Where the Pandemic Still Rages

Hospitals in Uganda’s capital, Kampala, are running out of space for Covid patients. In Brazil, people are dying of suffocation because there’s no oxygen for those who are desperately ill. In Indonesia, gravediggers are working into the night to bury all the latest victims of the coronavirus.

While Covid-19 had receded in much of the United States this summer and life was returning to something closer to prepandemic form, across the globe many countries are still fighting for their collective lives. In fact, the pandemic has tightened its grip in large swaths of the world, driven by highly contagious new variants and low vaccination rates in many places.

“In many parts of the world, the situation is very bad,” says Gavin Yamey of the Duke Global Health Institute. “There are epidemics really spiraling out of control in many of the countries of Latin America, sub-Saharan Africa, and Asia. And in many of these countries, there has been very little access to vaccine—1 to 3 percent of the populations have had a shot.”

Hospitals in Uganda’s capital, Kampala, are running out of space for Covid patients. In Brazil, people are dying of suffocation because there’s no oxygen for those who are severely ill. In Indonesia, gravediggers are working into the night to bury all the latest victims of the coronavirus.

Across much of the United States, Covid-19 had waned this summer and life was returning to something closer to prepandemic form. But many countries are still fighting for their collective lives. In fact, the pandemic has tightened its grip in large regions of the world. Highly contagious new variants and low vaccination rates in many places are fueling the spread.

“In many parts of the world, the situation is very bad,” says Gavin Yamey of the Duke Global Health Institute. “There are epidemics really spiraling out of control in many of the countries of Latin America, sub-Saharan Africa, and Asia. And in many of these countries, there has been very little access to vaccine—1 to 3 percent of the populations have had a shot.”

Scientists believe the so-called Delta variant may be twice as transmissible as the original coronavirus, alarming public health officials, including in the U.S., where it has spread mostly among the unvaccinated. Unvaccinated populations, whether in India or Indiana, may serve as incubators of new variants that could evolve in surprising and dangerous ways.

The surge of cases around the world has also highlighted the gulf between the world’s haves and have-nots. Like the U.S., the United Kingdom, Canada, and much of Europe have vaccinated a majority of their populations and had loosened Covid restrictions over the summer. But vast inequalities in economic development, health-care systems, and—despite the promises of world leaders—vaccine access have made the latest surge much bigger and much deadlier in poorer places (see “Helping Countries in Need,” below).

Carissa Etienne, director of the World Health Organization’s Pan American Health Organization, says that at a time when we’re experiencing some relief from the virus in wealthier countries, for most developing countries “the end [of the pandemic] remains a distant future.” (See map, below.)

“Despite this worrisome picture, just 1 in 10 people in Latin America and the Caribbean have been fully vaccinated against Covid-19,” Etienne adds, calling it an “unacceptable situation.”

The so-called Delta variant has alarmed public health officials. Scientists believe that it may be twice as transmissible as the original coronavirus. In the U.S., this variant has spread mostly among the unvaccinated. Unvaccinated populations, whether in India or Indiana, may serve as incubators of new variants. And these strains of coronavirus could evolve in surprising and dangerous ways.

The surge of cases around the world has also highlighted the gulf between the world’s haves and have-nots. Like the U.S., the United Kingdom, Canada, and much of Europe have vaccinated a majority of their populations. That enabled them to loosen Covid restrictions over the summer. But vast inequalities in economic development, health-care systems, and vaccine access have made the latest surge much bigger and much deadlier in poorer places (see “Helping Countries in Need,” below). And this has happened despite the promises of world leaders to donate vaccine doses.

Carissa Etienne, director of the World Health Organization’s Pan American Health Organization, says that at a time when we’re experiencing some relief from the virus in wealthier countries, for most developing countries “the end [of the pandemic] remains a distant future.” (See map, below.)

“Despite this worrisome picture, just 1 in 10 people in Latin America and the Caribbean have been fully vaccinated against Covid-19,” Etienne adds, calling it an “unacceptable situation.”

Peru, where more than 194,000 people have died, has the highest per capita Covid death rate of any nation. Brazil’s total Covid death count is the second-highest, after the U.S.

Brazil accounts for 2.7 percent of the world’s population but has suffered 13 percent of all Covid-19 deaths. More than 536,000 people have died in Brazil, according to the official count, but many experts believe the true death toll may be much higher. And the pandemic shows no signs of abating there.

“We’ve been in this battle for 15 months, and there’s no way out of the crisis,” says Francis Albert Fujii, an emergency care physician in São Paulo, Brazil’s largest city. “I’m very sad about the situation we’re in. We need leadership that believes in the disease and takes the situation seriously.”

Brazilian President Jair Bolsonaro has been widely criticized for his
casual approach to the pandemic: He’s downplayed the seriousness of the virus, promoted ineffective treatments, failed to enforce social distancing measures, and overseen a slow and ineffective vaccine rollout.

Peru, where more than 194,000 people have died, has the highest per capita Covid death rate of any nation. Brazil’s total Covid death count is the second-highest, after the U.S.

Brazil accounts for 2.7 percent of the world’s population but has suffered 13 percent of all Covid-19 deaths. More than 536,000 people have died in Brazil, according to the official count. But many experts believe the true death toll may be much higher. And the pandemic shows no signs of ending there.

“We’ve been in this battle for 15 months, and there’s no way out of the crisis,” says Francis Albert Fujii, an emergency care physician in São Paulo, Brazil’s largest city. “I’m very sad about the situation we’re in. We need leadership that believes in the disease and takes the situation seriously.”

Brazilian President Jair Bolsonaro has been widely criticized for his casual approach to the pandemic. He’s downplayed the seriousness of the virus and promoted ineffective treatments. He’s also failed to enforce social distancing measures. And the nation’s vaccine rollout has been slow and ineffective under his leadership.

There are some underlying reasons why Latin America has been particularly vulnerable, says Amanda Glassman of the Center for Global Development, a Washington, D.C.,-based think tank. The region has a high percentage of people over age 60 and a lot of young people with untreated health conditions that put them at higher risk—both factors that can make a Covid infection more severe and potentially more deadly.

Plus, Glassman says, most people live in crowded households in densely populated neighborhoods, where disease spreads quickly. And people in low-income countries are often unable to stay home to avoid exposure.

“For a trucker in Brazil or someone selling empanadas on the street in Peru,” Glassman says, “if they don’t work, they don’t eat.”

Africa is another region that has seen a particularly acute escalation of Covid over the summer. The W.H.O. attributes the surge there to lack of vaccination (about 1 percent of the continent’s population was fully vaccinated as of July), insufficient adherence to precautionary measures such as mask wearing and social distancing, and the rise of much-more-contagious variants of the virus.

The Democratic Republic of the Congo—where the virus has claimed the lives of more than 5 percent of lawmakers—is grappling with a third wave as it falters in rolling out vaccines. South Africa, the continent’s worst-hit nation, experienced record numbers of new infections in July, with the sharpest increases in major urban centers.

In Kenya, Edward Onditi, 33, lost his mother and his brother to Covid in June, within a few days of each other.

“It’s one of the toughest moments of my life,” Onditi says.

There are some underlying reasons why Latin America has been particularly vulnerable, says Amanda Glassman of the Center for Global Development, a Washington, D.C.-based think tank. The region has a high percentage of people over age 60. It also has a lot of young people with untreated health conditions that put them at higher risk. Both of these factors can make a Covid infection more severe and potentially more deadly.

Plus, Glassman says, most people live in crowded households in densely populated neighborhoods, where disease spreads quickly. And people in low-income countries are often unable to stay home to avoid exposure.

“For a trucker in Brazil or someone selling empanadas on the street in Peru,” Glassman says, “if they don’t work, they don’t eat.”

Africa is another region that has seen a particularly acute escalation of Covid over the summer. The W.H.O. attributes the surge there to lack of vaccination (about 1 percent of the continent’s population was fully vaccinated as of July), dismissal of measures such as mask wearing and social distancing, and the rise of much-more-contagious variants of the virus.

In the Democratic Republic of the Congo, the virus has claimed the lives of more than 5 percent of lawmakers. The country is now grappling with a third wave as it falters in rolling out vaccines. South Africa is the continent’s worst-hit nation. It experienced record numbers of new infections in July. The sharpest increases occurred in major urban centers.

In Kenya, Edward Onditi, 33, lost his mother and his brother to Covid in June, within a few days of each other.

“It’s one of the toughest moments of my life,” Onditi says.

While the crisis that hit India in the late spring has subsided, infection rates are also spiking in many Asian countries. In Indonesia, the world’s fourth-most-populous country, Covid cases began soaring in late June. Fewer than
5 percent of Indonesians have gotten fully vaccinated, and frontline medical workers were immunized with Sinovac, the Chinese-made vaccine that may be less effective than other inoculations.

In Bangladesh, a South Asian nation of 164 million, case counts soared in the early summer. The country instituted a July 1 national lockdown, but by then many migrant workers in Dhaka, the capital, had returned to their villages, some carrying the virus with them. And despite the lockdown, the government has refrained from shutting down the garment factories and mills that supply much of the country’s export-driven economy.

The crisis that hit India in the late spring has subsided. Still, infection rates are spiking in many Asian countries. In Indonesia, the world’s fourth-most-populous country, Covid cases began soaring in late June. Fewer than 5 percent of Indonesians have gotten fully vaccinated. And frontline medical workers there were immunized with Sinovac, the Chinese-made vaccine that may be less effective than others.

In Bangladesh, a South Asian nation of 164 million, case counts soared in the early summer. The country instituted a July 1 national lockdown. But by then many migrant workers in Dhaka, the capital, had returned to their villages. Some of them were carrying the virus with them. And despite the lockdown, the government has refrained from shutting down the garment factories and mills that supply much of the country’s export-driven economy.

“We are working to make a balance between lives and livelihoods,” says Mohammed Nasir, the former vice president of the Bangladesh Garment Manufacturers and Exporters Association.

The tide of cases in early summer was Bangladesh’s third wave of Covid infections, and many people are deeply frustrated, especially as they see life in the U.S. returning to normal.

“There will be a fourth wave, and there will be a fifth wave, before we can vaccinate everyone—while rich countries are lifting lockdowns and even giving people booster doses,” Senjuti Saha, a Dhaka-based microbiologist and public health activist, told NPR. “We will be stuck in this vicious cycle—more infections, more mutations, more variants—and we are scared.”

Indeed, public health officials worldwide keep stressing—and the course of the pandemic keeps proving—that as long as Covid is raging in one region, no part of the world is safe.

“We’re really not going to be done with Covid anywhere,” says Marcia Castro, chair of the Department of Global Health and Population at Harvard University, “until we’re done with it everywhere.”

“We are working to make a balance between lives and livelihoods,” says Mohammed Nasir, the former vice president of the Bangladesh Garment Manufacturers and Exporters Association.

The tide of cases in early summer was Bangladesh’s third wave of Covid infections. Many people living there are deeply frustrated, especially as they see life in the U.S. returning to normal.

“There will be a fourth wave, and there will be a fifth wave, before we can vaccinate everyone—while rich countries are lifting lockdowns and even giving people booster doses,” Senjuti Saha, a Dhaka-based microbiologist and public health activist, told NPR. “We will be stuck in this vicious cycle—more infections, more mutations, more variants—and we are scared.”

Indeed, public health officials worldwide keep stressing that as long as Covid is raging in one region, no part of the world is safe. It’s a point that the course of the pandemic continues to prove.

“We’re really not going to be done with Covid anywhere,” says Marcia Castro, chair of the Department of Global Health and Population at Harvard University, “until we’re done with it everywhere.”

With reporting by Livia Albeck-Ripka, Hannah Beech, Abdi Latif Dahir, and Daniel Politi of The New York Times.

With reporting by Livia Albeck-Ripka, Hannah Beech, Abdi Latif Dahir, and Daniel Politi of The New York Times.