Why are these countries reporting no coronavirus cases?

From testing capability to likely cover up, here's what you need to know

North Korea held muted celebrations for the 108th birth anniversary of President Kim Il-sung on Wednesday. EPA

The coronavirus has rattled governments across the world, as countries struggle to deal with a contagious disease that reached all continents except Antarctica in just three months.

But there are some countries yet to report a single case. Is it due to luck, geographical isolation, war or lack of diagnosis and reporting infrastructure?

Here’s what you need to know.

Turkmenistan

Isolated Turkmenistan, which held mass aerobic exercises and a cycling event with coordinated tracksuits this week, is one of only a handful of countries to have reported no coronavirus cases. AFP

If there are cases of coronavirus in Turkmenistan, the world is unlikely to come to know about it, experts say.

"Turkmenistan has never been open about its data on infectious disease, Martin Mckee from the London School of Hygiene and Tropical Medicine, told The National.

“For many, many years it only reported two cases of HIV, which nobody believed and then there were none."

He says it is “implausible” that the country has no cases.

After the end of the Soviet Union in 1991, and the coming to power of leader Kurbanguly Berdymukhamedov, numbers of tourists dropped from 300,000 in 2007 to just 6,000 in 2016.

The country is increasingly closed off to visitors, but has acted as a transit point for international flights, one of the most popular being from the UK’s Birmingham to India’s Amritsar, stopping in Turkmen capital Ashgabat. It also shares a border with Iran, one of the first countries to be hit hard by the pandemic after China.

Despite the country taking action to halt incoming flights six weeks ago, life inside Turkmenistan remains the same - no lockdown measures have been implemented.

Usually, the only indication of a large-scale outbreak in Turkmenistan would be infections bleeding into surrounding states, but as airlines aren't operating, it will be difficult to tell in the case of Coronavirus.

“They've had outbreaks of plague before which crossed the border into Uzbekistan... but they denied it,” said Mr Mckee, who has studied both the Turkmen and Tajik healthcare systems.

The UN Resident Co-ordinator for the country, Elena Panova, said the UN was working with Turkmenistan on preparation and testing for the virus.

"We are relying on official information because this is what all countries are doing," she told the BBC. "There is no question of trust because that's the way it works.”

Tajikistan

A Buddhist stupa in Vrang, Tajikistan, overlooks the Wakhan Valley. Bloomberg News

It may sound similar, but Tajikistan is a very different place, said Mr McKee, adding the country has “no history” of concealing health statistics.

It could be the country, which has a population of 9 million people, has a low number of cases, but is struggling to diagnose and report them.

“My suspicion with Tajikistan is that they haven't got their surveillance systems working particularly well,” Mr McKee added.

The country’s mountainous terrain makes it hard to travel across, lessening the chance of spreading the virus. However, travellers are known to cross borders into China, Uzbekistan and Afghanistan to avoid the peaks, increasing the chance of contracting the virus.

The World Health Organisation has been working in the country since 1992, just after Tajikistan gained independence from the Soviet Union.

But independent news group Eurasia reported four suspected deaths from the virus this week, amid conflicting government decisions on the virus. On March 20, airports across the country were closed, but on March 22 thousands attended a Nowruz ceremony at which long-time President Emomali Rahmon addressed the crowd.

Pacific Island nations

Vanuata is an archipelago 2,000 miles east of Australia. Courtesy Airbnb

At least eight Pacific Island nations remain virus-free, including Tonga, Vanuatu, the Soloman Islands, Kiribati and Samoa.

Bigger islands in the area with larger populations and links to countries with large outbreaks, including the US and France, have a number of cases, including Guam with 134 cases and five deaths, and Fiji with 17 cases. The small number of incoming flights per week to most of the smaller archipelagos and islands helped keep the virus from spreading, later combined with quick measures to close borders and lockdown islands with cases early on, have ensured smaller islands have been kept safe.

It is just as well, given Cyclone Harold’s path through four of the island nations last week, destroying hundreds of homes. Aid to Vanuatu, where World Vision estimates 35 per cent of the 300,00 population are now in temporary shelters, has been delayed due to concerns of spreading the virus.

Airport staff and Royal Australian Air Force personnel transfer boxes of humanitarian aid transported by a Royal Australian Air Force C-17A Globemaster III to Port Vila airport, following Cyclone Harold. Reuters

"From the outside, it looks frustrating," World Vision's Vanuatu director Kendra Gates Derousseau told AFP.

"There's no choice though, a Covid-19 outbreak on top of the cyclone would be unfathomable."

The islands are working together to deal with the spread of the virus. The Pacific Islands Forum agreed on humanitarian pathway earlier this month to expedite assistance and co-operation between member countries by enabling the provision of medical and humanitarian assistance from regional, international and development partners in a timely, safe, effective and equitable manner.

“The Covid-19 pandemic is a global health emergency of unprecedented scale. It poses a real and extreme danger to the health and security of the Pacific peoples,” Kausea Natano, Chair of the Pacific Islands Forum and Prime Minister of Tuvalu said on April 8.

“Never before has the full Forum Membership simultaneously been in crisis,” he added.

“WHO in the Pacific is pulling in resources with different areas of expertise, repurposing many of our staff in order to provide timely support,” said Dr Corinne Capuano, WHO director of Pacific technical support told Devex.

“We are working with governments and partners around the clock, making sure that our preparedness and response plan is strategic, well-coordinated, and timely.”

North Korea

North Korea held muted celebrations for the 108th birth anniversary of President Kim Il-sung on Wednesday. EPA

The famously reclusive state has thus-far reported no cases, even as neighbour South Korea passed 10,500 cases on Wednesday.

The WHO said the country does have the capacity to test for the virus at its national reference laboratory in Pyongyang.

“As of 2 April, 709 people - 11 foreigners and 698 nationals - have been tested for Covid-19. There is no report of a Covid-19 case. There are 509 people in quarantine – two foreigners and 507 nationals,” Dr Edwin Salvador, the WHO Representative to the Democratic People’s Republic of Korea (DPRK),  told Reuters last week.

“Since 31 December, 24,842 people have been released from quarantine, which includes 380 foreigners,” he said.

On April 13, a cabinet report reiterated the North's insistence that "not a single case" of the coronavirus had been found.

Pyongyang put thousands of its own people and hundreds of foreigners - including diplomats - into isolation and mounted disinfection drives as it sought to prevent an outbreak, which experts say could be devastating given its weak health sector and widespread malnutrition.

 Comoros and Lesotho

The African Centres for Disease Control said 52 of the African Union's nations had cases of the virus, totalling 17,200. Worst hit is South Africa with 2,506 cases, followed by Egypt with 2,505 and Algeria with 2,106.
The only two nations in Africa without a case of the disease are Comoros and Lesotho. It is unlikely Lesotho has no cases, due to its porous border with South Africa. 
Authorities said 93,000 Basotho people crossed back into the country from South Africa in the days before its much larger neighbour went into lockdown.
More likely is a health system unable to cope with testing and tracing. Indeed, the country's finance minister pleaded in an interview on Wednesday with South Africa's Eye Witness News for citizens currently working abroad not to return home.
"I am not confident at all and I am not convinced that there are no Covid-19 cases in Lesotho," said Moeketsi Majoro. "The risks and exposures that we see are completely inconsistent with no case."
Until last week the country had no tests or testing centres, and received its first kits thanks to a donation by Chinese billionaire Jack Ma. It instituted a 21-day lockdown in late March.

Lesotho soldiers are seen on the streets of Maseru on March 30, 2020 enforcing the lockdown ordered by Prime Minister Thomas Thabane. AFP

"There is a big gap in the continent on testing and tracing" across the continent, Africa CDC Director Dr John Nkengasong said on Thursday.
Dr Nkengasong told a press briefing that next week his organisation would roll out "more than 1 million tests to support countries to increase their ability to test" for Covid-19.
The Indian Ocean island nation of the Comoros, situated between Madagascar and Mozambique, has yet to detect a single case of the virus, according to the health ministry.
One doctor in the capital Moroni, Dr Abdou Ada, speaking with AFP, theorised  that the widespread use of the drug Artemisinin to treat malaria could be behind the lack of cases.
"I believe that the mass anti-malarial treatment explains the fact that the Comoros are, at least for now, spared from Covid-19. It is a personal belief that needs to be confirmed scientifically."
But Andjouza Abouheir, a journalist with La Gazette des Comores, found none of the samples taken from six people suspected of being infected were sent for analysis. Reporters Without Borders said journalists in Comoros were threatened with legal action if they published information on the pandemic "without going through the official channels." 
"This case is an example of the increasingly frequent attempts to ban or censor any information that has not come from the government, even when it is reliable and authentic," said Arnaud Froger, the head of RSF's Africa desk.