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.
Bibliographical noteFunding 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.
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