Up-And-Coming Countries Have Some Of The Largest Outbreaks Of COVID-19 : Goats and Soda They're up-and-coming nations. They're regional political powers. And they're especially vulnerable to the impact of the pandemic.

What 6 Of The 7 Countries With The Most COVID-19 Cases Have In Common

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The United States continues to lead the world in the most confirmed cases of the coronavirus. More than 4 1/2 million have been infected since the pandemic began. The next country behind the U.S., Brazil with more than 2 1/2 million. The six countries following the U.S. are considered middle-income nations. NPR's Jason Beaubien explains why these places were uniquely at risk from the virus.

JASON BEAUBIEN, BYLINE: Outside of the U.S., if you look at the countries with the most coronavirus cases, they have something in common. They're some of the most influential players in the global south. Brazil, India, South Africa, Mexico are not only major emerging market economies. They're regional political powers. And they're all grappling with accelerating COVID outbreaks.


PRESIDENT CYRIL RAMAPHOSA: This evening as I stand here before you, our nation is confronted by the gravest crisis in the history of our democracy.

BEAUBIEN: In mid-July, South African President Cyril Ramaphosa tightened lockdown measures, made wearing masks in public mandatory and reimposed a ban on the sale of alcohol.


RAMAPHOSA: The coronavirus storm is far fiercer and much more destructive than any that we have known before. It is stretching our resources as we speak, but it is also stretching our resolve to their very limits.

BEAUBIEN: South Africa has now reported nearly half a million cases of COVID-19. South Africa's borders remain closed, and the pandemic has pushed the country's official unemployment rate above 30%. Middle-income countries are a diverse group and home to 75% of the world's people, according to the World Bank. These are nations where annual per-capita income is between $1,000 and $12,000. The U.S., by comparison, is 66,000 per year. Collectively over the last decade, these countries have lifted hundreds of millions of people out of poverty. And Amanda Glassman with the Center for Global Development says these countries have a lot to lose in this pandemic.

AMANDA GLASSMAN: They have most of their population in this group that would fall back into poverty given a shock like this one.

BEAUBIEN: The entrepreneurial spirit that made countries like India, Brazil and South Africa dynamic, emerging markets also put them at greater risk of having large outbreaks. These are places with a lot of hustle, as Glassman puts it. Their economies are global. Business travelers and tourists jetted in and out. They have decent domestic transportation networks offering the coronavirus or other pathogens easy avenues to spread.

GLASSMAN: I'm just worried that we're setting back the process of economic and social development that has gone so quickly over the past decade, and it will just take us many years to catch back up.

BEAUBIEN: Unlike some extremely poor countries, most of these nations have health systems capable of detecting the disease.

JONATHON KEYMER: In India, for example, they're during a lot of testing.

BEAUBIEN: Jonathon Keymer is a risk analyst at WorldAware.

KEYMER: In Russia, they're doing a lot of testing. And the more people you test, the more confirmed cases you're going to have.

BEAUBIEN: He says some middle-income countries look worse simply because they're doing far more testing than their neighbors. For instance, Peru has one of the largest outbreaks, but it's also testing at a rate five times the global average. The potential for social instability during this crisis is higher in middle-income countries, Keymer says, compared to poor or wealthy nations. People in these countries have recently seen economic gains and now are having their aspirations dashed by government lockdowns.

KEYMER: One of the major things that we look at in these countries is how this impacts on public sentiment. So it's not just the health impacts. It's the public sentiment impacts. And negative public sentiment, of course, has a direct impact on rising crime, rising levels of civil unrest.

BEAUBIEN: In 2019, prior to the coronavirus pandemic, there were waves of middle-class protests in many parts of the world focusing on economic inequality. Keymer says in middle-income countries, particularly ones with pre-COVID social problems, the economic hardship of the pandemic is likely to make matters worse.

KEYMER: With the lockdown in South Africa, we're already seeing protesters gathering on the streets, demanding the right to protest. Here's this thing that - you know, that right has been taken away by the lockdown.

BEAUBIEN: Regardless of their COVID numbers, all the world's middle-income nations face potentially crushing economic impacts. Most don't have the financial reserves to bail out shuttered businesses or to pay workers to stay home. And they're faced with restless populations that are eager, maybe even desperate to improve their standards of living. Jason Beaubien, NPR News.

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