Future scenarios of the healthcare burden of COVID-19 in Low- or Middle-Income Countries

COVID-19 has caused large-scale outbreaks in many countries, particularly in Europe and Asia where many countries have experienced a level of healthcare demand that have placed health systems under strain. Many countries, particularly Low- or Middle Income countries (LMICs) (shown below), are at an earlier stage of the epidemic. 37 countries have reported fewer than 100 COVID-19 deaths. However, following the implementation of widespread suppression measures around the world, COVID-19 burden is increasingly becoming concentrated in LMICs.

Here we aim to provide each country with an indication of where they are in their epidemic and scenarios of how healthcare demand is likely to vary over the next 28 days. Changes in transmission from today will also shape the next 28 days so these estimates should not be viewed as predictions but scenarios to help countries understand how strategies today are likely to shape the next phase of the epidemic. Specifically, these reports will aim to help countries understand:

1. The total number of COVID-19 infections

2. The expected number of deaths within the next 28 days

3. The number of individuals requiring oxygen or mechanical ventilation in the next 28 days

4. The impact of changing their current intervention policy

For further guidance and questions about the methodology and caveats, please see the Frequently Asked Questions

Key aspects captured in our methodology (see methods and FAQs for full details)

  • Populations are typically younger in LMICs so, provided good access to care, the risk an average infection leads to mortality is lower. We take the risk of severe disease and death by age as observed in China and Europe and country-specific demography to calibrate our model. For example, in low-income countries our estimated infection-fatality ratio (IFR) is typically around 2-3 deaths per 1000 infections, contrasted to the 6-10 deaths per 1000 infections observed in high-income countries with older populations.
  • Not all COVID-19 infections are reported. Global testing capacity has improved substantially but both the percentage of cases that are detected and the proportion of infections that are symptomatic is likely to be highly variable by country and over time. Here our model is calibrated to reported deaths on the basis of our country-specific IFR.
  • The availability of healthcare varies by country. We estimate the availability of hospital beds and intensive care units within each country using a range of publicly available datasets. These are typically lower in lower-income countries. As epidemics begin to exceed these thresholds in some countries our estimate of the risk of mortality upon infection will incr