LIMA, Peru — Even as Americans swiftly take measures to slow the spread of the novel coronavirus, engaging in social distancing and frequent hand-washing, experts there are predicting a death toll that could run into the thousands.

Yet although it might not feel like it right now, those living in the United States and other developed nations including Europe, the current epicenter of the global crisis, may be among the lucky ones.

At least they can wash their hands.

Roughly 3 billion people, nearly 40% of the global population, almost all in developing nations, lack "basic hand washing facilities," according to a joint study by the World Health Organization (WHO) and the United Nations' children's agency, UNICEF.

Many of them are unlikely to be able to afford hand sanitizer, either, although it is possible that governments and aid agencies may yet distribute this to vulnerable populations.

That fact means that the toll of COVID-19, the disease caused by the coronavirus, both in human suffering and economic output, could be truly catastrophic for some of the world's poorest nations in Africa and Latin America if the virus takes hold there.

To make matters worse, many of these nations' health care systems are already seriously under-resourced and overstretched with existing problems, including, for example, in Latin America, the worst dengue outbreak in history .

In Africa, the average per capita annual spending on health care is less than $300 , a fraction of some Americans' monthly premiums. And just testing for coronavirus, which is a resource-intensive molecular process, is expensive, never mind treating the disease.

"You just need to look at H1N1, the swine flu, a few years ago," says Joseph Vinetz, an infectious diseases professor at Yale University, regarding the risk for developing nations. "It literally went around the world in a matter of months. That is quite possible here. There is 1% mortality (with COVID-19), perhaps, and millions could be affected."

In rural areas in poorer countries, the relative isolation — often exacerbated by inadequate infrastructure such as roads and bridges — offers a significant degree of protection against the coronavirus, according to the experts.

But in many impoverished, densely populated urban areas, the potential for serious outbreaks, even for a population aware of the risks and attempting to protect itself, remains high. For example, here in the Peruvian capital of Lima an estimated 10% of the population, roughly 1 million people, lack running water and sanitation.

"The risk is higher when people don't have access to running water and soap," says Marcos Espinal, head of communicable diseases at the Pan-American Health Organization. "These areas will need to have a very strong response. Governments cannot drop their guard."

On March 15, Peru's President Martin Vizcarra declared a national emergency that runs to the end of the month, but Mariana Leguia, a tropical infectious diseases expert who heads the molecular biology unit at the Pontifical Catholic University of Peru, warns that the country's inequality make overcoming any epidemic extremely difficult. "The real problem here is poverty, and the reality is that we can't solve poverty in two weeks."

As part of that state of national emergency, the Andean nation has closed its borders and ordered all 31 million residents to stay at home except to buy food, get medical treatment or help the elderly. Numerous governments around the world, from poor and rich countries, are adopting similar drastic actions .

By March 22, Peru had 363 confirmed cases , a figure that more than doubled in a week, and had entered the "community transmission" phase of the disease. Leguia says it remains to be seen whether the government's Draconian actions have been taken in time to avert a mass outbreak.

Yet to compound matters, the disastrous economic repercussions of coronavirus will likely further devastate poorer nations. The U.N. has warned that the slowdown will likely cost the world economy at least $1 trillion.

That kind of impact will be huge in developed nations such the United States, and inevitably entail more human suffering, including from the loss of employment. But they at least have the flexibility and resources to mitigate and manage that impact.

For countries such as Peru, which has roughly 10% of the U.S. population and just 1% of its gross domestic product, the impact will be outsized.

Already, the country has shuttered Machu Picchu, the Inca citadel that is arguably Latin America's greatest tourism magnet. The local government is predicting that will result in the loss of between $70 million and $100 million for the local economy, which is almost exclusively reliant on tourism.

One of the small mercies for most of the world's poorest societies is that the coronavirus struck China, Europe and the United States first.

Those living in Africa and Latin America, currently several weeks behind those other regions on the coronavirus curve, can only wait and hope that the extreme measures adopted by their governments, including curfews and national lockdowns, have been taken in time to avert the worst.

