Worldwide, with no available vaccines for Covid-19, strict lockdown measures have been implemented in preventing health systems from becoming overloaded and to save lives. These community-based measures have been particularly relevant in the low and middle-income countries (LMICs), such as Bangladesh, where: 1) the risk of transmission is high (populations are large and dense, with a high degree of interaction and physical contact), 2) adherence to preventative measures is often poor (eg, clean water and hygiene practices), 3) public health systems are under-resourced (eg, safety equipment and intensive care units/ICU), and 4) access to health care is limited and reliant on largely out-of-pocket payment. These strict social distancing interventions come with a price: They are unsustainable in the long term given their social, economic, and psychological impacts. For example, a recently completed survey in Bangladesh showed that after its initial days of lockdown, a staggering 72% of urban and 54% of rural households had lost their main source of earnings. Therefore, many LMICs are currently lifting the lockdowns, irrespective of the status of infection and the level of contagion. It remains, however, unclear what would be an optimal strategy for “safe re-opening” (given the likelihood of disease resurgence), especially across low-income settings, where diagnostic capacities and surveillance infrastructure is poor. In this regard, we have considered three community-based public health strategies for LMICs, which aim to strike a balance between health protection and preventing economic collapse and discuss the possible application, ideal pre-requisites, and inherent limitations for each. They include: 1) Sustained mitigation, 2) zonal lockdown, 3) rolling lockdown (dynamic measures). These strategies are not mutually exclusive and could be further adapted and combined depending on local needs and disease progression.
Worldwide, with no available vaccines for Covid-19, strict lockdown measures have been implemented in preventing health systems from becoming overloaded and to save lives. These community-based measures have been particularly relevant in the low and middle-income countries (LMICs), such as Bangladesh, where: 1) the risk of transmission is high (populations are large and dense, with a high degree of interaction and physical contact), 2) adherence to preventative measures is often poor (eg, clean water and hygiene practices), 3) public health systems are under-resourced (eg, safety equipment and intensive care units/ICU), and 4) access to health care is limited and reliant on largely out-of-pocket payment. These strict social distancing interventions come with a price: They are unsustainable in the long term given their social, economic, and psychological impacts. For example, a recently completed survey in Bangladesh showed that after its initial days of lockdown, a staggering 72% of urban and 54% of rural households had lost their main source of earnings. Therefore, many LMICs are currently lifting the lockdowns, irrespective of the status of infection and the level of contagion. It remains, however, unclear what would be an optimal strategy for “safe re-opening” (given the likelihood of disease resurgence), especially across low-income settings, where diagnostic capacities and surveillance infrastructure is poor. In this regard, we have considered three community-based public health strategies for LMICs, which aim to strike a balance between health protection and preventing economic collapse and discuss the possible application, ideal pre-requisites, and inherent limitations for each. They include: 1) Sustained mitigation, 2) zonal lockdown, 3) rolling lockdown (dynamic measures). These strategies are not mutually exclusive and could be further adapted and combined depending on local needs and disease progression.
