I've been tweeting a lot about #Coronavirus risk in the US. But my original field is int'l disaster/humanitarian relief, so let's take a look at that aspect.
The charts in the embedded thread help explain why WHO and others are so much more worried about the developing world.
The charts in the embedded thread help explain why WHO and others are so much more worried about the developing world.
(PSA - this will make more sense if you read the other thread first)
Here again is a simple conceptual representation of how case volume and health system capacity relate to create risk of elevated mortality.
Here again is a simple conceptual representation of how case volume and health system capacity relate to create risk of elevated mortality.
So if the red line represents quality treatment capacity in a first-world setting, the black line represents a developing world setting. Lower baseline, and likely to decline over time (this decline can happen in first world settings too). 
Decline in treatment capacity comes if numerous health care workers are infected, which happened during early phases of West Africa/Ebola. Few doctors to begin with, and many got sick due to weak infection prevention/control (which is a problem in rich countries, too).
So those factors have a big impact on fatality as case volumes will go beyond capacity to treat them.
If yellow is excess case volume over treatment capacity in wealthy countries, yellow plus purple is the excess in developing world. Social distancing can help; but still grim.
If yellow is excess case volume over treatment capacity in wealthy countries, yellow plus purple is the excess in developing world. Social distancing can help; but still grim.
Very important, therefore, to put a full court press into factors that protect health workers, particularly IPC support and PPE supply.
Also perhaps move treatment of novel pathogen out of main health system to protect it (this is the classic Ebola strategy).
Also perhaps move treatment of novel pathogen out of main health system to protect it (this is the classic Ebola strategy).
But treating in parallel depends on capacity to set up & run parallel facilities and triage patients effectively; those things are hard to scale. So facility-based IPC is important.
As in any country, social distancing measures and interventions like contact tracing can help.
As in any country, social distancing measures and interventions like contact tracing can help.
As Bruce said, treatment quality matters. Big challenge as this hits developing world.
Tho not the only variable:
- We don't know how disease will behave in tropical settings
- Dev world populations younger on avg, so may see fewer severe infections
- Population health status prob lower, so may see higher susceptibility and dangerous co-morbidities, esp respiratory
- We don't know how disease will behave in tropical settings
- Dev world populations younger on avg, so may see fewer severe infections
- Population health status prob lower, so may see higher susceptibility and dangerous co-morbidities, esp respiratory
Still, the development community should be thinking hard (and I'm sure they are) about how they can pivot their existing programs to support national health systems to deal with this.
And in crises, focusing on dense communities with weak sanitation. e.g. refugee/idp camps.
And in crises, focusing on dense communities with weak sanitation. e.g. refugee/idp camps.
Long road ahead.
