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Health Focus: Study reveals the Covid-19 pandemic impact is harder in the poor countries

At the onset of the COVID-19 epidemic, the risk of dying from the disease was twice as high for people living in low-income countries than in richer countries, reports the study. This is one of the growing numbers of research that reveals the high burden of COVID-19 in low-income countries. Early data from the epidemic suggested that mortality and infection rates in poorer countries were lower compared to those of rich. But the latest evidence presents a very different picture, says Madhukar Pai, an infectious disease specialist at McGill University in Montreal, Canada. “This paper is one of many indications that the biggest impact of the epidemic has been on low- and middle-income countries,” Pai said.

To assess the burden of COVID-19, Gideon Meyerowitz-Katz, an epidemiologist at the University of Wollongong in Australia, and his colleagues analyzed infection and mortality data collected from several studies in 25 low- and middle-income countries before vaccination coronavirus spread to those regions. Between April 2020 and February 2021, researchers collected blood samples from people of different ages and tested antibodies against SARS-CoV-2 – a sign that someone had been infected before.

In wealthier countries, older people – who are at greater risk of contracting the disease – are less likely to be infected than younger people. But the authors found that in many low-income countries, the percentage of adults 60 years of age and older who had antibodies against coronavirus was similar to that of young people. This is because so many people in these countries live in mixed-race homes, making it difficult to isolate themselves from the virus, says Meyerowitz-Katz. And many people in these areas have never had the opportunity to work from home, he says.

To calculate the risk of death, the team calculated the mortality rate in countries, half the number of people infected, including those who did not get tested or showed symptoms. The mortality rate of people infected with the virus within 20 years in low-income countries is almost three times higher than in rich nations, and 60-year-olds have almost twice the risk of death compared to rich countries (see ‘How to Kill Death. COVID-19’). The main difference in risk was probably because people in low-income countries had less access to quality health care, Meyerowitz-Katz said.

Research co-author Ana Carolina Peçanha Antonio, a critical care physician at Hospital de Clínicas in Porto Alegre, Brazil, saw this for the first time. In the temporary intensive care unit he managed, there were no specialized staff in the treatment of COVID-19, so Peçanha Antonio and his colleagues had to make great “efforts” to keep patients safe and well cared for – “surprisingly scenario, ”he says.

With the introduction of the COVID-19 vaccine, the mortality gap between low- and high-income countries could be reduced, Meyerowitz-Katz said. But it is also likely to be widespread, as many poorer countries still have limited access to vaccines. “It’s difficult to know exactly how that changed over time,” he said. When vaccines are approved, rich countries accumulate them, which widens the vaccine equality gap between rich and poor countries, says Pai. The main findings are not surprising, “said study author Daniel Herrera-Esposito, a neurologist at the University of the University of the Republic of Montevideo, Uruguay. But they highlight how rich countries have failed to help low-income countries effectively during times of violence, he said. “It’s sad.”

The results also highlight “the urgency of vaccinating countries in low- and middle-income countries”, said Gavin Yamey, who studies international policy and public policy at Duke University in Durham, North Carolina. Only 16% of people in low-income countries have received at least one dose of COVID-19, compared with 80% of people in rich countries. Contributions for vaccines that are limited to low-income countries can help achieve a more stable and fair vaccine distribution globally, says Yamey. Support for those countries to produce local volumes can also help.

But Pai is concerned that it may be too late for poorer nations to get enough vaccines for most of their people, as rich countries have begun to move forward and reduce funding for international aid programs related to COVID-19. He notes that similar approaches have played a role in the spread of other infectious diseases, such as malaria, tuberculosis, and AIDS, which have become even more serious in rich countries. “When these diseases stopped being a threat, we completely forgot about them, pretending they were gone. And where are they now? Killing people in the south of the world, ”he said. “In almost every major infectious disease you can think of, low- and middle-income countries are struggling.”

Source Journal Reference:  Giorgia Guglielmi, COVID was twice as deadly in poorer countries, nature News (2022), https://www.nature.com/articles/d41586-022-01767-z

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