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Long-term strategies to control COVID-19 in low and middle-income countries: an options overview of community-based, non-pharmacological interventions.

Published version
Peer-reviewed

Type

Article

Change log

Authors

Luhar, Shammi 
Khan, Nusrat 
Choudhury, Sohel Reza 
Matin, Imran 

Abstract

In low and middle-income countries (LMICs), strict social distancing measures (e.g., nationwide lockdown) in response to the COVID-19 pandemic are unsustainable in the long-term due to knock-on socioeconomic and psychological effects. However, an optimal epidemiology-focused strategy for 'safe-reopening' (i.e., balancing between the economic and health consequences) remain unclear, particularly given the suboptimal disease surveillance and diagnostic infrastructure in these settings. As the lockdown is now being relaxed in many LMICs, in this paper, we have (1) conducted an epidemiology-based "options appraisal" of various available non-pharmacological intervention options that can be employed to safely lift the lockdowns (namely, sustained mitigation, zonal lockdown and rolling lockdown strategies), and (2) propose suitable application, pre-requisites, and inherent limitations for each measure. Among these, a sustained mitigation-only approach (adopted in many high-income countries) may not be feasible in most LMIC settings given the absence of nationwide population surveillance, generalised testing, contact tracing and critical care infrastructure needed to tackle the likely resurgence of infections. By contrast, zonal or local lockdowns may be suitable for some countries where systematic identification of new outbreak clusters in real-time would be feasible. This requires a generalised testing and surveillance structure, and a well-thought out (and executed) zone management plan. Finally, an intermittent, rolling lockdown strategy has recently been suggested by the World Health Organization as a potential strategy to get the epidemic under control in some LMI settings, where generalised mitigation and zonal containment is unfeasible. This strategy, however, needs to be carefully considered for economic costs and necessary supply chain reforms. In conclusion, while we propose three community-based, non-pharmacological options for LMICs, a suitable measure should be context-specific and based on: (1) epidemiological considerations, (2) social and economic costs, (3) existing health systems capabilities and (4) future-proof plans to implement and sustain the strategy.

Description

Keywords

COVID-19, Exit plan, Local lockdown, Low and middle-income countries, Mitigation, Non-pharmacological interventions, Rolling lockdown, Zonal lockdown, Betacoronavirus, COVID-19, Communicable Disease Control, Coronavirus, Coronavirus Infections, Humans, Masks, Pandemics, Pneumonia, Viral, Public Health, Quarantine, SARS-CoV-2, Social Isolation

Journal Title

Eur J Epidemiol

Conference Name

Journal ISSN

0393-2990
1573-7284

Volume Title

35

Publisher

Springer Science and Business Media LLC
Sponsorship
British Heart Foundation (None)
British Heart Foundation (CH/12/2/29428)
Medical Research Council (MR/P02811X/1)