COVID-19 control in low-income settings and displaced populations: what can realistically be done?

While modelling predictions suggest that uncontrolled or even partially mitigated COVID-19 epidemics in high-income countries could lead to substantial excess mortality, the virus’ impact on people living in low-income settings or affected by humanitarian crises could potentially be even more severe. Three mechanisms could determine this -  (i) higher transmissibility, (ii) higher infection-to-case ratios and progression to severe disease, and (iii) higher case-fatality due to a lack of intensive care capacity, especially outside large cities. While these risk factors could be counterbalanced by younger age distributions and hot temperatures, on balance we believe that, this article posits that given current evidence and plausible reasoning, drastic action is required immediately to protect the world’s most fragile populations from this unfolding threat.