Intended for healthcare professionals


Bearing the brunt of covid-19: older people in low and middle income countries

BMJ 2020; 368 doi: (Published 13 March 2020) Cite this as: BMJ 2020;368:m1052

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  1. Peter Lloyd-Sherlock, professor1,
  2. Shah Ebrahim, honorary professor2,
  3. Leon Geffen, director3 ,
  4. Martin McKee, professor of European public health2
  1. 1School of International Development, University of East Anglia, Norwich, UK
  2. 2London School of Hygiene and Tropical Medicine, London, UK
  3. 3Samson Institute For Ageing Research (SIFAR), Cape Town, South Africa
  1. Correspondence to: P Lloyd-Sherlock P.Lloyd-sherlock{at}

A global expert group on older people might be useful

The global response to covid-19 has been described as being “too little, too late.”1 National and international efforts are now gathering pace. Those involved in these efforts can draw on a rapidly growing body of research, much summarised in regularly updated guidelines published by national and international authorities, covering the latest information on the virus, its mode of transmission, its spread, and the susceptibility of different groups within the population.

Although many aspects of this new infection remain uncertain, one thing is already clear. The risk of dying from covid-19 increases with age, and most of the deaths observed are in people older than 60, especially those with chronic conditions such as cardiovascular disease. This has important implications for the way in which public health and clinical responses should be developed. Yet, to date, guidance largely ignores this issue, not only in high income countries,2 but in low and middle income countries (LMICs), which contain 69% of the global population aged ≥60 and where health systems are weaker and covid-19 could potentially have the greatest impact.

Four concerns

In LMIC settings, there are at least four issues to consider. The first is the changing family dynamics. Increasing opportunities for labour …

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