Title: An Epidemiological, Strategic and Response Analysis of the COVID-19 Pandemic in South Asia: A Population Based Observational Study

Abstract

Background: South Asia has performed relatively better than initially during the COVID-19 pandemic. The overall burden and response have remained dynamic in the region with certain countries outperforming others despite limitations in health resources. Methodology: Using a population-based observational design, all 8 South Asian countries were analyzed using a step-wise approach. Data were obtained from government websites and publicly available data for population dynamics and other facilities. Results: South Asian countries have a younger average age of their population. Our findings demonstrate the inequitable distribution of resources centered in urban metropolitan cities within South Asian countries. Certain densely populated regions in these countries have better testing facilities and healthcare facilities that correlate with lower COVID-19 incidence per million populations. Trends of urban-rural disparities are not clear given the lack of clear reporting of the gap within these regions. COVID-19 vaccination lag has become apparent in South Asian countries with the expected time to complete the campaign being unfeasible as the COVID-19 pandemic progresses.Conclusion: The focus on response in the South Asia countries has been on controlling peaks rather than curbing them. With a redesign of governance policies on preventing the rise of COVID-19 promptly, the relief on the healthcare system and healthcare workers (HCWs) will allow for adequate time to roll out vaccination campaigns with equitable distribution.