COVID-19 response and lockdowns: Strategies for low- and middle-income countries

Featured illustration of the novel coronavirus
An illustration showing the novel coronavirus (COVID-19)

A new paper published in the journal Globalization and Health provides a commentary proposing strategies that low- and middle-income countries could adopt for a safe and responsible COVID-19 response, especially as it pertains to the use of lockdown.

Oghenowede Eyawo
Oghenowede Eyawo
A.M. Viens

The paper is co-authored by Oghenowede Eyawo, a York University assistant professor in the Faculty of Health’s School of Global Health/Kinesiology and Health Science; A.M. Viens, a York University associate professor in the Faculty of Health’s School of Global Health/Health Policy and Management; and Uchechukwu Chidiebere Ugoji, from the Salem Clinic and Maternity, Salem City, Warri, Delta State, Nigeria.

In the paper, the authors note that lockdowns can be an effective pandemic response strategy to “buy time” to slow disease transmission and increase responses with respect to prevention, diagnoses and treatment. However, imposing broad and coercive restrictive measures come at a cost and impose social and economic burdens on both individuals and societies, in particular for low- and middle-income countries (LMICs).

During the first wave of the COVID-19 pandemic, many LMICs adopted broad lockdown strategies – as did high-income countries (HICs). However, during subsequent waves LMICs are left more vulnerable; while HICs have returned to lockdown strategies until they can receive the vaccine, many LMICs will be waiting much longer to get comparable access to the vaccine.

This, say the authors, leaves LMICs vulnerable to subsequent waves for a longer period of time and increases the potential for longer lockdown periods.

With an inability to sustain long-term lockdowns, given their severe economic, social, and health impacts, countries continue to struggle with formulating adequate strategies for deciding when and how to enter and exit lockdowns in a safe and responsible way, states the paper.

In response to the need for more policy development around contextual challenges involved in imposing such measures, the authors proposed strategies LMICs could adopt to balance safety while avoiding and/alleviating coercive restrictive lockdown measures.

“While the proposed strategies will be critical for LMICs who may have to deal with the COVID-19 crisis for much longer than HICs – who will receive vaccines earlier – we believe some of our recommendations are arguably equally applicable to HICs, including Canada,” says Eyawo.

The key challenge for policymakers is achieving a lockdown strategy that is feasible, effective and ethical, and the acknowledgement that pandemic response strategies are not a one-size-fits-all approach.

A summary of the authors’ proposals include:

Follow the science

There is evidence that politicians who used science to guide strategy were less likely to have infection, death, and economic destabilization. Breaking the chain of infection is crucial in curbing the spread of COVID-19 and should be considered first in response measures including advice on testing, quarantine, contact tracing, physical distancing, hand hygiene, use of masks, and how to open up schools and businesses safely.

Adopt strategies of adherence rather than compliance

Rather than a compliance approach to lockdown measures, which seek to produce passive behaviours through prohibition and punishments, LMICs should move toward an adherence approach that continues to reduce people coming into close contact, but instead focuses on encouraging enabling and supportive behaviour. Examples of this include health education and government-led infrastructure development projects to improve access to clean water.

Community engagement and trust building

Increased engagement with communities can create an opportunity to address issues of misinformation that is fuelling stigma and discrimination against people infected with COVID-19, including impeding testing and care-seeking behaviour.

LMICs should take a targeted approach to testing

LMICs should focus on free, point-of-care targeted testing – demand-driven by jurisdictional epidemiological reports/statistics – among symptomatic individuals.

Recruit and train more healthcare and support workers in the short term

LMICs should focus on practical, short-term solutions, including: (i) fast-track medical/nursing students to start now in the field and then return to finish up their degrees later; (ii) organize short infection control courses for other allied health professionals to provide support on small non-technical tasks; and (iii) task-shift and train local community members who can be gainfully engaged to carry out contact tracing activities with some oversight.

“The COVID-19 crisis has highlighted the importance of the political determinants of health. Political decisions should target a combination of science-based and context-informed strategies for a safe and responsible lockdown entrance, exit, or to prevent the need for a restrictive lockdown measure altogether,” says Viens.

The study “Lockdowns and low- and middle-income countries: building a feasible, effective, and ethical COVID-19 response strategy” was published Jan. 20.