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The impact of COVID-19 and strategies for mitigation and suppression in low- and middle-income countries.
Science. 2020 07 24; 369(6502):413-422.Sci

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.

Authors+Show Affiliations

MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. patrick.walker@imperial.ac.uk a.ghani@imperial.ac.uk neil.ferguson@imperial.ac.uk.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. Pathology and Laboratory Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. Department of Statistics, University of Oxford, Oxford, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.Liverpool School of Tropical Medicine, Liverpool, UK.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. patrick.walker@imperial.ac.uk a.ghani@imperial.ac.uk neil.ferguson@imperial.ac.uk.MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. patrick.walker@imperial.ac.uk a.ghani@imperial.ac.uk neil.ferguson@imperial.ac.uk.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32532802

Citation

Walker, Patrick G T., et al. "The Impact of COVID-19 and Strategies for Mitigation and Suppression in Low- and Middle-income Countries." Science (New York, N.Y.), vol. 369, no. 6502, 2020, pp. 413-422.
Walker PGT, Whittaker C, Watson OJ, et al. The impact of COVID-19 and strategies for mitigation and suppression in low- and middle-income countries. Science. 2020;369(6502):413-422.
Walker, P. G. T., Whittaker, C., Watson, O. J., Baguelin, M., Winskill, P., Hamlet, A., Djafaara, B. A., Cucunubá, Z., Olivera Mesa, D., Green, W., Thompson, H., Nayagam, S., Ainslie, K. E. C., Bhatia, S., Bhatt, S., Boonyasiri, A., Boyd, O., Brazeau, N. F., Cattarino, L., ... Ghani, A. C. (2020). The impact of COVID-19 and strategies for mitigation and suppression in low- and middle-income countries. Science (New York, N.Y.), 369(6502), 413-422. https://doi.org/10.1126/science.abc0035
Walker PGT, et al. The Impact of COVID-19 and Strategies for Mitigation and Suppression in Low- and Middle-income Countries. Science. 2020 07 24;369(6502):413-422. PubMed PMID: 32532802.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The impact of COVID-19 and strategies for mitigation and suppression in low- and middle-income countries. AU - Walker,Patrick G T, AU - Whittaker,Charles, AU - Watson,Oliver J, AU - Baguelin,Marc, AU - Winskill,Peter, AU - Hamlet,Arran, AU - Djafaara,Bimandra A, AU - Cucunubá,Zulma, AU - Olivera Mesa,Daniela, AU - Green,Will, AU - Thompson,Hayley, AU - Nayagam,Shevanthi, AU - Ainslie,Kylie E C, AU - Bhatia,Sangeeta, AU - Bhatt,Samir, AU - Boonyasiri,Adhiratha, AU - Boyd,Olivia, AU - Brazeau,Nicholas F, AU - Cattarino,Lorenzo, AU - Cuomo-Dannenburg,Gina, AU - Dighe,Amy, AU - Donnelly,Christl A, AU - Dorigatti,Ilaria, AU - van Elsland,Sabine L, AU - FitzJohn,Rich, AU - Fu,Han, AU - Gaythorpe,Katy A M, AU - Geidelberg,Lily, AU - Grassly,Nicholas, AU - Haw,David, AU - Hayes,Sarah, AU - Hinsley,Wes, AU - Imai,Natsuko, AU - Jorgensen,David, AU - Knock,Edward, AU - Laydon,Daniel, AU - Mishra,Swapnil, AU - Nedjati-Gilani,Gemma, AU - Okell,Lucy C, AU - Unwin,H Juliette, AU - Verity,Robert, AU - Vollmer,Michaela, AU - Walters,Caroline E, AU - Wang,Haowei, AU - Wang,Yuanrong, AU - Xi,Xiaoyue, AU - Lalloo,David G, AU - Ferguson,Neil M, AU - Ghani,Azra C, Y1 - 2020/06/12/ PY - 2020/04/01/received PY - 2020/06/09/accepted PY - 2020/6/14/pubmed PY - 2020/8/1/medline PY - 2020/6/14/entrez SP - 413 EP - 422 JF - Science (New York, N.Y.) JO - Science VL - 369 IS - 6502 N2 - 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. SN - 1095-9203 UR - https://www.unboundmedicine.com/medline/citation/32532802/full_citation L2 - http://www.sciencemag.org/cgi/pmidlookup?view=long&pmid=32532802 DB - PRIME DP - Unbound Medicine ER -