Adoption of COVID-19 triage strategies for low-income settings

Despite major advances in epidemic preparedness, Africa remains uniquely susceptible to novel coronavirus disease 2019 (COVID-19). According to the Infectious Disease Vulnerability Index,1 22 of the 25 countries most susceptible to an infectious disease outbreak are in Africa. The high prevalence of HIV, tuberculosis, and other pathogens might potentiate the severity of COVID-19 and contribute to diagnostic uncertainty. Health-care systems and human resources are already spread thin. And although the young age of the population (with more than half aged younger than 20 years) might prove protective, it also means that Africa has much to lose in terms of disability-adjusted life years. On Feb 27, 2020, the first case of COVID-19 in sub-Saharan Africa was reported in Nigeria, making spread in the region more probable.2 While preparing a response to COVID-19 outbreak in Uganda, we read Jinnong Zhang and colleaguesu0027 work with great interest.3 We commend the authors for distilling complex information regarding triage and clinical care for patients who have a novel pathogen, for which there is little evidence, into a succinct flowchart. Unfortunately, many aspects of their algorithm would not be feasible in our setting. Chest CT, complete blood counts with differential, and C-reactive protein are all central to their algorithm, and none are routinely available in Uganda.