The COVID-19 crisis could be with us for at least 18 months, with lockdowns relaxed or tightened at intervals. It will only end when we have an effective treatment or vaccine, or enough people are infected and recover to achieve herd immunity (though the human cost of this would be high). Meanwhile, striking the right balance between lockdowns and relaxations is now a major concern for poor countries. As Heather Marquette has noted, we have to get this right.
Lockdowns aim to manage the flow of patients into health facilities by slowing disease transmission, but the consequences have been devastating in developing countries. Their economies are already poor, with limited safety nets for people out of work, while their health services cannot cope with any influx of extra patients.
No lockdown strategy can be determined without considering the elephant in the room: the governance constraints that limit the emergency expansion of basic COVID-19 testing and treatment facilities. If we don’t, the trade-offs will be dire. Even if developing countries could find emergency funds, governance weaknesses and corruption may constrain the emergency scale-up demanded by COVID-19. Existing governance and corruption problems will become more crippling if countries have to expand their health capacity at speed. These problems must be addressed if lockdowns are going to do their job: slowing the transmission of disease to the point where some relaxation is possible, while reducing the loss of life.