HomeMedicineCOVID-19 in low- and middle-income countries - an impending disaster

COVID-19 in low- and middle-income countries – an impending disaster

While high-income countries have been hit hard by COVID-19, an economic and health disaster may be just around the corner due to COVID-19 in low-and middle-income countries.

At the beginning of the COVID-19 pandemic, the countries that were hit the hardest were the high-income industrialized countries.  This was mostly due to a great deal of cross-border travel of business people and tourists between these countries.  A person who is infected with COVID-19 (SARS-CoV-2) can be symptom-free for several days before he/she begins to feel the effects of the virus.  Unfortunately, during this time they spread the virus to other people while going about their daily lives.  Many of the early signs of COVID-19 resemble those of the common cold and a regular flu, so most people who were infected in the first months of the COVID-19 pandemic went about their business without ever suspecting they were infected with a much more serious disease.

While news of COVID-19 infections was first broadcast in late 2019, it was not until February and March of 2020 that many countries began testing their populations and implementing serious measures to control the spread of the disease.  The most effective methods of controlling COVID-19 were found to be social distancing, shutting down all non-essential businesses and services, and closing down borders.  This, along with encouraging non-essential workers to stay at home, rigorous testing, hand washing and wearing masks has allowed most high-income countries to greatly reduce the spread of the virus and limit the deaths associated with COVID-19 infections.

However, a country’s economy is based on open businesses and a healthy amount of trade and sales.  By forcing people to stay home and closing down the majority of businesses, the economy of a country grinds to a halt.  Employees are laid off or fired.  The unemployment rate skyrockets.  Businesses fail due to lack of income.  Many people who have limited to no financial security are placed in a situation where they must choose between feeding themselves and their family or paying bills and rent.

Many of the high-income countries have been able to mitigate these serious effects by artificially pumping a great deal of money into the economy.  For example, Canada has spent a great deal of money on loans and relief packages for businesses to help them survive until the economy reopens.  Employment insurance has allowed those who were laid off or fired to survive until they can go back to work or find a new job.

In order to implement such massive financial relief, a country has to have a good financial standing and the governmental structures in place to implement such a large undertaking.  Most high-income countries have such structures in place and enough financial stability to survive such a drastic blow to their economy.  Unfortunately, the same cannot be said for middle- and low-income countries.

Daniel Vigo, Graham Thornicroft and Oye Gureje, three scientists who specialize in medicine and/or psychiatry, have written an article in the Journal of the American Medical Association: Psychiatry discussing how there is an impending COVID-19 disaster for low- and middle-income countries.  They looked at not only the governmental structures and COVID-19 mitigation strategies used by these middle- and low-income countries, but how their lack of resources will impact the health and mental well-being of citizens in these countries.

Middle- and low-income countries seem to have avoided the large number of infections that hit high-income countries — partly because the infections in the high-income countries happened earlier and allowed many middle- and low-income countries to shut down their borders and ask their citizens to self-isolate and social distance before a large number of their populations were affected.  In many cases, the governments of these countries took what resources they could and used them to try and limit the economic damage caused by the economic shut-downs.

However, middle- and low-income countries do not have the financial stability nor the governmental structures in place to efficiently help the businesses and citizens to hunker down and wait for the infection rates to reduce enough to safely restart the economy.  Already, their economic resources are close to depleted.  There is not enough money to supply employment insurance to those in need.  Workers in these countries live day-to-day.  One day of missed work means that a family goes hungry.  This unstable workforce makes up 53% of Latin American workers, 68% of Asian-Pacific workers, and 86% of African workers.  People are left to make the frightening and heart-breaking choice to risk their lives and the lives and health of their entire family just so they can eat and pay their rent.

The inability to properly shut down a country, along with the desperation felt by those who live day-by-day has allowed COVID-19 to continue infecting larger and larger segments of populations, leading to an impending COVID-19 disaster for low- and middle-income countries.  Such countries are stretched to their limits and must make a decision to re-open their economy and trade earlier than would be considered safe by medical professionals.  This, combined with problems in housing and hygiene for a large segment of their population, leads to an explosion of cases such as has recently been seen in Brazil, India, and Iran.

A stressed medical system with limited resources leads to a higher mortality rate in middle- and low-income countries.  This exacerbates the toll on the population’s well-being.  Stress is magnified as daily needs are not met and families deal with illness and loss.  What little money had been available for medical and psychological help is diverted in order to stop the country’s economy from crashing completely.  Such effects are not seen in high-income countries.  Even though there is an increase in need for psychological help, the high-income countries’ structures can cope with the added stress.

In order to prevent an impending disaster due to COVID-19 in low- and middle-income countries, and to allow them to navigate through these difficult times, the authors of the article strongly recommend that high-income countries pool their resources and set up a relief fund to help the middle- and low-income countries.  This, along with programs like debt forgiveness and donations of medical and protective equipment, will go a long way to helping the struggling countries stay afloat and limit the economical, medical and psychological damages caused by COVID-19 infections.

Written by Nancy Lemieux


1. EurekAlert!. 2020. Outcomes Of COVID-19 In Countries With Different Income Levels. [online] Available at: <https://www.eurekalert.org/pub_releases/2020-06/jn-ooc060920.php> [Accessed 18 June 2020].

2. Vigo, D., et al. 2020. The Differential Outcomes Of Coronavirus Disease 2019 In Low- And Middle-Income Countries Vs High-Income Countries. [online] JAMA Psychiatry.

Image by Miroslava Chrienova from Pixabay 


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