Abstract

Currently, South Asia has only 19% of the global COVID-19 infections and 10% of resulting deaths, whereas Europe and North America share as high as 23% and 32% of worldwide COVID-19 casualties, respectively. Unlike the popular opinion of inadequate testing, we mention the factors that might be keeping COVID-19 spread less lethal in South Asia. Notably, the South Asian regions are sunnier than Europe and the Americas, exposing the population to higher levels of vitamin D, naturally. Research suggests that a higher intake of vitamin D reduces the likelihood of respiratory tract infections by 50%, further supporting the notion of vitamin D preventing COVID-19.1 Another possibility for the low rate and mortality could be that the majority of people in South Asia have blood type B (B > O > A > AB),2 which is arguably deemed more immune than A toward COVID-19. Lower susceptibility of blood groups B and O can be linked to the natural presence of anti-A antibodies, which limit the adhesion of SARS-CoV S protein to ACE2 expressing cell lines. Additionally, according to the World Bank data, the South Asian demographic shows a 6% population of those aged 65 or older as compared with 19.2% and 16% of Europe and North America, respectively. Despite COVID-19 being inclusive toward all demographics, the virus can be exceptionally fatal toward those >65 years. Furthermore, limited movement across the South Asian borders and an earlier strict lockdown might have contained the caseloads. For instance, Pakistan imposed a lockdown when the countrywide total COVID-19 cases were less than 1000. Conversely, Italy and the United Kingdom imposed a lockdown when the nationwide cases had surpassed about 7000 in both these countries. The prevalence of existing disease trends in South Asia can be a factor for better immunity. Preliminary research suggests a negative association between the incidence of malaria and COVID-19.3 In 2018, the World Health Organization predicted that 19 countries in sub-Saharan Africa and India carried ~85% of the global malaria burden. The prolific use of antimalarial drugs within these regions could have contributed to COVID-19 recovery. Also, a negative correlation exists between the occurrence of tuberculosis and COVID-19. The high-burden tuberculosis South Asian countries have long had a national Bacillus Calmette-Guerin childhood vaccination policy. Conversely, countries without such policies (ie, Italy and the United States) have been hit harder by COVID-19. Unfortunately, the weak health care systems of South Asia, coupled with poverty and high population, pose stringent risks of massive COVID-19 spread. Recently, thousands of migrant workers have protested in Mumbai, India, against lockdown, out-of-fear of dying from hunger. Similarly, lockdown was eased in Pakistan during the Eid occasion, causing an increase in caseload. South Asian governments should share technical expertise to devise and implement comprehensive strategies to stop COVID-19. For instance, the recent setting up of a joint virtual SAARC (South Asian Association for Regional Cooperation) conference is a commendable step in establishing anti-COVID cooperation in the region. Welfare assistance should also be ensured to the poverty-stricken. Likewise, the national governments should address stigma related to COVID-19 while promoting prevention.