Reflections on the Covid-19 pandemic in Low and Middle Income Countries (LMIC)

Abstract

The Covid-19 pandemic has rapidly expanded from China to the other continents, following global economic activity and international travels. In LMIC, the rapid political decision process necessary for either its mitigation or suppression is conditioned by the huge economic impact that will lead millions to extreme poverty. The incidence in these countries is variable and depends on the state of the economy and the control measures adopted once the first cases showed up but also on a combination of social factors such as population density, family overcrowding and the productive system. In the absence of a vaccine, control of the pandemic can only be achieved where a strong epidemiological surveillance is present, for which the possibilities are very limited in LMIC. The strategic priorities in these countries are thus based on capacity building of laboratories, surveillance, prevention and control in hospitals, case management, communication and logistics. Covid-19 infection is characterized by endotheliitis and an inflammatory reaction with a multi-organ symptomatology. It is unknown how it manifests clinically in LMIC where endemic diseases with similar physio-pathological mechanisms are highly prevalent. Beyond the limited medical capacities in many LMIC with its consequences in terms of morbi-mortality, the response capacity depends on the setup of non-pharmaceutical measures at the individual and social level to avoid the spread of the virus. These measures, apart from economic implications, have societal consequences for mental health and coexistence, and also structural ones since the pandemic has caused a collapse of the already weak health systems at the primary and hospital levels. Moreover, the fact that the majority of attention and resources have been diverted to Covid-19, with direct damage to the rest of communicable and non-communicable programs, will lead to an increase of other diseases, poverty and mortality. Finally, assuming that the advances will come from the North, a fluid dialogue with the South is required in the decision making process regarding the distribution of medicines or vaccines that will be used in the near future, and when and how these will be tested, and this without preventing the LMIC capacities to carry out their own research. The coordination with WHO and a number of ad-hoc platforms is of paramount importance to empower the South to decide about its future. Only solidarity and concerted efforts by the public and private sectors can avert an even bigger disaster.