In the response to the COVID-19 pandemic, it is now evident that many of the public health and hospital-based interventions deployed by high-income countries (HICs) may be ineffective or infeasible in low- and middle-income countries (LMICs).  Social distancing including lockdowns, rapid deployment of effective test-and-trace protocols followed by quarantine, the ability to properly self-isolate, effective protection of hospital staff from infection with appropriate PPE, and upscaled hospital care – many of these interventions cannot be implemented in the time frame required, or carry consequences so significant that they are socio-politically unacceptable. In this piece, we sound caution about the feasibility of lockdowns and isolation in LMICs, and the cost-effectiveness of putting large-scale resources into upscaled hospital care. We also suggest a different order of priority for immediate next steps.

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