The coronavirus is not done with this world, and the world cannot think it’s done with the coronavirus.
Here in the United States, there are already worrying signs that the pandemic is not only not abating but starting to pick up in some places. If we zoom out to look at the whole globe, there are numerous countries where the coronavirus outbreak is getting worryingly worse.
I asked a handful of public health experts Monday to identify some of the international hot spots they are concerned about. There was a lot of overlap in their responses, which indicates to me there is a clear group of places that we should be keeping a close eye on for the foreseeable future. Data for each country’s stats pulled from Our World in Data on Monday, June 8.
Total cases: 256,611
Total deaths: 7,135
Two-week percentage change in cases: 64 percent
Tests per 1,000 people: 3.38
The second most populous country in the world was, along with the second entrant on this list, the most common country to be cited by public health experts as an area of concern.
The fear for India is simply the slow, steady rise in its Covid-19 cases as well as the risk that its deep social inequities will exacerbate the outbreak.
“In Asia, India is the country of most concern, due to the large population [and] vastness of the country as well as the easing of restrictions that is ongoing,” Wafaa El-Sadr, who works on epidemiology and global health at Columbia University, told me. “It is also likely that deaths are underreported particularly from rural areas.”
As El-Sadr and some of the other experts I spoke with pointed out, India is relaxing its social distancing measures even as cases continue to climb. Restaurants and shops are opening up, and religious services will be allowed again. Masks are going to be mandatory, but it’s a troubling combination.
Total cases: 672,846
Total deaths: 35,930
Two-week percentage change in cases: 54 percent
Tests per 1,000 people: 2.28
The largest country in South America — which is broadly experiencing an uptick in Covid-19 cases; several experts also mentioned Peru to me — is maybe the likeliest candidate to eventually supplant the United States as the biggest epicenter for the coronavirus outbreak.
Brazil has seen the worst of all worlds for Covid-19: Government leaders were initially in denial about the coronavirus threat, and now some cities are already starting reopening despite the continued surge in cases.
There have also been widespread reports of hospitals being overwhelmed, which could augment Covid-19’s toll beyond the disease itself if people with other needs can’t get necessary medical care.
Albert Ko, a Yale University epidemiologist, ticked through the issues converging in the country: “Many highly populated cities are in exponential phase and may serve as foci for spread to other regions; low testing capacity; poor governance at the federal level, which has refused to implement strong social distancing.”
3) South Africa
Total cases: 48,285
Total deaths: 998
Two-week percentage change in cases: 105 percent
Tests per 1,000 people: 15.03
South Africa has not been as ravaged by Covid-19 to date as some of the other countries on this list, but the rate at which its epidemic is growing has put it on experts’ radar.
“South Africa has experienced its largest-ever case numbers in the previous week, as winter sets in and as relaxation of earlier lockdown gets underway,” Josh Michaud, associate director of global health policy at the Kaiser Family Foundation, said.
As in the United States and some of the other countries on this list like Brazil and India, the existing racial and social inequities in South Africa could prove to be a dangerous combination with Covid-19.
“Health and housing disparities there make for an explosive potential for black South Africans in crowded townships,” Chris Beyrer, a Johns Hopkins professor who studies epidemiology and international health, told me.
Total cases: 171,789
Total deaths: 8,281
Two-week percentage change in cases: 28 percent
Tests per 1,000 people: 12.62
Iran has been a coronavirus epicenter since the coronavirus first left China and started spreading around the world; you might recall that some of its government leaders were infected in the early days of the pandemic.
But it should be monitored carefully now because a second wave is well underway, after the first wave seemed to have subsided, Michaud said.
The Washington Post reported that after the first wave was concentrated in the capital city of Tehran and the holy city of Qom, this second wave popped up in the Khuzestan province.
There is a large Arab population there, which has been mistrustful of the government and its public health restrictions. A mask shortage and a weak health system have added to the difficulty in containing the second wave.
The Iranian example is a reminder for Americans that countries around the world are not monoliths and the same kind of divisiveness we’ve seen here can be a factor in Covid-19’s spread elsewhere as well.
Total cases: 117,103
Total deaths: 13,699
Two-week percentage change in cases: 44 percent
Tests per 1,000 people: 2.2
The Mexican government was slow to react to the coronavirus — soccer tournaments and concerts were permitted in the spring — and public health experts think the official death toll may be a dramatic undercount.
Yet social distancing is already easing, even as the case and death counts continue to climb in a country where many people live in poverty and the health system does not have great capacity.
El-Sadr lumped Mexico together with Brazil and Peru as “countries of concern, due to reported rise in number of cases as well as in deaths. In addition, reports of how the health system is being overwhelmed by the number of cases and the lack of intensive care beds and ventilators are also concerning.”
Total cases: 467,673
Total deaths: 5,859
Two-week percentage change in cases: -9 percent
Tests per 1,000 people: 87.17
Russia is, in a way, a cousin to America in its Covid-19 outbreak: It has experienced a huge number of cases, and while the number of cases is no longer growing, it remains stubbornly high.
On top of the high number of cases, Russia’s official Covid-19 death toll has also come under scrutiny. The New York Times and other news outlets have reported that the overall excess mortality in Russia indicates the country has not counted all of its likely Covid-19 deaths.
The government has vehemently disputed those reports, but the experts I spoke with were doubtful of the low official fatality figures. The mortality data, Beyrer said, is “totally unreliable.”
7) United States
Total cases: 1,942,363
Total deaths: 110,514
Two-week percentage change in cases: -5 percent
Tests per 1,000 people: 61.59
If this seems like trolling or ethnocentrism, I promise that wasn’t my intention when I started reporting this story.
But in several of my correspondences, public health experts emphasized that although social distancing is ramping down and the media’s focus has shifted to the problem of police violence, America is still the global epicenter of the pandemic.
“Let’s also not forget the USA, where the burden is huge and the early opening with insufficient public concern for behavior change will undoubtedly lead to more problems ahead,” David Celentano, who leads the epidemiology department at Johns Hopkins, said. “Texas and North Carolina are two current examples of growing epidemics after opening up early.”
Beyrer felt much the same: “Sorry to say the USA continues to be a country of real hot spot concern — particularly the South and Midwest regions.”
So did El-Sadr: “Lastly, I remain concerned about the US, particularly in view of disparate situation with some municipalities and states doing quite well while others are struggling and continue to have an increase in number of cases.”
Look at the countries in deep blue on this map, which reflects the gross number of new Covid-19 cases over the past two weeks. You’ll see all of the countries that are the deepest shade of blue, an ignominious distinction, are on this list — including the US.
This story appears in VoxCare, a newsletter from Vox on the latest twists and turns in America’s health care debate. Sign up to get VoxCare in your inbox along with more health care stats and news.