While countries including the United States struggle with the growing number of coronavirus cases, others have slowed them or haven’t reported a single one since the virus was first discovered in December 2019.
New Zealand recorded its first day with no new coronavirus cases Monday, according to the country’s Ministry of Health. As of Wednesday, the country has 1,488 confirmed and probable cases and 21 deaths.
Meanwhile, the World Health Organization confirmed to USA TODAY that some countries haven’t reported any cases of COVID-19 including Comoros, Lesotho, Turkmenistan, North Korea, Kiribati, Marshall Islands, Federated States of Micronesia, Samoa, Solomon Islands, Tonga, Tuvalu, Vanuatu, Cook Islands, Nauru, Niue and Palau.
Are these countries impervious to the coronavirus?
The majority of nations that haven't reported any cases of the coronavirus are isolated island chains in the Pacific.
Dr. Thomas Tsai, assistant professor of health policy at Harvard T.H. Chan School of Public Health, said these islands were mostly spared of the coronavirus because countries in Asia were quickly locked down preventing travel and tourism.
However, this isn't the case for North Korea, Turkmenistan and Lesotho, which all share borders with countries that have reported coronavirus cases.
Despite its 880-mile border with China, North Korea still claims to have had zero infections. China is North Korea’s biggest trading partner, accounting for as much as 95% of the country’s reported imports, according to 38 North, a website that tracks the country’s developments.
“It’s a near impossibility for them not have cases,” said Jung H. Pak, a former CIA analyst and North Korea expert with the Brookings Institution, a Washington think tank.
Pak and other experts say there's evidence of at least a small-scale COVID-19 outbreak in North Korea, a country where much of the population is already in poor health, the economy is crippled and the health system is abysmal.
The true picture of how widespread COVID-19 is inside North Korea will probably never be clear. North Korea is one of the world's most secretive, repressive and authoritarian countries in the world, and the regime's propaganda machine controls the flow of information.
Turkmenistan leader Gurbanguly Berdimuhamedow vehemently insists that the country has miraculously avoided the coronavirus, while its neighbor Iran has confirmed over 100,000 cases as of Wednesday, according to the Johns Hopkins website.
Dr. Robert Saunders, professor of international relations at Farmingdale State College (SUNY), said one of the reasons why the country has no confirmed cases may be due to lack of testing.
"Willful ignorance can be framed as victory," he said.
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United Nations Resident Coordinator Elena Panova told the BBC Turkmenistan is testing everyone who arrives to the country exhibiting symptoms, relying strictly on official information.
However, experts agree that official information from Turkmenistan is notoriously unreliable. Saunders believes there are definitely coronavirus cases in the country and said the government could be working hard to suppress those test results by controlling social media and manipulating death certificates.
Panova also told the BBC Turkmen authorities are working with UN agencies to plan for a possible outbreak, closing most of its land border crossings and cancelling flights.
Despite these measures, daily life in Turkmenistan appears as normal. In mid-April, hundreds of soccer fans crowded a stadium in the capital, Ashgabat, to watch its domestic teams play.
J. Stephen Morrison, who directs global work at the Center for Strategic and International Studies as the think tank’s senior vice president, said there are a couple of reasons why Lesotho could be successful in managing their case counts.
He said the mountainous country is mostly remote and difficult to access, making social distancing easier than other more populated countries. South Africa, which surrounds Lesotho, imposed a strict lockdown early in the pandemic, which kept its numbers low and may have inadvertently benefited its neighbor.
Lesotho, like many other African countries, also has experience managing pandemics. Methods such as social isolation and contact tracing are well established in parts of southern and eastern Africa.
“There’s something to be said for having those durable and resilient infrastructures and having had that political experience of going through an epidemic where at its peak 20 years ago was threatening to destabilize these societies,” Morrison said.
While all this may be true, he still believes there may be some unaccounted cases in the country.
Although Lesotho closed its borders March 10, Morrison said Lesotho’s economy is very dependent on South Africa and the history of migration between the two countries puts into question the lockdown’s effectiveness.
Lesotho is also in the midst of political turmoil as prime minister, Thomas Thabane, is charged with murdering his estranged wife who was assassinated in 2017. According to Deutsche Welle, Thabane struggles to hold onto power deploying the country’s army while citizens demand his immediate resignation.
Morrison said this may have distracted the government from focusing on managing the pandemic.
“Lesotho is a country that has been prone to instability,” he said. “That sort of instability doesn’t speak well to control over a virus.”
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While experts question if any of these countries are truly free of the coronavirus, Morrison said what's more important is to make sure they're prepared in case its residents do come in contact with the virus.
"They all have to play the long game," he said. "They may be successful up to a point for now but their population doesn't have immunity from this."
He argues the international health community must ensure these countries have sufficient testing, PPE and the hospital capacity to successfully manage the pandemic if it somehow appears. Morrison said trade, migration and travel will certainly reintroduce the virus when the world begins to reopen its borders.
"If they want to preserve their low rates, remain relatively or largely free [of the virus], ultimately they have to create the capacity to detect, respond and control," he concluded.
Contributing: Deirdre Shesgreen, USA TODAY; Associated Press. Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT.