Science
24 July 2020 Vol 369, Issue 6502
http://www.sciencemag.org/current.dtl

The impact of COVID-19 and strategies for mitigation and suppression in low- and middle-income countries
By Patrick G. T. Walker, Charles Whittaker, Oliver J. Watson, Marc Baguelin, Peter Winskill, Arran Hamlet, Bimandra A. Djafaara, Zulma Cucunubá, Daniela Olivera Mesa, Will Green, Hayley Thompson, Shevanthi Nayagam, Kylie E. C. Ainslie, Sangeeta Bhatia, Samir Bhatt, Adhiratha Boonyasiri, Olivia Boyd, Nicholas F. Brazeau, Lorenzo Cattarino, Gina Cuomo-Dannenburg, Amy Dighe, Christl A. Donnelly, Ilaria Dorigatti, Sabine L. van Elsland, Rich FitzJohn, Han Fu, Katy A. M. Gaythorpe, Lily Geidelberg, Nicholas Grassly, David Haw, Sarah Hayes, Wes Hinsley, Natsuko Imai, David Jorgensen, Edward Knock, Daniel Laydon, Swapnil Mishra, Gemma Nedjati-Gilani, Lucy C. Okell, H. Juliette Unwin, Robert Verity, Michaela Vollmer, Caroline E. Walters, Haowei Wang, Yuanrong Wang, Xiaoyue Xi, David G. Lalloo, Neil M. Ferguson, Azra C. Ghani

Global prospects for COVID-19 control
Lower-income countries have recognized the potential impact of coronavirus disease 2019 (COVID-19) from observing ongoing epidemics. Many have intervened quickly and early with measures to slow viral transmission, which may partly explain the low rates observed so far in these countries. Walker et al. calibrated a global model with country-specific data (see the Perspective by Metcalf et al.). Despite the potentially protective effects of younger demographics, the closer intergenerational contact, limitations on health care facilities, and frequency of comorbidities in lower-income countries require sustained nonpharmaceutical interventions (NPIs) to avoid overwhelming health care capacity. As a result of strict NPIs, the protective effects of immunity will be reduced, and it will be important to improve testing capacity. Ensuring equitable provision of oxygen and—when they are ready—pharmaceutical interventions should be a global priority.
Abstract
The ongoing coronavirus disease 2019 (COVID-19) pandemic poses a severe threat to public health worldwide. We combine data on demography, contact patterns, disease severity, and health care capacity and quality to understand its impact and inform strategies for its control. Younger populations in lower-income countries may reduce overall risk, but limited health system capacity coupled with closer intergenerational contact largely negates this benefit. Mitigation strategies that slow but do not interrupt transmission will still lead to COVID-19 epidemics rapidly overwhelming health systems, with substantial excess deaths in lower-income countries resulting from the poorer health care available. Of countries that have undertaken suppression to date, lower-income countries have acted earlier. However, this will need to be maintained or triggered more frequently in these settings to keep below available health capacity, with associated detrimental consequences for the wider health, well-being, and economies of these countries.