Managing COVID-19 in Low- and Middle-Income Countries

Hopman J, Allegranzi B, Mehtar S. Managing COVID-19 in Low- and Middle-Income Countries [published online ahead of print, 2020 Mar 16]. JAMA. 2020;10.1001/jama.2020.4169.

Review written by:

Apoorva Srinivasan, edited by Elizabeth Harty

Yellow - This paper is classified as a viewpoint

This paper comments on how various aspects of healthcare and life within low- and middle-income countries, especially those within Africa, may affect the spread of SARS-CoV-2 infections.

Critical care: China, an upper, middle-income country, was able to rapidly convert many of its general beds to ICUs and transfer physicians and nurses trained in critical care medicine to the most affected areas in the 2019 - 2020 COVID-19 outbreak. Many LMICs do not have the same level of personnel trained in critical care as China and also lack sufficient health budgets to exercise the same type of response to an outbreak of this nature.

Minimum requirements for prevention and control: Most health facilities in LMICs do not meet the WHO IPC minimum requirements to provide minimum protection and safety to patients, health care workers, and visitors. Furthermore, panic buying and irrational use of personal protective equipment (PPE) has led to inadequate supplies of N95 respirators, and these shortages will have potentially devastating consequences for these countries.

Influence of Climate and Seasons:  The authors hypothesize that the spread of COVID-19 in Africa will diverge from patterns observed in the current outbreak, predominantly affecting the Northern hemisphere due to the fact that: respiratory viruses tend to spread more effectively in the winter and there are differences in cultural practices, UV light exposure, innate immunity, preexposure with coronaviruses, and higher temperatures. 

Refugees and Conflict Zones: According to UNHCR, the vast majority of internally displaced people and refugees are located in LMICs with weak health care system infrastructure. The authors recommend consideration of the model utilized by Médecins Sans Frontières with Syrian refugees in Lebanon to attend to comorbidities that are poorly controlled  in these settings and are risk factors for worse outcomes related to COVID-19. Additionally, triage and the implementation of minimum WHO IPC requirements should be initiated as part of COVID-19 preparedness in the existing health care facilities of these areas.

Media Partnerships:  There was negative stigma for patients and suspicion during past Ebola outbreaks, so there is a crucial need to learn from past mistakes as it can negatively affect and worsen the course of the outbreak. The authors discuss how social media can support public health responses, both in preparedness and controlling the outbreak, by teaming up with their respective governments in providing consistent, simple, and clear messages.

Review Notes

This paper is a viewpoint only.

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