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Science (New York, N.Y.)
07 24, 2020;369 (6502): 413-422.

The impact of COVID-19 and strategies for mitigation and suppression in low- and middle-income countries.

Patrick G T Walker, Charles Whittaker, Oliver J Watson, Marc Baguelin, Peter Winskill, Arran Hamlet, Bimandra A Djafaara, Zulma Cucunubá, Daniela Olivera Mesa, Will Green, Hayley Thompson, Shevanthi Nayagam, Kylie E C Ainslie, Sangeeta Bhatia, Samir Bhatt, Adhiratha Boonyasiri, Olivia Boyd, Nicholas F Brazeau, Lorenzo Cattarino, Gina Cuomo-Dannenburg, Amy Dighe, Christl A Donnelly, Ilaria Dorigatti, Sabine L van Elsland, Rich FitzJohn, Han Fu, Katy A M Gaythorpe, Lily Geidelberg, Nicholas Grassly, David Haw, Sarah Hayes, Wes Hinsley, Natsuko Imai, David Jorgensen, Edward Knock, Daniel Laydon, Swapnil Mishra, Gemma Nedjati-Gilani, Lucy C Okell, H Juliette Unwin, Robert Verity, Michaela Vollmer, Caroline E Walters, Haowei Wang, Yuanrong Wang, Xiaoyue Xi, David G Lalloo, Neil M Ferguson, Azra C Ghani
Author Information
  1. Patrick G T Walker: 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. ORCID
  2. Charles Whittaker: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  3. Oliver J Watson: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  4. Marc Baguelin: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  5. Peter Winskill: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  6. Arran Hamlet: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  7. Bimandra A Djafaara: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  8. Zulma Cucunubá: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
  9. Daniela Olivera Mesa: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  10. Will Green: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  11. Hayley Thompson: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  12. Shevanthi Nayagam: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  13. Kylie E C Ainslie: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  14. Sangeeta Bhatia: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
  15. Samir Bhatt: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  16. Adhiratha Boonyasiri: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  17. Olivia Boyd: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  18. Nicholas F Brazeau: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  19. Lorenzo Cattarino: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  20. Gina Cuomo-Dannenburg: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  21. Amy Dighe: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  22. Christl A Donnelly: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  23. Ilaria Dorigatti: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  24. Sabine L van Elsland: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
  25. Rich FitzJohn: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  26. Han Fu: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  27. Katy A M Gaythorpe: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  28. Lily Geidelberg: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  29. Nicholas Grassly: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  30. David Haw: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  31. Sarah Hayes: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  32. Wes Hinsley: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  33. Natsuko Imai: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  34. David Jorgensen: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  35. Edward Knock: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  36. Daniel Laydon: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  37. Swapnil Mishra: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
  38. Gemma Nedjati-Gilani: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  39. Lucy C Okell: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  40. H Juliette Unwin: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  41. Robert Verity: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  42. Michaela Vollmer: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  43. Caroline E Walters: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. ORCID
  44. Haowei Wang: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
  45. Yuanrong Wang: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
  46. Xiaoyue Xi: MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
  47. David G Lalloo: Liverpool School of Tropical Medicine, Liverpool, UK. ORCID
  48. Neil M Ferguson: 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. ORCID
  49. Azra C Ghani: 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. ORCID
PMID: 32532802 DOI: 10.1126/science.abc0035

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.

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Grants

  1. MC_PC_19012/Medical Research Council
  2. MR/V038109/1/Medical Research Council
  3. /Wellcome Trust
  4. MR/R024855/1/Medical Research Council
  5. MR/R015600/1/Medical Research Council

MeSH Term

COVID-19
Coronavirus Infections
Developing Countries
Global Health
Humans
Pandemics
Patient Acceptance of Health Care
Pneumonia, Viral
Poverty
Public Health
Journal Article Research Support, Non-U.S. Gov't
Article has an altmetric score of 1060

Word Cloud

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