Health workers and human rights defenders are working tirelessly to protect the poorest communities of Africa and South Asia from a ‘COVID-19 human timebomb’.

Until now the worst of the outbreak has hit developed countries, putting health systems like the NHS under great strain.

There are now cases recorded in all 10 of the countries where The Leprosy Mission England and Wales works across South Asia and Africa.

These countries are among the world’s poorest nations where many have no access to health care. Mozambique is one of these nations. It has 30 ventilators across the country for a population of almost 30 million. This signals that millions may not survive when the virus undoubtedly gathers momentum.

Recognising this, governments of many of these countries have been swift to impose a lockdown. They know all too well the power of a highly-infectious virus. West Africa still bears the scars of the Ebola outbreak of 2014.

These are countries where levels of literacy are low. Digital communication, particularly in rural areas, is limited. Social distancing is not only alien but totally unattainable in overcrowded slum communities. People are either unaware or very afraid. 

While COVID-19 is a highly-contagious virus, leprosy is a mildly-infectious bacterial disease. Yet both are surrounded by superstition, ignorance and misunderstanding. They both see people facing stigma as well as isolation. And it is people affected by leprosy who will be most at risk as COVID-19 as sweeps through their country.

Head of Programmes at The Leprosy Mission, Sian Arulanantham, said: "We must act now, at a time when the coronavirus is on the brink of ripping through the majority world, overwhelming fragile health systems. 

“Devastatingly this is a human timebomb waiting to explode.

"As ever it is people living in leprosy-affected communities that will be hit the hardest. Well-off travellers have returned to developing nations bringing with them the COVID-19 virus. Yet these travellers are able to self-isolate, stockpile food and stay at home.

"Communities affected by leprosy are among the most vulnerable. Individuals are more likely to be disabled and have weakened immune systems as well as underlying health conditions.

"And just like leprosy; malnutrition, overcrowding and poor sanitation create an ideal environment for the spread of the virus."

The Leprosy Mission is working with colleagues and partners across Asia and Africa to ensure the hundreds of thousands of people it serves receive clear messaging on COVID-19.

"These are communities who know only too well the suffering caused by fear and age-old myths. For example, leprosy being a curse for sins committed in a previous life," explained Sian.

"The truth is the greatest slayer of fear so it is vital that our communities, which all too often lie on the fringes of society, are reached. 

"They must receive clear messaging on the symptoms of COVID-19. The need to know the necessity of self-isolating and the importance of social distancing and handwashing.

“Social distancing and isolation, however, are an almost impossible task in densely populated areas. So it is essential that governments engage in testing and active contact tracing of known cases to prevent the spread of the virus. We would be very happy to support this. Likewise, movement between communities must stop in order to contain the virus.”

In countries where lockdown has been imposed, Leprosy Mission staff and partners are phoning individuals with key health information. WhatsApp groups have been set up to share messaging.

Where lockdown is yet to be imposed, for example in Mozambique, staff and partners are working with community health workers and volunteers. They, in turn, are relaying health messaging to villagers.

Sian applauded the efforts of some countries, including the Indian government which announced food parcels for those affected by the lockdown.

"People in the majority world face very different challenges to the COVID-19 pandemic from us in the UK," she explained.

"For those living hand to mouth, it is difficult to blame a day labourer for being tempted to work with a sore throat. If they stay at home, it is very likely their family will not eat that day.

"This is why The Leprosy Mission is advocating that these communities receive the state aid they are entitled to wherever possible, including food parcels. Where this is not available, we are praying for resources to be available so that we can help those most in need. 

“We heard of a young woman who cannot work because of lockdown and she and her family had no food for days. Her three children were crying with hunger. Thankfully we were able to help. We can’t stand by and watch, we need to act.

"All too often people with visible scars of leprosy are refused medical treatment. This is entirely illegal but tragically happens. So we are working hard to ensure anyone needing medical attention for symptoms of COVID-19 receives it.

"There are so many issues our teams are addressing currently. This includes finding solutions to practical problems like how to stop people congregating at water pumps. It is very hard to self-isolate and undertake frequent handwashing when you do not have running water to your home."

The Leprosy Mission’s hospitals and the hospitals it supports across Asia and Africa all have isolation beds. Heat testing for fever and handwashing is taking place outside Outpatients’ departments.

Necessary steps are being taken to ensure that Multidrug therapy, the treatment for leprosy, remains available. People will still be able to receive the cure or have enough medication to last them for at least a few months.

The Leprosy Mission’s Anandaban Hospital in Nepal is a designated Disaster Response Centre by the Government of Nepal. This follows the 2015 earthquakes which killed 9,000 people. Staff from Anandaban Hospital reached out to 18,000 people with emergency medical care, shelter and food parcels.

Following a request from the Nepali government, an isolation ward is being set up at Anandaban Hospital for COVID-19 patients. 

Sian said The Leprosy Mission is keen to work with the Department for International Development to ensure any UK Aid dedicated to COVID-19 reaches the communities where it is most needed.

Erik Berglof, director of the Institute of Global Affairs at the London School of Economics, last week warned against ‘sprinkling money from helicopters' in developing economies. He said it would never reach the intended receivers.

He advised that carefully managed programmes and projects were required to prevent millions of deaths across the developing world and economic devastation from the coronavirus pandemic. 

Working with health-focused charities already present in marginalised communities, in partnership with national governments, can help limit the devastating effects of this potential human timebomb.