The Washington PostDemocracy Dies in Darkness

Global surge in coronavirus cases is being fed by the developing world — and the U.S.

Motorists pass near a mural paying homage to essential workers in New Delhi on Tuesday. (Rajat Gupta/EPA-EFE/Shutterstock)

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When the United States began shutting down this spring, a virus that emerged months earlier as a mysterious outbreak in a Chinese provincial capital had infected a total of fewer than 200,000 people worldwide.

So far this week, the planet has added an average of more than 200,000 cases every day.

The novel coronavirus — once concentrated in specific cities or countries — has now crept into virtually every corner of the globe and is wreaking havoc in multiple major regions at once.

But the impact is not being felt evenly. Poorer nations throughout Latin America, the Middle East, South Asia and Africa are bearing a growing share of the caseload, even as wealthier countries in Western Europe and East Asia enjoy a relative respite after having beaten back the worst effects through rigorously enforced lockdowns.

And then there’s the United States, which leads the world in new cases and, as with many nations that possess far fewer resources, has shown no sign of being able to regain control.

Nearly all the countries struggling with a surge share something in common: After weeks or months of trying to suppress the virus, they reopened their economies, only to find that the virus came roaring back. Now they are using a more limited arsenal to contain the spread, with little success.

“Let me be blunt: Too many countries are headed in the wrong direction,” World Health Organization chief Tedros Adhanom Ghebreyesus declared in Geneva this week. “The virus remains public enemy number one, but the actions of many governments and people do not reflect this.”

The severity of the toll on the United States was evident in new infection figures released Tuesday, with multiple states — including Oklahoma and Nevada — hitting record highs. Florida has now reported more cases in the past week — nearly 78,000 — than most European nations have in their entire struggle with covid-19, the illness caused by the novel coronavirus.

That sort of explosive growth is mirrored in other nations, though none with the sort of wealth, infrastructure and scientific know-how of the United States. Across much of the developing world, rampant coronavirus outbreaks came relatively late. But now that the virus has taken root, governments are flailing in their attempts to halt it and citizens are resisting changes to their way of life.

“As restrictions have been lifted, we’re going back to a new normal,” said Alain Labrique, a Johns Hopkins epidemiologist. “But this virus is still circulating. There are still high rates of susceptibility. We have to continue wearing masks and being smart about crowd activities. The new normal is not the old normal.”

The struggle has been especially fraught in Latin America, where countries have been lashed by covid-19’s ferocity and many have not yet hit their peaks. Brazil has the second-highest number of covid-19 deaths in the world, at more than 74,000, while Mexico has the fourth-highest, with more than 37,000. (The United States, with at least 133,000 deaths, is far and away the global leader.)

With their high levels of poverty and inequality, Latin American countries were more vulnerable to the pandemic than wealthier nations. An estimated one-fifth of people in Latin America and the Caribbean have at least one of the health conditions that puts them at higher risk of a severe covid infection.

Many couldn’t afford to stay home for long periods. In Mexico, for example, more than half of workers are employed in the informal economy — as street vendors, gardeners, construction workers — surviving largely on their daily earnings. And people living in cramped homes and densely packed neighborhoods found it hard to isolate.

Mexico ended its 70-day lockdown May 30 and began to gradually reopen, maintaining a state-by-state system of restrictions depending on conditions.

As with the U.S., though, cases are surging in Mexican states where reopening has moved especially rapidly.

“The risk is that the opening, the end of quarantine, is moving too fast, that it’s not orderly, that people aren’t obeying the health measures, that they’re not social distancing,” the country’s coronavirus czar, Hugo López-Gatell, recently told reporters.

Mexican authorities have been surprised by the lethal force of the pandemic. The virus appeared to spread slowly during its initial weeks, leading López-Gatell to initially predict there could be as few as 6,000 deaths in total. The country massively expanded its hospital system to receive patients, hiring 45,000 doctors, nurses and other professionals — a crucial step given its lack of beds and medical personnel. It has avoided the kind of disaster that occurred in Guayaquil, Ecuador, where bodies littered the streets in April.

But Mexico has been slow to implement the kind of testing and contact tracing recommended by the WHO to break chains of transmission.

“We don’t have the capacity,” López-Gatell said in a recent interview. “Nor do we have quarantine sites where we can put people into isolation.”

The leftist government has been widely criticized for not being more forthcoming about the scale of the pandemic. President Andrés Manuel López Obrador initially played down the danger of the virus and has provided limited economic support to residents who have lost jobs or customers.

Another regional leader who initially scoffed at the pandemic — Brazilian President Jair Bolsonaro — has now tested positive for it, along with 1.9 million of his fellow citizens. And though hospitals in Brazil report that some of the strain is easing, the weekly average of deaths continues to rise, up 7 percent in the past week.

The Post analyzed hundreds of videos and photos of the Brazilian president to retrace his steps in the two weeks before he tested positive for covid-19. (Video: The Washington Post)

Unlike Bolsonaro and President Trump, the leader of the country with the third-largest number of cases — Indian Prime Minister Narendra Modi — has not played down the gravity of the virus.

Yet his government’s efforts to halt its spread have not succeeded. A strict nationwide lockdown imposed in late March slowed, but did not reverse, the growth in infections. Faced with devastating consequences — more than 100 million people jobless, a historic exodus of migrant workers leaving cities on foot — the government rolled back many restrictions on transport and commerce.

Since then, infections have risen at a brisk pace, hitting more than 906,000. The total is expected to cross the 1 million threshold later this week. Still, the number of deaths in India is comparatively low, at about 24,000.

But it is unlikely that official statistics reflect the full scope of the outbreak: India has conducted about eight tests for every 1,000 people, compared with 127 in the United States.

“It is a large country. The numbers will go up,” said Jayaprakash Muliyil, a leading Indian epidemiologist. Muliyil believes that India’s total number of cases will eventually eclipse that of the United States, especially as infections move from cities to the country’s vast hinterland where the health system is even less prepared to cope.

India’s economy remains crippled and life is very far from normal, with local officials reinstating lockdown measures in individual cities.

Bangalore, India’s technology hub, began a week-long lockdown on Tuesday. Bihar, one of India’s poorest states with a population of more than 100 million people, said it would impose a new lockdown for the second half of July.

Health experts say renewed lockdowns would be beneficial in places where numbers are spiraling. But there is little political will.

In the Middle East, most governments were relatively swift to lock down during the earliest days of the pandemic, averting the sudden and deadly surge of infections seen in Europe and the United States. But the restrictions exacted a heavy economic toll, and few countries show any inclination to revert to the stringent measures of a few months ago even though coronavirus rates are rapidly climbing.

The number of cases reported in the region in June alone was higher than during the previous four months combined, WHO Middle East director Ahmed al-Mandhari told reporters this month.

The region, he said, is entering “a critical threshold,” having exceeded 1 million cases and 25,000 deaths. Over half of those are in three of the region’s most populous countries: Iran, Egypt and Saudi Arabia.

The rate of new infections in both Saudi Arabia and Egypt has begun to slow in recent days. But Iran, with over 262,000 cases, has consistently struggled ever since it became an early global epicenter in March.

On Sunday, the country’s supreme leader, Ayatollah Ali Khamenei, wearing a face mask as he addressed parliamentarians, called the latest resurgence “deeply tragic” and pleaded with citizens to observe preventive measures “to save the country.”

Worse may lie ahead, according to Ali Mokdad, director of Middle Eastern initiatives at the University of Washington’s Institute for Health Metrics and Evaluation. Projections by his institute suggest there may be 160,000 deaths in the Middle East’s worst-affected countries by Nov. 1, including 62,000 in Iran and 50,000 in Saudi Arabia.

The root of the problem, he told an online panel hosted by the Atlantic Council, is simple: “People are letting down their guard.”

Countries where infection rates have jumped in recent weeks are continuing to open up. Egypt is inviting tourists to come back, including to the pyramids. Saudi Arabia has severely restricted travel to the annual hajj pilgrimage to Mecca but has not reimposed any of the lockdown measures that earlier kept citizens indoors.

Russia, too, has held firm to its decision to lift most of its restrictions in late June, just ahead of a vote on a package of constitutional amendments that will enable President Vladimir Putin to seek two more terms in office. Putin cast his own ballot without wearing a mask.

Russia continues to post more than 6,000 new infections per day, adding to a total of more than 735,000 — the world’s fourth-highest. But those daily figures are well below the country’s peak of more than 11,000 daily in May.

Countries across Western Europe — including Spain, France, Britain, Italy and Germany — have also recorded sustained declines. Not so in some Eastern European countries, however, where experts say outbreaks have been driven by government decisions to hastily drop restrictions — including on mass events such as soccer matches.

Serbia was the first country in Europe to restart soccer matches as it lifted virtually all restrictions from one of the continent’s strictest lockdowns just before elections June 21.

Since then, the country has experienced one of the continent’s most notable spikes. President Aleksandar Vucic last week declared a critical situation in five cities, and nationwide infection numbers returned to levels last seen in April.

While epidemiologists in much of the world are warning about a second wave, countries like Poland, Hungary and Greece, which locked down early, are bracing for their first.

In the next week, Poland plans to resume concerts and reopen stadiums, spawning concerns that it will experience what so many other parts of the world already have.

“Our lockdown intervened very early,” said Pawel Grzesiowski, president of the Warsaw-based Foundation Institute for the Prevention of Infections. “But now we are switching off the lockdown.”

Sheridan reported from Mexico City, Slater from New Delhi and Sly from Beirut. Loveday Morris in Berlin, Isabelle Khurshudyan in Moscow, Heloísa Traiano in Rio de Janeiro and Jacqueline Dupree in Washington contributed to this report.

Correction: A previous version of this story stated incorrectly that the United States conducts 127 coronavirus tests per 100,000 people. The correct ratio is 127 per 1,000 people.

Coronavirus: What you need to know

Vaccines: The CDC recommends that everyone age 5 and older get an updated covid booster shot designed to target both the original virus and the omicron variant. Here’s some guidance on when you should get the omicron booster and how vaccine efficacy could be affected by your prior infections.

Variants: Instead of a single new Greek letter variant, a group of immune-evading omicron spinoffs are popping up all over the world. Any dominant variant will likely knock out monoclonal antibodies, targeted drugs that can be used as a treatment or to protect immunocompromised people.

Tripledemic: Hospitals are overwhelmed by a combination of respiratory illnesses, staffing shortages and nursing home closures. And experts believe the problem will deteriorate further in coming months. Here’s how to tell the difference between RSV, the flu and covid-19.

Guidance: CDC guidelines have been confusing — if you get covid, here’s how to tell when you’re no longer contagious. We’ve also created a guide to help you decide when to keep wearing face coverings.

Where do things stand? See the latest coronavirus numbers in the U.S. and across the world. In the U.S., pandemic trends have shifted and now White people are more likely to die from covid than Black people. Nearly nine out of 10 covid deaths are people over the age 65.

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