The region is coping, despite the population, and a tough healthcare system. Until Now
As on 18 March 2020, the COVID-19 claims more than 169 cases in India, followed by 189 in Pakistan, nine cases in the Maldives, 21 reported cases in Afghanistan, 18 in Sri Lanka, 10 cases in Bangladesh and one each in Nepal and Bhutan. South Asia seems to be less affected than Europe, East Asia, and the US; given the numbers and some basic issues, it is not an easy achievement.
Population Bulge: With a total population at 1.8 billion, South Asia’s numbers are staggering. Importantly, the numbers are most concentrated in its urban spaces. The cities of Karachi in Pakistan, Mumbai in India, Colombo in Sri Lanka and Dhaka in Bangladesh are estimated to have the highest number of the urban population in the world. South Asia’s urban population grew by 130 million between 2001 and 2011 – which is more than the entire population of Japan – and is poised to rise by almost 250 million by 2030 (World Bank).
Huge workforce outside South Asia: The virus cases seem to be an external import and the numbers have not been staggering in spite of a large workforce of South Asia (recently brought back home) working in the Middle East, East Asia and Europe.
Challenging Healthcare structure: South Asia is also not known for its best healthcare systems, the absence of proper health infrastructure and lack of hygiene adds to the risk of increasing the number of affected cases.
The impossibility of social distancing: South Asia is known not only for its numbers but also how it gathers – socially and culturally. The public response to social distancing has been equally difficult to impose as the deep-seated community gathering norms and living in close quarters in big families make self-quarantine an unfathomable concept for most South Asian families.
The federal structure: South Asia is also predominantly federal. Some states are known for its lethargic response – whether it is a social disaster or a natural one. The federal government response has been tough with border restriction and suspension of visa-free entries. The federal responses have also been so far swift in human tracing, a digital portal to track people with foreign country travel history with the use of both national media, telecom services, and social media in spreading the affects of diseases in all vernacular languages. Some states have been proactive; while the others are yet to pick up. South Asia’s coping mechanism in disasters might have helped it to keep the numbers low but as the region enters its third stage, the region will now have to mitigate over cope.
India: With 147 cases, it is contained so far; the challenge now is to prevent the community spread
India reported its first case in February when three students studying in Wuhan returned to Kerala. As of 18 March 2020, the total number of active COVID-19 cases in the country is 147, including 25 foreign nationals. So far, three patients have succumbed to the virus, while 14 patients have been cured.
Maharashtra, Kerala, Uttar Pradesh, Karnataka, Delhi and the Union Territory of Ladakh account for with the highest number of cases.
Reports by various organizations pointed out that India is one of the countries at risk of importing coronavirus. The gravity of the situation pushed the government to take specific measures as a precaution. At present, India is taking several steps both at the central as well as the state level to contain the further spread of the epidemic.
Ministry of Health and Family Welfare along with the Prime Minister’s Office is at the helm of affairs, trying to generate awareness through visual, print and social media. To ensure preparedness, the provisions under the Epidemic Diseases Act of 1897 has been invoked. India has issued advisory for travel within borders and has imposed strict restrictions on international travel. Travel of passengers from China, Afghanistan, Philippines, Malaysia, European Union, European Free Trade Association, Turkey and the United Kingdom have been prohibited. The government has also undertaken Universal Health Screening at all points of entry into the country.
The government has arranged for quarantine facilities at public hospitals and few quarantine shelters run by the Indian Army. However, due to the weak health care system in place, the country might be at a higher risk in the near future. The crumbling public health infrastructure has forced few patients to flee the quarantine facilities at Delhi and Maharashtra, while many more patients have demanded treatment from private hospitals. An epidemic such as this reflects on the necessity for spending on strengthening the health care system in the country.
At the provincial level, states like Karnataka, Kerala, Maharashtra, Madhya Pradesh, Delhi, Uttar Pradesh and West Bengal have imposed restrictions on gatherings, travel, encouraged social distancing and have ordered for a temporary closure of educational institutions and public places. Kerala is being praised for its swift action in combating the virus. It has successfully implemented both hospital-based and community-based quarantine for a period of 28 days in total. Community surveillance systems are ensuring that the community spread does not begin in the state. Maharashtra faces a severe challenge, as new cases have been reported in rural areas like Yavatmal and Ahmednagar. The state government has extended restrictions to rural areas as well. Another big challenge for the state is the mass transit network in Mumbai, which, when completely halted, can adversely affect the economy of the commercial capital of India.
While governments at the federal and state levels are responding with all might, it is essential to know the public response to this epidemic. In the age of all-pervasive media, the spread of fake news in India regarding COVID-19 is much faster than the spread of the epidemic itself. Though the authorities have time and again busted the myths of coronavirus, social media has been bustling with false information, aimed at generating chaos among the public.
The society, on the other hand, has responded by taking some precautionary measures, though the apathy still prevails. Private schools declared holidays in early March. While the governments – especially the state government announced the closure of public places – malls and theatres, people took it seriously.
The media – especially the print media in the vernacular languages have provided more space on the virus – both informing and explaining.
Also, in certain regions, fearing social stigma, many people with symptoms of the virus have refused to get themselves tested. Maharashtra’s step to stamp the hands of home-quarantined people will further encourage stigmatization.
So far, India has been able to contain the epidemic to a large extent. The challenge would be to ensure that community spread does not take place. A pandemic such as this, demands a joint action from the authorities, health professionals, sensitive population and responsible media.
Nepal: In the second stage, with 137 confirmed cases; cancels “Visit Nepal 2020”
In view of the rapid spread of Global COVID -19 Coronavirus pandemic which was first identified in Nepal confirmed its first and only case on 24 January 2020. The patient had been discharged with instructions to self-quarantine at home while he showed only mild symptoms. As of 16 March, Nepal tested 477 other people who reported negative for the virus.
Nepali Prime Minister K P Sharma Oli, in a video conference with SAARC members initiated by Indian Prime Minister Narendra Modi and presented the preventive measures that Nepal is taking against the virus. “Our region is at high risk of COVID-19. The epidemic knows no boundary, nationality or region. We need to devise ways to combat this pandemic collectively, “said Prime Minister Oli.
Nepal government took various precautions to prevent the spread of disease in Nepal. Nepal evacuated 175 Nepalese from Hubei in February and kept at quarantine set up at the premises of the training centre of Nepal Electricity Authority (NEA) Bhaktapur for two weeks. They were sent home after they tested negative.
Nepal has already established health desks at the international airport and border checkpoints with India. Nepal closed down the Rasuwagadhi border with China completely halting the Nepal – China trade. In addition to this, medical personnel were deployed to various entry points along the Indo – Nepal border.
Nepal cancelled its international promotional activities ‘Visit Nepal Year 2020’. The government of Nepal issued an urgent notice and announced cancelling the spring mountaineering expeditions and temporary suspension on arrival visas of 8 countries in Nepal. International flights have been cut almost every day in recent days whereas 45 to 50 international flights used to be operated daily at Tribhuvan International Airport in normal conditions. Considering the outbreak, a 70 bed hospital is going to be constructed at Chitwan Exhibition Centre in Bharatpur Metropolitan City for treating COVID -19 cases within 72 hours in case of an outbreak of COVID -19.
The people of Nepal are scared. The WHO has already alerted Nepal about the possible risk of the spread of the virus. Yet, with the flow of Chinese tourists, there is also a high risk of transmission of the disease. On the other hand, neighbouring country India is in the second transmission stage of the pandemic COVID-19.
As per health experts, the total confirmed cases have already touched 137 as of 17 March 2020. Therefore, people seem more aware, and they are self-disciplined in this respect. To some extent, it is a relieving feeling that Nepal is still on the safer side as it continues to alarm the rest of the world.
Expressing deep concerns regarding the widespread Coronavirus infection, a high-level committee was formed by the Deputy Prime Minister for Defense, Ishwor Pokharel which closely observes the activities in the countries connected to Nepal and formulate necessary measures. Nepali media is trustworthy, and most of them are following the authentic updates from Nepal government. However, sometimes credible news gets overshadowed by fake news while social media has made people it’s content developer and publisher.
Sri Lanka: With 43 cases so far, the casualty number is low. So far.
Even though COVID-19 originated in China, it didn’t take long to spread towards South Asia. It was approximately one and half months later that the first patient was discovered in Sri Lanka, who was a Chinese tourist that was tested positive at the end of her tour on 27 January 2020. She was receiving treatment at the Infectious Disease Hospital (IDH) and fully recovered by 1 February 2020. Since then no cases were reported till 11 March. Meanwhile, Sri Lanka was able to successfully evacuate Sri Lankan students from Wuhan, with the support of Sri Lankan Airlines, tri forces and the Ministry of Health. The students were quarantined for 14 days, and none of them was found infected.
However, on 11 March, the first Sri Lankan was tested positive, who is a tour guide and suspected to be infected by Italian tourists. Since then, the number of infections has risen to 43 with 204 suspected cases under observations.
Various policy decisions have been taken by the government including the shutdown of all schools and pre-schools island-wide, shared two hotlines for the general public to gather information and updates on COVID-19 and to seek assistance for any emergency, travel bans for 11 countries including Italy, South Korea and some European countries which was followed by a halt of all passenger arrivals while continuing departure, transit and cargo, suspension of screening of movies, ban on public gatherings and closure of national museums etc. Considering the global situation, Sri Lanka has acted swiftly to take necessary actions, as Sri Lanka, which is a developing country under heavy debt burden, cannot afford rising numbers of infected people.
Sri Lanka possesses one hospital solely dedicated to treating infected diseases and therefore currently, actions are taken to open up another hospital in Polonnaruwa with ICU facilities. With the leadership of Sri Lankan Army, 16 quarantine centres have been established with 2258 people being quarantined. However, it is burdensome that around 1500-2000 Sri Lankans who arrived in Sri Lanka before the travel bans, from highly infected areas, have escaped security measures at the airport, disrespecting the rules and regulations set for mandatory quarantine. It is thoroughly advised to all families of COVID-19 patients and all travellers from infected areas to self-quarantine themselves with strict regulations. Medical officers continue to check these people on a regular basis.
As seen globally, Sri Lankans too began panic buying supplies when the first Sri Lankan patient was announced. However, it was assured from the private and public sector that there would be no shortage of essential commodities, although Sri Lanka has run out of masks and hand sanitizers. At a time, when the government has declared a three-day holiday, some people have made this a time to go out relaxing and specifically on pilgrimages, despite warnings from the authorities. Unfortunately, the public is disappointed with the fact that the authorities haven’t given any thought to postpone the upcoming elections, like France did, as this provides space for large public gatherings. Therefore, public opinion is formed asking for a lockdown of the country, but the issues remain if Sri Lanka can afford a situation as such, which will grow towards a grave recession.
Fake news has been circulating on the number of COVID-19 patients and how people in the quarantine centres were ill-treated. However, this was immediately tackled by updates broadcasted by the Department of Government Information and National Operational Centre for the prevention of the spread of COVID-19, headed by the Commander of Army of Sri Lanka.
The immediate steps of Sri Lanka should include assessment of available health kits and essential medication for at least a buffer period of 4 weeks, immediate fever checks within all public buildings that run essential services. Postponing of upcoming elections should be given more consideration. It is high time that Sri Lanka learns from Singapore and Taiwan and acts with preparedness and vigilance.
Maldives: With 17 cases, it has been contained so far, with no community spread
Maldives confirmed its first two cases of COVID-19 on 7 March 2020 both employees at Kuredhoo Island Resort from an Italian tourist. On 9 March two other COVID-19 cases were confirmed both from tourists. As of 17 March, there are 13 confirmed cases of COVID-19 in the Maldives.
Immediately after the first two cases were confirmed, four Resorts of Kuredu, Vilamendhoo, Batalaa and Kuramathi island were placed under temporary quarantine. Schools have been closed as precautionary measures. Out of the 13 cases confirmed so far, most are foreign nationals. The four foreign Nationals from Kuredu Island Resort who tested positive are recovering well in isolation. Three islands which were temporarily restricted for entry/exit were screened thoroughly and reopened for travel.
As on 17 March, 15 people are in isolation in Farukolhu island, and 13 are in quarantine in Villivaru island awaiting results of the tests. A few have been released after 14 days isolation. Two Maldivians living in Wuhan evacuated to India continue to be in 14-day isolation. Contact tracing has been completed in all the above-mentioned islands with a few persons placed under room isolation and self-monitoring in resorts islands. The National Emergency Operations Centre is working 24/7 to determine the gaps and strengthen response in addition to enhancing contact tracing. Authorities say the island is well stocked. The Government of Maldives announced a ban on entry into Maldives of anyone who has left or transited the UK in the last 14 days, with effect from 18 March.
The Government of Maldives has declared a Public Health Emergency, effective until 10 April. For 14 days, effective from 14 March, travel from and to resorts from all inhabited islands have been suspended. Excursions have been limited, and public spaces like parks or sports grounds are temporarily closed. All cruise ships are currently banned from entering and docking in the Maldives. Besides, all persons who have been in the last 14 days to Mainland China, Iran, South Korea, Italy, Bangladesh, Spain, Germany and France are not allowed to enter or transit through the Maldives. Passengers and airline crew must undergo a screening procedure. WHO has been helping efforts to contain the virus through teleconference awareness calls and COVID19 test kits. Sitreps are shared daily and new technical documents immediately.
Another important angle to look at is that even though the Maldives declared a 30-day Public Health Emergency, it hasn’t rescheduled its local council elections scheduled for 4 April which generally sees high voter turnout. The political opposition has although suspended its campaign after early cases of virus outbreak. However, “If COVID-19 infects Maldives’ local population, predictions suggest 60% to 80% could be affected without government intervention” says foreign affairs minister Abdulla Shahid.
Tourists who have been kept under quarantine at the luxury Maldives resorts cited “lack of information” and “workers in hazardous material clothing”. All guests and staff were restricted from leaving until further notice.
A few people, including the Italian guests, refused isolations at the resort and insisted on using facilities like the restaurants and bars. Besides, a few people began panicking, and sanitisers were stolen at the resorts but largely the virus has been well contained so far and has not escalated into community spread.
The Missing Collective: South Asia’s regional attempt through the SAARC
More Ideas, Less Action
Afghanistan, India, Bangladesh, Bhutan, Maldives, Nepal, Sri Lanka and Pakistan came together after six years on the SAARC platform on 15 March, for a video conference. The video conference was attended by President Ashraf Ghani of Afghanistan, Prime Minister Sheikh Hasina of Bangladesh, Prime Minister Lotay Tshering of Bhutan, President Ibrahim Mohamed Solih of Maldives, Prime Minister KP Sharma Oli of Nepal, President Gotabaya Rajapaksa of Sri Lanka, Zafar Mirza, a special assistant to Prime Minister Imran Khan from Pakistan.
The total number of cases registered in SAARC, 443 and counting. The first hit in was seen in Nepal on 24 January followed by the spread across the South Asian countries.
The challenge is to operationalize the ideas
The first-ever video conference initiated by Prime Minister Narendra Modi of India. This initiative aimed at bringing all the regional leaders on the same platform to address the social, economic impact of the pandemic. It also aims at bringing solidarity, a corporate bonding, and inclusivity of ideas among neighbours.
Several concerns were raised during this video conference. The Maldives President Solih and Bhutan Prime Minister Tshering are worried on the economic implication, as per there economy is highly dependent on the tourist sector.
During the conference, Narendra Modi said, “We all agree on evolving a common strategy to handle such a challenge, we will also find a cooperative solution. We will share our knowledge for the best practices, capacity and possible resource for all.” He also proposed funds to fight COVID-19, at a regional level by contributing $10 million and also offered for an online training facility to scale up the capabilities of SAARC countries. Later, he also suggested leaders of all the SAARC countries decide the plan for the SAARC COVID-19 Emergency Fund.
Additionally, Prime Minister, Sheikh Hasina approached with an idea “to create an institute to prevent and fight against any public health threat in the South Asian region in the future.” The Indian government has also proposed, sooner on a meet with G20 leaders, to beat COVID-19.
China: Fall in numbers
As of 18 March 2020, Wuhan remains one of the worst affected regions. Of the 200,102 cases so far, over 80,000 cases have been from China, with 69,614 cases recovered and 3,237 deaths. The count of new cases peaked in the first half of February, and since 6 March 2020, there has been a drastic fall in the number of new cases. Many of the makeshift centres in China have begun to close down after the fall in the number of cases.
China adopted unprecedented and aggressive measures as the number of cases escalated in China. They ensured extreme lockdowns to bring the crisis under control in the country. One of the first measures was to suspend trains and block all roads to Wuhan and 15 other cities in Hubei. Strict instructions were circulated to the people in China to stay home and leave home only for medical assistance or food.
According to the New York Times, up to half of China’s population; 760 million people were confined to their homes, for over two months. This confinement has been helpful in containing the spread, from having thousands of new cases in a day to less than a dozen new cases daily. However, the flaw in China’s response was that it began late and hence had to face the massive spread of the outbreak.
Strong measures to reduce contact among people and travel bans have helped slow-down the spread of the virus worldwide. The best success story is that of Singapore; in terms of public responses, China may be considered as the second-best in containing the virus considering the fact that it started there and spread before any knowledge of it was known.
Cancellation of work, schools, and events have caused a lot of chaos among the people, especially because the spread came at the same time as the Chinese New Year, many of those who were displaced remained in the same place due to shutdowns. Classes were suspended for a while, after which online courses have been recommended for students. With the fall in the number of cases, there have been measures to ease the restrictions placed; however, it is unclear if the situation would return/worsen once the movement begins.
Europe: Shut down in Italy and Spain, and the danger in Germany
In Europe, Italy registered the most cases (outside China) at more than 31,500. The country witnessed another surge in the number of deaths on 17 March, from 2,150 to 2,503. The country remains in lockdown. Since it began on 20 February with three cases of coronavirus in Lombardy, the number of cases surged to more than 30,000 in less than a month in Italy. The health officials in Italy have concluded that the virus arrived in Italy long before the first case was discovered. Italy was experiencing an unusually high number of pneumonia cases in its northern provinces. Around 26 February, Austria, Croatia, Greece, Norway, Switzerland, Georgia, and North Macedonia reported their first coronavirus cases. Many of them involved people who had been to Italy. Italian researchers at the Sacco hospital in Milan have identified two variations of coronavirus, including a local variant that may have circulated for several weeks before the first identified case in northern Italy. The second variant spread across Europe through people with travel history in Italy or in the Middle East. Denmark registered its first case from Iran and the other two with travel history in Egypt.
Since the spread from Italy, the number of confirmed cases in France grew by more than 16 per cent on 17 March, at 7,730 confirmed cases, 1,097 more than the previous day. The death toll rose to 175, with 7 per cent of the dead aged under 65. More than 2,500 people are being treated in hospital, including 699 in intensive care. In Britain, the death toll is 71. The number of confirmed cases in Spain has soared by 2,000 to 11,178. Authorities there are maintaining a partial lockdown on 47 million people. It is now the second European country to be worst-affected after Italy. Germany has had more than 8,000 confirmed cases and 13 deaths. The Prime Minister of Ireland Leo Varadkar has announced a possible 15,000 cases of coronavirus before the end of March.
EU proposed the strictest travel ban with Belgium and France joining Spain and Italy in complete lockdown. Meanwhile countries like Austria, Hungary, the Czech Republic, and Poland, unilaterally have begun imposing border checks.
In Italy, under the new lockdown legislation, people can be issued fines for travelling within or outside the country without a permit. All public events have been banned, and schools have been cancelled throughout the country. Public spaces, such as gymnasiums, theatres, and cinemas, have also been closed down by the government. Individuals who defy the lockdown could face up to three months in jail or a fine of $234. The new rules prohibit inmates from having visitors or day releases, which set off protests at 27 prisons throughout the country. Similar rules have been imposed in France where citizens who leave home must now carry a document detailing the reasons why, with fines for transgressors to be set at €135 ($150; £123). In Britain, the chancellor, Rishi Sunak, has unveiled a financial package worth £330bn ($400bn) to ease the burden on the people. Prime Minister Boris Johnson on 16 March has urged people to avoid pubs, clubs, and cafes. At midnight on 17 March, Spain began stopping cars crossing its borders from France and Portugal with a rule that only Spanish nationals, residents and cross-border workers were being allowed to enter the country.
Germany has banned religious services and would proceed with an airlift of its nationals in other countries.
The EU travel ban and move to seal its borders will apply to 26 EU states as well as Iceland, Liechtenstein, Norway and Switzerland with the exception of the UK. Free travel is a cherished principle within the European border-free Schengen area but as many countries unilaterally impose full or partial border shutdowns in a bid to stop the spread of the coronavirus, the EU travel ban is a prompted decision by the EU Commission.
The initial responses of the virus were racist slur and contempt against the Asians in Europe. Cases of Sinophobia were increasingly observed in France, Germany, Italy, and Spain. This propelled many Asians of Chinese, Vietnamese and South Korean origin to take to social media with a counter-narrative on “I am not the Virus.” As the cases of coronavirus started increasing in Europe, the partial to complete lockdown has led people to adopt social distancing goals as the new SDG to contain the coronavirus spread. The people in Spain and Italy have used social media to record and spread the messages on how life looks in a quarantine. The social etiquette of handshakes has been increasingly replaced with a nod to ‘namaste.’
The United States: Strong public response, despite the late spike and Trump’s slow reaction
As on 18 March there are 6,524 cases, with 116 deaths, and importantly, 106 recovered.
The first case of COVID-19 was reported in the US in Washington State in late January 2020. The first person infected with the virus happened to visit a family in Wuhan, China. Since then more than 6,300 people have been diagnosed with the virus in the US The national health protection agency, Centres for Disease Control and Prevention (CDC) is actively coordinating and directing the state and people of the US to contain the spread of the coronavirus. The source of the coronavirus can be categorized broadly as imported cases in travelers, cases among close contacts of a known case and community-acquired cases where the source of the infection is unknown. Three US states are experiencing sustained community spread – New York is the number one hotspot.
The US was unfortunately slow to respond by three weeks at the beginning that resulted in missing the opportunity to contain like what Singapore has done. It was unfortunately politicized and called as a hoax. The person who has the loudest microphone in the White House did not send the right message to the public, kept shaking his hands and hosted events and gatherings while Singapore made its military to make N95 masks.
Finally, when the Government was ready to put its act together, the US had to straight go to mitigation skipping the containment. Significant problems were there, for example, the global shortage of masks and test kits. The US, being the big brother, did not seek help from the WHO in regards to getting the kits. Twelve million masks that were used during the SARS outbreak was never replenished. The US is still playing the catch-up game.
There have been aggressive measures led by the White House task force Dr Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases. Finally, the President has started to listen to medical experts. Million test kits are made available this week with multiple drives by testing centres all over the country.
Centers for Disease Control and Prevention (CDC) is studying the virus worldwide and helping communities respond locally. National emergency, state emergency has been called, FDA working with the medical community to develop vaccines, drugs and diagnostic tests. CMS (Medicare) offering new benefits for US citizens, so their insurance covers telemedicine, and they get their medical care without leaving their home.
State governments are responding proactively like in New York and California, state emergencies have been declared before the national emergency and “Shelter in place” ordered for social distancing. Million ventilators are being purchased by the Government, medical supplies, preparation for makeshift hospitals, ICU beds etc. Tests are free for all American citizens regardless of insurance. Disability benefits for people who are unable to work due to COVID and or who require child care because of school closures. Travel restrictions to China, Europe and many other countries, scrutinized entry and screening at airports. Medical community’s response is remarkable, working with CDC when things change by the hour. Retired doctors and nurses are requested to come back to work, and special benefits are announced to handle the staff shortage that is expected to happen as medical personnel get sick
Life in America is changing so rapidly. COVID-19 has infiltrated every aspect of American citizen’s lives. Two weeks ago, when the mainstream tech companies like Facebook, Google acted before Government requesting their employees to work from home and not to travel, it sent a strong message to the public. The typical brutal airlines have been the kindest during this unprecedented crisis, and have been so flexible with cancellations and flight changes. Doctors are seeing patients through video visits; every hospital has set its own drive by testing centres to help with testing and quarantine.
People are serious and following social distancing. Schools, colleges, restaurants, bars, gyms, libraries and parks are closed. Streets are deserted, stores are empty, even teenagers are not ‘hanging out’ with friends. Elderly people in the community are bringing ‘checked’ to make sure they get the supplies they need without getting out of their homes due to the high risk. A religious ICU nurse shaved his beard today because the hospital was trying hard to find an N95 mask that can fit him and he simply went to the bathroom and shaved his beard to focus on what’s more important. Stories like this by the public is heartwarming and people are coming together as a community to take care of each other. Not following “shelter in place” is a misdemeanour and the society is taking it very seriously.
The US is two weeks behind Italy and unfortunately, it has been a similar trend so far to repeat what has happened in Italy. Hope these aggressive measures by the Government, and public with strict social distancing and robust response by the medical community will flatten the curve.