftitwitha thin
and creaky system (see chart on previous
page). There are not enough docton, not
enough beds and not enough equipment
for the countly's 1.3bn people, even in or-
dinary times. Moreover, these scant re-
sources are unevenly distributed. Excel-
lent printe hospitals and prestigious
public medical schools mean that big cities
such as Delhi and.Mumbai may be reason-
ably served. But in 2017 some 63 children
suffering from encephalitis died when the
oxygen supply ran out at a state-run hospl-What's in store for the small plaas of the Padflc
D BMO'l"B AND pristine, the tiny island
~tions of the Pacific are often the
object of apocalypse-proofing fantasies.
Butifyou think they are in any state to
ride out covid-19, dream on.
Many Pacific jurisdictions have
thrown up barriers to the newcorona-
virus. In late January the Federated States
of Micronesia banned entry to travellers
from countries with con finned cases.
The cook Islands, Fiji, French Polynesia,
NewCaledonia, Papua New Guinea
(PNG), 'lboga and vanuatu have banned
cruise ships. Anyone coming to Samoa
has bad to produce a medical certificate.
In early March the Marshall Islands
sealed itself off, banning all inbound
visitors. nen supplyvessels mustwait14
days at sea before berthing.
Theeconomiccostwillbedevastat-
ing. The island states import nearly
everything. Moreover, tourism is the
main earner for many. Fiji bad a full·
blown fiscal crisis even before empty
hotels removed a big source or revenue.
The NorthemMarianas, an American
territory, relies on nnished visitors from
China, Japan and south Korea. writing to
President Donald Trump for help, the
govemorwamed of the ·unequivocal
and complete collapse of the founda-
tions or our private sector-.
If the measures kept the coronavirus
at bay, they might be worth it. But they
won't. Already, five cases have been
confirmed in Guam, five in French Poly-
nesia (including a retumingmember of
France's National Assembly), two in New
Caledonia and one in Fiji. one is suspect-
ed in PNG. Testing facilities barely exist
in the South Pacific-samples are sent to
Austnlia or New Zealand-although Fiji
has raced to set one up.
Thecoronavirus has many routes to
spread. PNG, the region's most populousstate, bas a porous borderwithAustralia,
just across the Torres StRit, and a land
borderwith Indonesia. Itis trying to seal
the sea-lanes to the nearby SOiomon Is-
lands. Turuu andKiribatiareamongthe
tiniest, most isolated states in the world,
yetmanyoftheirmenfolkworkassea-
farers, with a history of canying infectious
diseases home. Half of the populations of
Samoa and 'lboga are abroad, many in
infected countries. There are more pos-
sible vectors than isolated atolls.
It is cause for alarm. The MaJshall
Islands is only now recovering from a
dengue outbreak infecting 3,000, followed
by bursts of influema. It left the little
hospital in the capital, Majuro, looking
"like a war zone·, says the health secretary,
JackNiedenthal.Anoutbreakofmeaslesin
Samoa in December killed 83, most of them
children. Both countries are racing to
respond to covid-19. But the Marshall
Islands has just six ventilators. Of just mo
protective gowns, goggles and gloves, the
hospital got through 22 sets investigating a
single suspected case. Meanwhile, the
Solomon Islands has such a dilapidated0
The Economist March 21st 2020tal in Gorakhpur, a drab provincial city near
the border with Nepal. India's 100,000-odd
intensive-care beds, which cater to per·
haps sm people a year, could be faced with
that many in a month.
The public is not well prepared either,
partlcularly for a disease that primarily af-
flicts the lungs, and is more severe in pa-
tients with pre-existing conditions. The
prevalence of both extreme air pollution
and drug-resistant tuberculosis do not
bode well. Indians also account for an esti-
mated 49% of the world's diabetics. Wide·
spread poverty not only exacerbates such ~health system thatmanywill viewthe
main hospital in HoniaJa, the capital, as
the last place to go with covid-19.
To cope with the pandemic, Pacific
islanders will be thrown back on support
networks such as family and church.
People are all too used to catastrophes,
from cyclones to tsunamis. Only rarely,
asJonathanPrykeoftheLowylnstitute
in Sydney puts it, do they feel the hand of
the state. Traditional networks will prove
a blessing, but also carry risks if in-
fections are carried back to villages from
capitals. It helps that Pacific populations
are relatively young (covid-19 guns for
the elderly and infirm). But high rates of
non-communicable diseases, notably
diabetes, put more people at risk. Thanks
to an atrocious diet (think Spam and
Kool-Aid), seven of the ten most diabetic
countries are in the Pacific. The hospital
in Honiara saws off three limbs a day.
Peter Kenilorea., an opposition figure
in the SOiomon Islands, says the govem·
ment is unprepared. In its speech mark-
ing the opening of Parliament in Honiara
this wt!ek, only two sentences were
devoted to covid-ig. A Jildio station in Fiji
has been broadcasting public-health
advice for weeks about washing hands.
Yetthegovemmentwillnotletitlink
those messages to the pandemic, lest
they spark panic.
Australia and New Zealand both
emphasisewhatNewZealand'sleader,
Jacinda Ardem, calls "a duty of care• to
Pacific nations. Both countries have
promised to send medical equipment
and personnel. But Sheldon Yett ofUn-
icef says that the region's travel clamp-
down hampers the movement of aid
workers and supplies. And once Austra-
lia and New Zealand face full-blown
crises of their own, how much will they
look out forthe Pacific?