Will the Higher-Income Country Blueprint for COVID-19 Work in Low- and Lower Middle-Income Countries?

BACKGROUND

The Spanish Flu pandemic of 1918–1919 waxed and waned over 2 years, evolving in the process, eventually reaching every corner of the planet and striking down an estimated 50–100 million people.¹ Disproportionately, it killed young adults. There was no vaccine and no effective treatment. In many cases, the viral illness killed through secondary bacterial pneumonia. At that time, antibiotics to treat these secondary infections did not exist.

A century later, we are dealing with a different virus that attacks in a somewhat different way. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)—the virus that causes coronavirus disease (COVID-19)—infects the lungs directly and also causes death by inducing a state of “cytokine storm,” disturbing coagulation, and attacking other organs. Disproportionately, it kills the very old. The new virus appears to be similarly infectious² and similarly lethal³ to the Spanish Flu. However, these are still early days and there’s much we do not know, including how it may affect different populations in different geographies and what long-term sequelae may result.

Modelers from Imperial College London and elsewhere have warned that, unimpeded, SARS-CoV-2 could kill millions over the next 1–2 years.⁴ Although it is appropriate that we focus very seriously on impeding progress of the pandemic, at the same time, we need to give equally serious attention to ensuring the least terrible collateral outcomes. And that will be tricky.

Policy makers and public health officials around the world are struggling to optimize their response across multiple dimensions of complexity: to maximize benefit and minimize collateral harm. One common …