As COVID-19 Spreads Rapidly, Low- and Middle-Income Countries Face Intense Challenge

Last week China marked a milestone: its first day without a new domestic case of SARS-CoV-2.

The moment marked a potential turning point in the country where the virus first became a public health crisis. It also offers further evidence that a robust and successful response to the virus is possible even in low- and middle-income countries.

In a new article published this week in the Journal of the American Medical Association, corresponding author Joost Hopman, MD, PhD, DTMH, of Radboud University, in the Netherlands, and of Doctors without Borders, discusses strategies low- and middle-income countries (LMICs) can take as the virus continues to spread around the world.

Hopman and colleagues note that while China now appears to have made great strides against the virus, the early spike in cases led to pressure on resources and ultimately an increase in mortality. It can therefore be concluded that insufficient health care resources ultimately will lead to a higher number of deaths during the pandemic.

In Africa, a task force (dubbed AFTCOR) has already been set up to help the continent’s countries prepare for things like testing, surveillance, and supply chain demands.

“Should COVID-19 spread rapidly in Africa, most countries will not be able to afford large-scale diagnostics, although AFTCOR could increase this capacity to more than 40 African countries (the continent has a total of 54 countries),” Hopman and colleagues write. “Therefore, in the absence of testing, triage based on clinical case definition or presumptive diagnosis should be prioritized.”

In China, the number of patients needing ventilator support exceeded the capacity of intensive care unit rooms (ICU), therefore requiring the conversion of some general rooms to ICU rooms. In Africa, many countries might not be able to fund such conversions, and thus the authors write that mortality rates might very well be higher in Africa.

Still, LMICs ought to be able to institute basic infection prevention and control measures (IPCs) as outlined by the World Health Organization (WHO). To do so, they’ll need to ensure sufficient supplies of personal protective equipment (PPE).

“To prevent shortages of essential PPE for the COVID-19 response, governments should give clear guidance on the use of PPE and act now to secure adequate supplies and stocks in case the outbreak spreads to these countries,” Hopman and colleagues write.

LMICs must also be mindful of displaced persons and those living in refugee camps. Hopman and colleagues note that, according to the United Nations High Commissioner for Refugees (UNHCR), there are more than 41 million internally displaced and 25 million displaced refugees around the world. Many of these people are located in LMICs. Though challenging, it is possible to reduce the risk of COVID-19 transmission in these sites, the authors argue.

“Furthermore, triage and the implementation of minimum WHO IPC requirements should be initiated as part of COVID-19 preparedness in the existing healthcare facilities,” they say.

As in other parts of the world, Hopman and colleagues say the media will play an important role in the COVID-19 response, though that role could be either positive or negative. Misinformation and confusion spread easily on social media, and they must therefore be combated with simple health messaging and regular briefings.

Though the challenge may be steep, Hopman and colleagues say China ultimately offers a proof of concept that containment of the novel coronavirus can be achieved.

“China has illustrated that the COVID-19 pandemic can be limited when public health outbreak response strategies and tactics are implemented early,” they conclude.