TY - JOUR
T1 - COVID-19 control in low-income settings and displaced populations
T2 - What can realistically be done?
AU - Dahab, Maysoon
AU - Van Zandvoort, Kevin
AU - Flasche, Stefan
AU - Warsame, Abdihamid
AU - Ratnayake, Ruwan
AU - Favas, Caroline
AU - Spiegel, Paul B.
AU - Waldman, Ronald J.
AU - Checchi, Francesco
N1 - Funding Information:
FC is supported by UK Research and Innovation as part of the Global Challenges Research Fund, grant number ES/P010873/1. SF is supported by a Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society (Grant number 208812/Z/17/Z). KvZ was supported by Elrha’s Research for Health in Humanitarian Crises (R2HC) Programme, which aims to improve health outcomes by strengthening the evidence base for public health interventions in humanitarian crises. The R2HC programme is funded by the UK Government (DFID), the Wellcome Trust, and the UK National Institute for Health Research (NIHR). RR is supported by Canadian Institutes of Health Research (Award no. DFS-164266). We would like to thank members of various international organizations who provided informal feedback on this viewpoint since its pre-print. We would also like to thank colleagues in the humanitarian field who have since developed guidelines to operationalize the shielding approach as outlined in that pre-print.
Publisher Copyright:
© 2020 The Author(s).
PY - 2020/7/31
Y1 - 2020/7/31
N2 - COVID-19 prevention strategies in resource limited settings, modelled on the earlier response in high income countries, have thus far focused on draconian containment strategies, which impose movement restrictions on a wide scale. These restrictions are unlikely to prevent cases from surging well beyond existing hospitalisation capacity; not withstanding their likely severe social and economic costs in the long term. We suggest that in low-income countries, time limited movement restrictions should be considered primarily as an opportunity to develop sustainable and resource appropriate mitigation strategies. These mitigation strategies, if focused on reducing COVID-19 transmission through a triad of prevention activities, have the potential to mitigate bed demand and mortality by a considerable extent. This triade is based on a combination of high-uptake of community led shielding of high-risk individuals, self-isolation of mild to moderately symptomatic cases, and moderate physical distancing in the community. We outline a set of principles for communities to consider how to support the protection of the most vulnerable, by shielding them from infection within and outside their homes. We further suggest three potential shielding options, with their likely applicability to different settings, for communities to consider and that would enable them to provide access to transmission-shielded arrangements for the highest risk community members. Importantly, any shielding strategy would need to be predicated on sound, locally informed behavioural science and monitored for effectiveness and evaluating its potential under realistic modelling assumptions. Perhaps, most importantly, it is essential that these strategies not be perceived as oppressive measures and be community led in their design and implementation. This is in order that they can be sustained for an extended period of time, until COVID-19 can be controlled or vaccine and treatment options become available.
AB - COVID-19 prevention strategies in resource limited settings, modelled on the earlier response in high income countries, have thus far focused on draconian containment strategies, which impose movement restrictions on a wide scale. These restrictions are unlikely to prevent cases from surging well beyond existing hospitalisation capacity; not withstanding their likely severe social and economic costs in the long term. We suggest that in low-income countries, time limited movement restrictions should be considered primarily as an opportunity to develop sustainable and resource appropriate mitigation strategies. These mitigation strategies, if focused on reducing COVID-19 transmission through a triad of prevention activities, have the potential to mitigate bed demand and mortality by a considerable extent. This triade is based on a combination of high-uptake of community led shielding of high-risk individuals, self-isolation of mild to moderately symptomatic cases, and moderate physical distancing in the community. We outline a set of principles for communities to consider how to support the protection of the most vulnerable, by shielding them from infection within and outside their homes. We further suggest three potential shielding options, with their likely applicability to different settings, for communities to consider and that would enable them to provide access to transmission-shielded arrangements for the highest risk community members. Importantly, any shielding strategy would need to be predicated on sound, locally informed behavioural science and monitored for effectiveness and evaluating its potential under realistic modelling assumptions. Perhaps, most importantly, it is essential that these strategies not be perceived as oppressive measures and be community led in their design and implementation. This is in order that they can be sustained for an extended period of time, until COVID-19 can be controlled or vaccine and treatment options become available.
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U2 - 10.1186/s13031-020-00296-8
DO - 10.1186/s13031-020-00296-8
M3 - Review article
C2 - 32754225
AN - SCOPUS:85091789206
SN - 1752-1505
VL - 14
JO - Conflict and Health
JF - Conflict and Health
IS - 1
M1 - 54
ER -