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-DannenburgAmy 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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

188 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)413-422
Number of pages10
Issue number6502
Publication statusPublished - 24 Jul 2020
Externally publishedYes

Bibliographical note

Funding Information:
C.W. is supported by a UK Medical Research Council Doctoral Training Programme studentship. P.W. is supported by an Imperial College Junior Research Fellowship. This work was supported by a grant from the Wellcome Trust and Centre funding from the UK Medical Research Council Centre for Global Infectious Disease Analytics, both under a concordat with the UK Department for International Development. We additionally acknowledge support from Community Jameel and the NIHR Health Protection Research Unit in Modelling Methodology.

Publisher Copyright:
© 2020 American Association for the Advancement of Science. All rights reserved.


Dive into the research topics of 'The impact of COVID-19 and strategies for mitigation and suppression in low- And middle-income countries'. Together they form a unique fingerprint.

Cite this