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March 16, 2020

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

Author Affiliations
  • 1Radboudumc Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
  • 2Médecins Sans Frontières, Amsterdam, the Netherlands
  • 3Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
  • 4Institute of Global Health, University of Geneva, Geneva, Switzerland
  • 5Infection Control Africa Network, Cape Town, South Africa
JAMA. 2020;323(16):1549-1550. doi:10.1001/jama.2020.4169

The public health response to coronavirus disease 2019 (COVID-19) in China has illustrated that it is possible to contain COVID-19 if governments focus on tried and tested public health outbreak responses.1,2 Isolation, quarantine, social distancing, and community containment measures were rapidly implemented. In China, patients with COVID-19 were immediately isolated in designated existing hospitals, and new hospitals were rapidly built to manage the increasing numbers of cases in the most affected areas. Home quarantine for contacts was initiated and large gatherings were canceled. Additionally, community containment for approximately 40 million to 60 million residents was instituted. A significant positive association between the incidence of COVID-19 cases and mortality was apparent in the Chinese response.3 That is, the rapid escalation in the number of infections in China had resulted in insufficient health care resources, followed by an increase in mortality.

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    1 Comment for this article
    Financial Markets and Government Action Against COVID-19 in LMICs
    Michael McAleer, PhD (Econometrics), Queen's | Asia University, Taiwan
    The informative paper about China’s public health response to COVID-19 illustrates that it is possible to contain the disease with swift, decisive and strategic national government action, including testing, isolation, quarantine, social distancing, community containment measures, and expanding hospital facilities in a timely manner.

    This insightful discussion of the preparedness of low- and middle-income countries (LMICs), especially in Africa, presented helpful lessons that every country should heed, including:

    Critical care; risk management; minimum requirements for infection prevention and control at the national level; supply chains; depletion and shortage of medical stock; management of drugs; climatic and seasonal
    effects on transmission, especially from Europe; innate immunity; preexposure to other coronaviruses; displaced refugees in camps and conflict zones; known comorbidities; negative media effects; social media stigmatizing; culturally appropriate health messaging; and establishing confidence in governments.

    Factors that would also be worth considering include:

    Relaxing regulatory requirements to aid speedy and efficient manufacturing; transportation, distribution and storage of medical equipment; messaging about hygiene, including frequently cleaning hands with soap and clean water after contact with people and public surfaces; and the performance of governments at the national, state, regional and local levels, in dealing with the pandemic.

    In countries with well-regulated and developed financial markets, the performance of financial stocks is a healthy barometer of the performance of national governments in dealing with COVID-19.