COVID-19: the worst may be yet to come

Type Journal Article Author The Lancet URL https://linkinghub.elsevier.com/retrieve/pii/S0140673620315178 Series Editorial Volume 396 Issue 10244 Pages 71 Publication The Lancet ISSN 01406736 Date 11/07/2020 Journal Abbr The Lancet DOI 10.1016/S0140-6736(20)31517-8 Library Catalog DOI.org (Crossref) Language en Abstract As much of western Europe begins to ease countrywide lockdowns, globally the pandemic may still be in its infancy, with more than 160000 new cases reported each day since June 25. Individual countries count cases differently, so direct comparisons are difficult, but the numbers illustrate a worrying pattern. At a subnational level the picture is nuanced, with local hotspots, but at a country level the picture is clear—the world is facing a worsening multipolar pandemic. The USA, Brazil, and India each logged more than 100000 new cases from June 26 to July 3. But the pandemic also rages in Russia, forming a belt of infection that tracks through central Asia and into the Middle East and the Indian subcontinent. Increasing COVID-19 cases in South Africa mean that the pandemic has a strong foothold in sub-Saharan Africa, which is particularly alarming as parts of Africa consider resuming internal air travel later this month. Despite President Trump’s July 4 claims that “99% of cases are harmless” and of a “strategy that is moving along well”, the USA has the most new cases worldwide—53213 on July 4, and a total of 128481 deaths, almost a quarter of the total deaths globally. These beacons of infection show the fragility of any progress. During the first days of July, 2020, Kazakhstan recorded the second highest number of new cases within Europe after Russia. Reporting in the largely authoritarian central Asian states has been unreliable. Turkmenistan has yet to report a single case of COVID-19 and Tajikistan has yet to provide breakdowns to WHO. Regardless, the health and economic outlook for the region is bleak. These countries have some of the highest ratios of out-of-pocket health-care spending to total health expenditure in the world, with women in particular having very poor access to health care, further obscuring the true numbers of COVID-19 cases. At the beginning of the pandemic, 2·7 million to 4·2 million central Asian labour migrant workers were estimated to be residing in Russia. Many remain stranded in areas with a high infection risk, meaning reintroduction of the virus might become a problem after the initial wave Short Title COVID-19