Emerging COVID-19 implications for humanitarian operations in developing countries

Imperial College recently produced analysis on the potential global impact of Covid-19. The analysis includes predictions on how health measures could restrict Covid-19 contagion, serious illness and mortality rates across the world. Within this analysis some interesting findings emerged on the impact of Covid-19 on developing countries and how these countries are likely to have a very different experience of Covid-19. Current health measures on Covid-19 are largely focused on the following logic:

Medical consensus is that best way to achieve this goal of reducing the number of deaths is a combination of social restrictions (lockdown) and isolation of those reasonably expected to be most vulnerable to serious Covid-19 illness. In most research and modelling, predictions suggest that these measures could reduce the number of deaths in High Income Countries from c9 deaths per 1000 population to c3 deaths per 1000 population. Put another way, for Europe and Central Asia that’s the difference between roughly 7 million deaths and somewhere in the region of 280,000  (the latter figure depending on when restrictions come into force). But modelling suggests that this huge reduction in the number of potential deaths does not occur when  the same restrictions are applied in Low Income Countries.  In these countries even with lockdown and isolation measures, the overall number of deaths is predicted to reduce from c2.1 deaths per 1000 of population to c1.8 per 1000 population. Or, again to put it another way, comparatively far fewer deaths will be prevented by lockdown and isolation measures in developing countries compared to other higher income countries. That doesn’t mean these measures may prevent some deaths rather that they are of much more limited effect.

Why? Let’s go back to two reasons for lockdown and isolation: 1. Reduction of contagion through lockdown will allow healthcare systems to cope with volumes of critical patients and increase recovery rates. In all income grouped countries, demand for critical care is anticipated to exceed capacity. In some High Income Countries this could be by a factor of 7, for Low Income Countries this could be as much as by a factor of 25. Healthcare systems in Low Income Countries are in such a condition that lockdown will have minimal impact on preserving capacity to help patients recover. So many more patients with serious Covid-19 illness will die. 2. Isolating over 65+ will reduce overall mortality rates. It’s become a trope that many developing countries have low life expectancy rates so there are fewer vulnerable people over the age of 65+ and therefore, proportionality fewer people will die from Covid_19. However, elderly populations in developing countries are typically part of a family unit meaning isolation is highly impractical and that they are exposed to a greater range of age groups increasing their risk of contagion and serious illness. Secondly, vulnerable groups have thus far been categorised broadly as either: those whose ability to produce immunity has decreased with age (65+); or those with a chronic respiratory or immunity deficiency related illnesses. The novel nature of Covid-19 means there is not enough data to understand likely mortality rates for children in Lower Income Countries who often represent the highest levels of individuals carrying infectious diseases or co-morbidities where Covid-19 could prove fatal. This lack of data means predicted mortality rates for children are often not included in modelling. While there is limited data, several researchers agree that the mortality rate among children in Low Income Countries could be significant. This means the per 1000 of population mortality rate is likely to be much higher than currently predicted for Low Income countries and that isolation of individuals aged 65+ will have limited impact on the overall number of deaths.

What does all this mean for humanitarian and development operations? The different experience of developing countries where the number of deaths is not offset by the number of lives saved and a likely a higher rate of child deaths, will have long term social and economic implications for these countries. For the near term it is also likely to have a profound impact on how Covid-19 is responded to in developing countries, which will in turn have a direct impact on current humanitarian operations. Here are a few scenarios organisations should prepare for:

• Limited success in countering Covid-19  measures in Low Income Countries is likely to result in restrictions being imposed on the international travel to/from these countries. This will impact short term deployments/sharing of expertise particularly with remote and unconnected communities.

• The greater mortality rate versus recovery rate in 65+ populations may change social structures where elder members of a family unit are responsible for the care and protection of children or vulnerable adults, presenting new safeguarding challenges.

• Some countries may adopt more draconian restrictions or -when faced with populations who have no confidence in restrictions- may use more heavy handed approaches to imposing them. The organisational and personal risks of any deteriorating security environment will be compounded for organisations which maintain outdated security operating procedures.

• Organisations should start to plan for the likelihood of there being different types of restrictions aimed at addressing the specific challenges for Low Income Countries. For example, restrictions aimed at reducing child mortality rates could limit the success of NGO’s educational programmes and reduce access to vulnerable children.

Over the coming weeks we’ll be exploring these areas in more detail. In the meantime, if you recognise these risks and need help or advice please reach out to us.