The View In Thailand And Nepal

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March 23, 2020 9:25 a.m.
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TPM reader JH writes in from Asia…

I’m an American (from Colorado), but I split my time between Nepal (where my work is) and Thailand (where my husband lives and works). And both countries exhibit so many of the key challenges that the world is facing as this pandemic expands beyond the developed, and frankly high capacity, countries of China, East Asia, Europe, and the US.

Thailand was the first place where a case was identified outside of China, all the way back in January, but has been lucky in that the growth of identified cases was quite slow until recently (we saw nearly 400 new cases in the last week and a clear exponential growth line seems to indicate the big hit is coming). Good contact tracing and a general willingness by everyone to self-distance and religiously wash hands helped slow things down early on. And, while there is still minimal evidence the virus spreads more slowly in heat and humidity, if that is at all true, it would certainly help here in Thailand. But while the public health impact has been slow, the economic impacts have been devastating. The two largest sectors of the economy are tourism and manufacturing. Half of Thai tourism is from China, with Wuhan being the single largest source of tourists, meaning that the impact of China shutting down was felt swift and early. Now with travel restrictions across Europe and the US, tourism has almost entirely disappeared, leaving everyone from large hoteliers to informal workers such as street food sellers hurting. Because of this, the Thai government has been reluctant to fully close off the country, the way neighbors such as Singapore and Philippines have, much to the chagrin of the well-educated in Bangkok. But that is the reality, without tourists, many of the country’s biggest companies and a huge chunk of the informal and most vulnerable workers will lose their livelihoods.

At the same time, the Thai manufacturing sector is very tied in to Chinese supply chains. Thus, even while demand for products was still high through January and early February, factories were already struggling to source parts and fill orders. Now that Chinese supply chains are coming back on line, demand has evaporated, dealing a kind of one-two punch to the economy.

Thailand, fortunately, has a very strong health system (thanks to a large medical tourism sector) and quite competent bureaucrats, which will help the country take care of its people. But as the economy is so globalized and so exposed to the kinds of shocks this crisis has brought, combined with the reality that the government does not have the reserves or borrowing capacity of a wealthier country, the impact will be deeply felt and the recovery uncertain.

However, none of that compares to what is happening to Nepal. Nepal has very minimal public health infrastructure, has almost no testing capacity, and has very low capacity medical institutions. The first case was recorded in a Nepali returning from Wuhan in January, and the government has recorded no new cases since. No one believes that there are actually no new cases, just that there is no ability or willingness to start testing for it. Last week, as restrictions ratcheted up worldwide, and as reports of spikes in respiratory illness in villages made their way through Nepali social media, the government acted and acted swiftly. On Saturday, the Prime Minister declared the country would close, the last international flights flew out on Sunday, and as of Monday all non-essential businesses, government agencies, and border checkpoints with India and China were shut down. (I was fortunately in Bangkok when this was announced, so I get to ride this out here where I have much better access to health care if I need it).

That there is still no data on the extent or the spread of cases in Nepal underscores the challenge. Even if it wanted to, Nepal does not have the capacity to test or treat the coming pandemic. All it can do is shut things down, ask people to cooperate, and hope the population rides it out. The spread of rumors and information on social media (some real, much of it fake), such as a video making the rounds today of returnees from European fleeing quarantine, both threatens to undermine cooperation and potentially inflames tensions.

While it will hurt, there is still a chance that Europe and the US will bring the virus under control, but looking to Thailand and Nepal shows how much the management of the pandemic in the rest of the world will impact the long-term prevalence of this disease. Poor countries don’t have resources to manage this and middle-income countries are too dependent on global flows to survive an extended shutdown. Unless the virus is contained in these places as well as it is contained in New York or Milan, it will continue to spread widely, become endemic, and eventually be part of the global disease landscape. Unfortunately, the world is providing far too little way too late to make any kind of difference.

Just this morning, Nepal confirmed its second case.

Key Coronavirus Crisis Links

Josh Marshall’s Twitter List of Trusted Experts (Epidemiologists, Researchers, Clinicians, Journalists, Government Agencies) providing reliable real-time information on the COVID-19 Crisis.

COVID-19 Tracking Project (updated data on testing and infections in the U.S.).

IHME Projections Site (COVID-19 epidemic model which has become the canonical model for many states and hospitals.)

Johns Hopkins Global COVID-19 Survey (most up to date numbers globally and for countries around the world).

Worldometers.info (extensive source of information and data visualizations on COVID-19 Crisis — discussion of data here).

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