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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 publication

DOI

10.1126/science.abc0035

Type

Journal article

Journal

Science (New York, N.Y.)

Publication Date

07/2020

Volume

369

Pages

413 - 422

Addresses

MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK. patrick.walker@imperial.ac.uk a.ghani@imperial.ac.uk neil.ferguson@imperial.ac.uk.

Keywords

Humans, Pneumonia, Viral, Coronavirus Infections, Public Health, Developing Countries, Poverty, Patient Acceptance of Health Care, Pandemics, Global Health, COVID-19