Covid-19 Management in

South Asia is one of the most populous and least developed world regions, and is considered highly vulnerable to any large scale outbreak of an infectious disease. The performance of the Region is so far so good. The first case of south Asia was reported in on January 24, 2020. The current situation in the SAARC countries is given in table 1 as following:

Table 1: Reported Cases and Deaths in SAARC Region as on April 29, 2020 Tests/ Total Total Total Active Tot Cases/ Deaths/ Total Country 1M Cases Deaths Recovered Cases 1M pop 1M pop Tests pop Afghanistan 1,828 58 228 1,542 47 1 9,000 231 6,462 155 139 6,168 39 0.9 54,733 332 7 5 2 9 9,865 12,785 31,332 1,008 7,747 22,577 23 0.7 770,764 559 250 17 233 462 5,296 9,798 Nepal 54 16 38 2 54,826 1,882 Pakistan 14,885 327 3,425 11,133 67 1 165,911 751 Sri Lanka 619 7 134 478 29 0.3 17,715 827 Source: Worldometer available at https://www.worldometers.info/coronavirus/ retrieved on April 29, 2020

Figure 1: Impacted of Covid-19 in SAARC Region as on April 29, 2020

Figure 2: Highly and Lowly impacted countries in the world as on April 29, 2020

Afghanistan, Bangladesh, Pakistan and Maldives have implemented partial lockdowns, Sri Lanka has responded with quarantine curfews while India and Nepal have declared a country- wide lockdown. Countries have also instituted various levels of restrictions on international travel; some countries have completely sealed off their land borders and grounded most international flights. Governments are attempting to coordinate a response to the pandemic through the regional organization, SAARC, Prime Minister Narendra Modi proposed a joint emergency fund to tackle the pandemic, and pledged to seed US$10 Million. As of 11 April, SAARC COVID-19 Emergency Fund is $21.8 million. Regional response On 13 March, India Prime Minister Narendra Modi called for a joint regional response to the pandemic through the regional organisation, SAARC; the proposal was met with positive response. A conference call was attended by heads of governments of all member states, except Pakistan which sent the special adviser to the Prime Minister, on 15 March. proposal to setup an emergency fund was agreed upon. India also proposed creating a common research platform to coordinate research within the South Asia region, while Afghanistan proposed creating a common framework for telemedicine. SAARC COVID-19 Emergency Fund An emergency fund was proposed by India during a video conference of SAARC heads of government from New . The purpose of this fund is to tackle and mitigate the risks associated with the coronavirus pandemic in the South Asian region. Other member nations welcomed the proposal of coronavirus emergency fund. India announced US$10 million as its initial contribution to support the initiative and contributions for the fund from member countries would be voluntary. As of 11 April 2020, the Emergency fund had accumulated sum of US$21.8 million with the pool of contributions from seven member countries. Medical response coordination A video conference was held among health professional of all countries at the Director General of Health Services (DGHS) level on 26 March, to discuss a framework for cooperation as agreed in the 15 March conference. A shared electronic platform for sharing of information, knowledge and expertise was proposed. The SAARC Disaster Management Centre later launched a website for information related to the pandemic in member countries.

Management at respective Country levels1

Afghanistan

Afghanistan temporarily closed its border with Iran on 23 February when first suspected cases emerged in Herat province bordering Iran. In March, it restricted most international flights. By the end of March, strict restrictions on the movement of people and public gatherings were in place in several provinces; lockdowns had also been implemented, including in Kabul and Kandahar.

Testing and health facilities

COVID-19 health facilities in Afghanistan by Province Hospitals for COVID-19 Province Testing capacity per day patients Balkh 1 50 Herat 2 140 Kabul 3 400 Kandahar 1 - Nangarhar 1 200 Total (5 Provinces) 8 790 Lockdown measures - On 18 March, the Ministry of Interior Affairs banned all large gatherings, including the closure of venues that attract large crowds such as entertainment places, sports grounds, swimming pools, fitness clubs and wedding halls. Kabul went under lockdown from 28 March for three weeks. The lockdown will ensure that residents stay at home, avoiding all non-essential travel and gatherings. The lockdown

1 India has not been included in this section measures in Kabul Province were made stricter on 12 April. All main highways were closed, as the lockdown was extended for a further two weeks. The Ministry of Interior Affairs announced that there would be consequences for anyone that violates the lockdown. On 17 April, the lockdown in Kabul Province was extended by three weeks until 9 May. International funding and local aid - On 14 March, Beijing (China) announced that they would give aid to Afghanistan. The World Bank, and World Health Organization also announced that they would provide help. The Chinese medical aid arrived on 2 April, after aid from the was received on the previous day. It was also announced on that day that Uzbekistan would provide aid for five of the northern provinces of Afghanistan. On 23 April, a second shipment of medical equipment arrived from China. On 3 April, the World Bank approved $100.4 million of aid to help Afghanistan. In April 2020, the European Union (EU) announced that they would provide technical support and €117 million for Afghanistan. During the lockdown in Kabul, the Ministry of Agriculture, Irrigation, and Livestock donated food for an emergency group to distribute across the province. Public awareness campaigns - Messages on social distancing and use of hand washing with soaps to reduces the rate of COVID-19 transmission were propagated by different agencies/groups at national level. The group consists of doctors and religious scholars. Clerics and religious scholars enforced a fatwa on 5 April. Taliban cooperated with efforts of the Government in spreading awareness in insurgent- controlled areas of Afghanistan and supported governmental health workers. Cultural events and religion - The annual Nowruz festival was not held in 2020, in order to prevent the spread of the global coronavirus pandemic. Around 500 mosques were closed in Herat in late March 2020. On 5 April, the Ministry of Hajj and Religious Affairs and clerics announced a fatwa, including restrictions on Friday prayers and other prayers in mosques across Afghanistan. Wedding halls and hammams were closed and governmental departments with large numbers of employees stopped working. The five week lockdown in the capital, Kabul, affected small businesses, such as local shop owners. Immigration - Border with Iran were closed. The Afghan Civil Aviation Authority restricted most international flights by Afghan due to the global pandemic. Ariana Afghan Airlines and Kam Air suspended all flights, except from flights to and Pakistan. Pakistan's response - In response to Afghanistan's and Iran's cases, Pakistan closed its border at Chaman with Afghanistan for at least three weeks, starting on 2 March, as both countries confirmed rising number of cases over the weeks.

Bangladesh

On 22 March, Bangladesh declared a 10-day shut down effective from 26 March to 4 April. This was later increased to 05 May. Experts criticised that not enough tests were conducted in the country that has a population of over 160 million. Newspaper reports and social media continued to report about additional deaths of patients with COVID-19 symptoms. Some of the deceased were treated at COVID-19 isolation centres at hospitals in the districts and others were denied treatment, though no tests were conducted to confirm contagion. For a long time, testing was centralised to only Institute of Epidemiology, Disease Control and Research (IEDCR) in the capital , although patients with symptoms were reported all around the country.

Evacuations - On 1 February, 312 Bangladeshi citizens (297 were adults and 15 children) stranded in Wuhan, China were evacuated and brought back to Bangladesh. Majority of the evacuees were quarantined for 14 days.

Social distancing measures - On 17 March, the government closed all schools, for the remainder of March. The Dhaka University was also closed for the same period. This reportedly increased tourist traffic at the beaches in and Cox's Bazar, counteracting the government measure. The government also failed to ban congregational prayers in mosques and the Imams refused to follow guidance from the Islamic Foundation. On 23 March, the government declared a ten-day nationwide holiday for the period 26 March–4 April, ordering all public and private offices to be closed, with exception for emergency services. People have been asked to practise social distancing and stay at home. Public transport would be limited and advice was given to avoid them. The measure has been described as a "lockdown" by the media, albeit a "relaxed" one. The government asked the Army to enforce social distancing. 290 teams of soldiers were deployed across the country, that streets were empty in the capital Dhaka and the roadside shops were closed. It also said that thousands of people left Dhaka for their home villages. On 9 April, Bangladesh imposed a 'complete lockdown' on the Cox's Bazar District where the majority of the Rohingya refugee camps are located. "No entry, no exit – until the situation improves".

Testing and surveillance - Keeping refugee communities healthy and informed in Cox's Bazar, from the International Organization for Migration. Older Rohingya refugees in overcrowded camps in Bangladesh are being left behind in humanitarian response to COVID- 19, which could have devastating consequences given the high risks older people everywhere face from this deadly pandemic. Treatment - Bangladesh has 1,169 ICU beds, amounting to 0.72 beds per 100,000 citizens. Of these 432 beds are in government hospitals and 737 in private hospitals. There are only 550 ventilators in the country. The government was in the process of procuring 380 ventilators. There were also 7,693 isolated beds around the country.

Economic impact - Even though garment factories were allowed to continue operating under the country's lockdown, an estimated one million garment workers, or one quarter of the workforce, were laid off due to declining orders for export.

Bhutan

On 22 March, Bhutan, announced in a national address that the country's land borders would be sealed off. On 24 March, the government closed all its borders with India. On 25 March, a student who had returned from the United Kingdom was found to be positive for COVID-19, the third case in the country. On 29 March, According to the Ministry of Health, a returning student in the quarantine facility tested positive. The patient was moved to the isolation ward in .

Agriculture - Farmers reported large increases in sales, as Bhutanese buy local produce, due to facing import hurdles.

Education - All schools have been closed countrywide, leaving almost 190,000 students to attend classes online. Printed study material is distributed to students that do not have access to the internet, in addition to radio broadcasts.

Tourism - suspended all flights, leaving only to provide air transport to and from Bhutan.

Maldives

The Maldives declared a public health emergency over COVID-19 on 12 March. On 27 March, the government announced the first confirmed case of a Maldivian citizen with COVID-19, a passenger who had returned from the United Kingdom. This brought the total number of confirmed cases in the country to 16; the other 15 were foreign citizens. The Maldives declared a public health emergency over COVID-19 on 12 March. The government of the Maldives and the Ministry of the Maldives with the guidance of the Health Protection Agency of the Maldives (HPA) placed a temporary travel restriction for the number of countries to control new cases. No passengers originating from, transiting to or with a travel history of said country/province is to be permitted into the Maldives. Maldivians and spouses of Maldivians who are foreign nationals will be allowed in but may be subject to quarantine measures.

Impact - The Maldives' economy is dependent on tourism, which dropped severely due to travel restrictions amid the pandemic. Experts warned of an economic contraction and possible difficulties paying back foreign debt, especially to China.

Nepal

Land borders with India as well as China have been sealed off, and all international flights suspended. All academic examinations were cancelled. Schools and colleges were closed. A country-wide lockdown came into effect on 24 March, and was scheduled to end on 8 April. Nepal cancelled its international promotional activities related to Visit Nepal Year 2020. Its economy is expected to be severely affected by the pandemic due its impact on foreign employment, tourism, manufacturing, construction and trade. Between January and March, Nepal took steps to prevent a widespread outbreak of the disease, while preparing for it by procuring essential supplies, equipment and medicine, upgrading health infrastructure, training medical personnel, and spreading public awareness. A country-wide lockdown came into effect on 24 March, and is scheduled to end on May 7. Nepal established health-desks at the as well as on border checkpoints with India, starting in mid-January. Land borders with India as well as China were later completely sealed off, and all international flights suspended. All academic examinations were cancelled, and schools and colleges were closed. Quarantine centres and temporary hospitals are being setup across the country. Laboratory facilities are being upgraded and expanded. Hospitals have been setting up ICU units and isolation beds. The SAARC countries have pledged to cooperate in controlling the disease in the region. India, the United States and Germany have increased their support to Nepali health sector. Before the pandemic, hospitals in Nepal had few ICU beds (just three in Teku Hospital) which were almost always occupied, with people in critical condition usually having to wait for the beds to become empty. Teku Hospital, the only one designated for handling infectious disease, had built an isolation ward during the avian influenza outbreak a decade ago, but had never brought it into use, as it did not have experts to evaluate or maintain the required standards. As news of a new infectious disease in China broke, concerns were raised in Nepal over the high potential risk, the need to implement preventive measures and a severe lack of necessary medical equipment and infrastructure. Nepal does not have any double cab ambulances to transport highly infectious patients safely, isolation wards in hospitals, or biosafety level-3 or better laboratories needed to test for highly infectious diseases. Sukraraj Tropical and Infectious Disease Hospital is the designated primary hospital for the treatment of COVID-19; isolation wards, makeshift hospitals and quarantine centres have been established throughout the country. Nepal Public Health Laboratory in was the only laboratory capable of testing for the disease as of 15 March 2020; laboratory capabilities were later expanded to other major cities.

Impact and response - The tourism sector has been reported to be suffering due to the absence of Chinese tourists, as well as the various travel restrictions imposed on travel globally. Manufacturing sector is experiencing a shortage of raw materials, most of which used to come from China. The situation is exacerbated by spread of the pandemic to the Middle-east which is the main source of remittance that makes up more than half of Nepal's GDP. Remittances were expected to sharply drop after Nepal suspended issuance of workers permit to Nepalis for all countries. The wholesale and retail sector has also been affected due to fall of imports from China. The construction sector which imports most of its building materials from China has slowed down. As the Chinese contractors and workers who went home for the Chinese new year could not return, the public construction projects have also been affected. The domestic airlines were reported to be struggling for survival as ticket prices dropped to half or a third of normal following a sharp decline in demand. Number of international flights to and from Nepal had decreased by more than 50% by 13 March. Nepal's import-dependent economy is also vulnerable to depreciation of Indian currency to which its currency is permanently pegged, as Indian economy suffers the impact of the pandemic. 20,000 tour, trek and mountaineering guides lost their livelihood when mountaineering was suspended. The annual Holi celebrations, which fell on 9 and 10 March in 2020 saw decreased activities, low business and cancellation of organised celebrations. Nepal had declared 2020 as the Visit Nepal Year and aimed to bring in two million foreign tourists, almost double the figure from previous year. As the pandemic spread and Nepal had to suspend air travel to and from China, the biggest source of international tourists arriving by air, Nepal suspended its promotional campaigns. Essential drugs - Nepal's pharmaceutical industry has been impacted due to lack of raw materials as a number of essential ingredients were previously imported from Hubei. Nepal faced the prospect of a potential shortage of essential medicines when India imposed restrictions on export of 26 types of raw materials including of essential medicine citing disruption in the supply chain from Hubei; however India later agreed to relax restrictions in case of Nepal, and asked the Nepalese government to provide a list of names and quantities of essential medicines that it needed to supply to Nepal. Poaching - Poachers in Nepal took advantage of slack monitoring and sparse public movement during the Covid-19 lockdown and the country saw a surge in killing of wildlife under the shadow of the coronavirus pandemic.

Pakistan

By the end of January, the Government of Pakistan began screening of passengers at airports in Islamabad, Karachi, Lahore and Peshawar to prevent entry of coronavirus in the country. Pakistan closed its borders with Iran on 23 February. Several regions have been put under lockdown. The country has been put under a nation-wide lockdown until 9 May, which was initiated on 1 April and later extended twice. A Tablighi Jamaat religious congregation which took place in Lahore in early March 2020 became a coronavirus super-spreader, accounting for 27% of cases in the country by late April. Pakistan started vaccine trials in collaboration with Sinopharm a Chinese pharmaceutical company in April 2020 Raiwind, a city of Lahore, On 10 March, hosted a congregation of the Tablighi Jamaat congregations, which are popular with Muslims and cuts across socio-economic classes. About 70,000 to 80,000 members may have attended the congregation, with the majority being from various parts of Pakistan and 3,000 attendees from 40 foreign countries, resulted as a coronavirus super-spreader event with more than 539 confirmed cases linked to it reported across the country. The event carried on despite the strong opposition and warnings by the Government of Punjab. On 2 April, Pakistani authorities placed the entire city of Raiwind under quarantine, and shut down all general and medical stores after 40 Tablighi Jamaat participants tested positive for coronavirus. A report in late April revealed that the event had caused over 2,000; 27% of the country's total positive cases. Prevention measures and response - The national carrier, PIA decided to suspend the flight operation between Pakistan and China till January 30 due to the outbreak. On 13 March, Pakistan also stopped all international flights, except those at Islamabad, Karachi and Lahore airports on the day. On 13 March, all schools and universities were closed until 5 April. The lectures and classes will be held online in some institutions. Pakistan closed all land borders from 16 March. On 26 March, Pakistan decided to seek $3.7 billion additional financing from three multilateral creditors including another loan of $1.4 billion from the International Monetary Fund to cope with the challenges being posed by the novel coronavirus outbreak. A youth force labelled ‘Corona Relief Tigers’ to help government in fight against the spread of coronavirus nationwide was announced on 27 March. The force was distributed across the country and would be used to supply food items to people in their houses in case Covid-19 cases sharply rose in a locality. The recruitment began on 31 March. Healthcare professionals - The federal government's economic relief package also benefited the healthcare professionals in the country. It was decided that if a doctor or a paramedic died while treating coronavirus patients, they would be considered martyrs and their families would receive the package that is given to martyrs. Making a landmark, the Pakistani Law enforcement presented the Guard of honour as a mark of respect from 27–29 March to the doctors and para medical staff fighting on the front lines of the global COVID-19 outbreak across the nation in Sukkur, Quetta, and Dera Islamil Khan. The medical staff of a Mayo hospital in Lahore were given a guard of honor by the Lahore police for their efforts to help Pakistan fight the coronavirus pandemic. Observing social distance (home-quarantined) citizens of Pakistan together with celebrities raised white flags on 27 March across Pakistan from their balconies, rooftops expressing love for the doctors and para-medics who are combating without fearing from the epidemic COVID-19 virus. The Government of Punjab announced a one-month honorarium for the healthcare workers at the end of March. This meant that in case a healthcare worker lost their life, a martyr package was included in the regional government's relief package. Medical professionals across the province were also provided with one-month additional salary in recognition of their services. Doctors in Pakistan have complained about the lack of personal protection equipment (PPE) required to deal with the coronavirus, and that without protection doctors have become infected and in turn were infecting other patients. On 6 April, police broke up protests in Quetta by more than 100 doctors, who were demanding better safety equipment. Police arrested 53 doctors involved in these protests, and doctors reported being "beaten and humiliated" by the police. Religion -Returning devotees from Iran, a Tablighi Jamaat religious gathering and prayer congregations became a cause of concern due to their potential to exacerbate the outbreak in the country. Some clerics took conservative position that mosques should remain open and operational during the holy month of Ramadan since congregational prayers are believed to be obligatory for Muslim men. The federal government decided to extend the lockdown until the middle of Ramadan. However, permission was granted under the leadership of the President, in consultation with the ulama and state representatives for Mosque congregations. Unemployment -The Ministry of Planning has estimated that 12.3 million to 18.5 million people will become jobless due to pandemic.

Sri Lanka The country is under "curfew" and a ban on foreign arrivals has been instituted at least until 30 April. Prior to 27 January, a 22-member National Action Committee has been set up by the ministry to prevent the spread of coronavirus in Sri Lanka. Sri Lankan government has requested the general public to practice proper hygiene methods and self quarantine methods to safeguard from the disease. On 14 March, the Sri Lankan government declared 16 March 2020, as a national public holiday to contain the coronavirus spreading in the country. On 16 March, Public holiday was extended 1 week, and to close all ports of entry to the country. The government extended the public holidays to three days from 17 March to 19 March due to increase in new cases except for health, banking, food supply and transportation. On 19 March, the government decided to further extend the public holidays for 8 days from 20 March to 27 March to both private and public sectors as a remedy to confront the coronavirus pandemic. The government urged the public to work at home and declared a "work from home period" for those eight days. On 21 March, the government strictly cautioned that younger children and older people shouldn't be allowed to purchase at the supermarket and urged only one person per family to visit the supermarket to avoid unnecessary gatherings. The government also urged the public to not utilize chloroquine which is used to treat the patients who are diagnosed with Malaria. On 23 March, Sri Lankan President Gotabaya Rajapaksa introduced a relief fund called "COVID-19 Healthcare and Social Security Fund" to combat the novel coronavirus pandemic. The government extended the work from home period until 3 April due to extension of indefinite curfews in high-risk zones of the country. Disposal of bodies - According to the guidelines by the authorities, the bodies of deceased COVID-19 patients must be bagged and disinfected while the closest relatives are allowed to see the face of the deceased for a limited time within the hospital and touching of the body is not allowed. Philadelphia Missionary Church - On 21 March 2020, the authorities urged all the people who attended the Sunday service at Philadelphia Missionary Church, Jaffna to self quarantine themselves for at least 14 days. It was reported that on 15 March 2020, the main senior pastor of the church conducted special Sunday service. It was later reported that the pastor was tested positive for COVID-19 and went to Switzerland on that day itself with his wife for medical treatment. The person also believed to have infected with the virus after coming to Sri Lanka. The Northern Province Governor confirmed that the pastor with the coronavirus symptoms hugged and blessed all worshippers during the service. Travel restrictions - The government also banned the arrival of travellers from several countries of continental Europe. The travel ban was also imposed to foreign travellers from India, South Korea and Iran. The landing of aircraft were also suspended for two weeks with immediate effect from 19 March until 25 March at BIA airport except the arrival of cargo goods. The government also extended the validity of all visas of foreigners till 12 April. On 22 March, the government banned the arrival of all incoming passenger ships and planes. Curfews and Lockdowns - On 18 March, Sri Lanka Police imposed an emergency curfew in certain areas where around 800 returnees from Italy have speculated to have visited those areas. On 20 March, the Sri Lankan went a lockdown styled curfew for the entire nation from 20 March 6pm in the evening to 24 March 6am. On 23 March, the government announced that it will impose the quarantine curfew from 24 March 12pm in the noon until 27 March to contain the spreading of coronavirus and also the government banned the citizens from inter- district travel from 24 to 27 March. On 24 March, the government imposed curfew for very high risk zones such as Colombo, Gampaha and Kalutara indefinitely for a maximum period of two weeks. On 28 March, government extended curfew further for Jaffna district and Kandy district until further notice. On 9 April, government announced curfew in the Ratnapura and Pelmadulla police divisions in the Ratnapura District until further notice. International support - The Government of China extended their support to Sri Lanka by extending the concessionary loan of US$500 million in order to fight the coronavirus. The US government also lent their support to combat coronavirus outbreak by donating essential supplies such as nitrile gloves and heavy duty work gloves. The founder of Alibaba Group announced his plans to help the Asian countries affected by the coronavirus including Sri Lanka by providing essential emergency supplies such as masks, test kits. On 7 April, the donated 10 tonnes of consignment of essential medicines to tackle the coronavirus. Tourism - The coronavirus outbreak further affected the downfall of the tourism sector of the country which was recovering slowly from the impact of the 2019 Easter bombings. Education - The government ordered to close schools for five weeks from 12 March to 20 April. On April 11, 2020, Government announce that new school year was postponed until May 11, 2020. Entertainment -All film theatres, national parks, zoological gardens and botanical gardens throughout the country have been closed until further notice. Religious services - On 15 March 2020, Roman Catholic Archdiocese of Colombo Malcolm Ranjith held a televised church service to combat coronavirus pandemic and the archbishop revealed that church service and holy masses in Colombo and Chilaw will not be conducted until 31 March 2020. The ACJU also requested to stop Friday Jummah prayers in mosques until further notice. However, isolated incidents of Mosques ignoring the curfew to hold gatherings and prayers were reported and in one incident in Horowpathana 18 were arrested while several dozen fled the police. As a result, the ACJU suspended the board of Trustees of the concerned Mosque and issued a statement praising the government and requested action against those spreading hate speech due to the incidents. The Sunday mass services were cancelled for two weeks as of 14 April. Sri Lankan buddhist monks started Pirith Chanting a type of prayers to combat against COVID-19 island wide temples on a weekly basis. Prison riots - On 21 March, a protest was held by prison inmates in Anuradhapura to separate themselves from each other after the identification of four reported coronavirus cases in Anuradhapura. The protest became violent during a shooting incident resulting in the death of two prisoners, leaving a further six injured.