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The Differential Outcomes of Coronavirus Disease 2019 in Low- and Middle-Income Countries vs High-Income Countries

Educational Objective
To understand the differential outcomes of COIVD-19 in low- and middle-income countries vs high-income countries
1 Credit CME

Coronavirus disease 2019 (COVID-19) has affected high-income countries (HICs) first and, to date, foremost: Asia to begin with, then Europe and North America. Industrialized countries have driven the 5.3 million confirmed cases of COVID-19 worldwide and 350 000 global deaths to date.1 Most low- and middle-income countries (LMICs) may seem to have been spared; for example, 80 000 confirmed cases and 2000 deaths in the whole of Africa may spur relative optimism.1 Many LMICs have implemented some version of the lockdowns adopted by HICs, and some have sought to mitigate the economic paralysis by distributing food, cash, tax benefits, and loans. Compared with HICs, lockdowns in many LMICs appear to have been implemented earlier and more forcefully, while the aid seems woefully insufficient.2 This has led to an impression of successful viral control followed by economic catastrophe. Most of the labor force in LMICs (53% in Latin America, 68% in Asia-Pacific, and 86% in Africa) is informal.3 People can go hungry within a day if they cannot work. Governments lack resources for palliation, and even if they create them by printing money or acquiring debt, they lack effective disbursement and control mechanisms. In settings where most adults with low incomes may not own bank or mobile banking accounts, people may be left out and funds diverted.

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Article Information

Corresponding Author: Daniel Vigo, MD, Lic Psych, DrPH, Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T2B8, Canada (daniel.vigo@ubc.ca).

Published Online: June 11, 2020. doi:10.1001/jamapsychiatry.2020.2174

Conflict of Interest Disclosures: Dr Thornicroft is supported by the National Institute for Health Research Applied Research Collaboration South London at King’s College London National Health Service Foundation Trust, the National Institute for Health Research Asset Global Health Unit award, the National Institute of Mental Health of the National Institutes of Health (grant R01MH100470), and the UK Medical Research Council in relation to the Emilia (grant MR/S001255/1) and Indigo Partnership (grant MR/R023697/1) awards.

Disclaimer: The views expressed are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research, or the Department of Health and Social Care.

References
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World Health Organization. Coronavirus disease 2019 (COVID-19) situation report–126. Published May 25, 2020. Accessed June 3, 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200525-covid-19-sitrep-126.pdf?sfvrsn=887dbd66_2
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Hale  T , Webster  S , Petherick  A , Phillips  T , Kira  B . Oxford COVID-19 government response tracker. Published 2020. Accessed May 1, 2020. https://www.bsg.ox.ac.uk/research/research-projects/coronavirus-government-response-tracker
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International Labor Office. Women and men in the informal economy: a statistical picture. Published 2018. https://www.ilo.org/global/publications/books/WCMS_626831/lang--en/index.htm
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