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Insights into the developing countries’ inappropriate responses to COVID-19: A Randomised Controlled Trial analytical framework

The trade-off between the health and the economic stakes associated with tackling COVID-19 with or without lockdowns in developed countries is trickier in developing countries as, for them, both concern saving human lives. Therefore, the question of the appropriate policy between locking or not locking down should boil down to detect the one with the lower opportunity cost in terms of the expected number of deaths. Therefore, this paper had the major goal of assessing the appropriateness of lockdowns decided in most developing countries in response to the COVID-19 pandemic. As a method, it resorts to the Randomised Controlled Trial analytical framework taking DRC as a case study and the response to the Ebola epidemic as the counterfactual to that of the COVID-19 pandemic. Besides the introduction and the conclusion, first and last sections, the investigation is done and presented in five major sections.

The second section mainly indicates that DRC faces simultaneously many deadly endemics and epidemics and that has created a resource competition. The outbreak of a new dangerous epidemic, as COVID-19, diverts important national and international resources and attention from its predecessor and other endemics and hence indirectly takes lives which could be saved by the diverted resources and attention.

Considering the socio-economic precariousness in which the majority of the population lives in DRC and the unstable financial situation of corporates, the third section finds that putting people in lockdown without any financial or food support amounts pushing them to entirely spend the meagre capital they have in few days and gradually die from malnutrition and hunger.

Drawing on similarities between the 2018–2020 outbreak of Ebola and that of COVID-19, the fourth section shows that the trancing and isolating method used in response to the former is a good counterfactual of the lockdown used in response to the latter. The analysis of the possible sources of bias indicates that none of them is susceptible to bias the assessment towards an underestimation of the effectiveness of the lockdown. Some may bias the assessment toward an overestimation of its effectiveness. Consequently, a result suggesting ineffectiveness is robust to most of the possible biases but a result suggesting effectiveness is not.

Using the 2018–2020 outbreak of the Ebola epidemic as counterfactual, the fifth section shows that the COVID-19’s inter-regional transmissions with or without resorting to a lockdown and quarantines are not significantly different. Furthermore, with or without lockdowns and quarantines, intra-regional transmissions are high but controllable up to a full eradication.

The sixth section indicates that analysis is extendable to any country having, like DRC, the majority of its population under the age of a significant risk of getting complications and die in case of infection to the COVID-19 and facing, as in DRC, precarious economic and financial situations. The two conditions are met in most developing countries and not in developed countries.

As a conclusion, the study indicates that the lockdown has been an inappropriate response to COVID-19 in DRC: the number of lives we estimate it has saved is insignificant compared to that of lives we estimate it has taken just by deepening malnutrition and hunger and diverting resources and attention from other deadly epidemics and endemics. The core arguments and results are consistent with the situations in most developing countries but not with those of developed countries. Consequently, these lives we expect lockdowns to take concern mostly the poorer in poor countries. This is an alarming result as they may suffer and die more and longer during the post-COVID-19 economic crisis if they are not adequately rescued by domestic governments and the international community.

Palabras clave

COVID-19 Developing countries Economic stakes Health stakes Lockdown Randomized Controlled Trial

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Mongongo Dosa Pacifique

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      Guido Cimadomo

      Comentó el 11/12/2020 a las 19:37:16

      Dear prof. Dosa, thank you for this inspiring insight into the effects of COVID in Africa.
      During the lockdown we have seen in Spain, as in the rest of Europe, the raising of a "safety network" of citizens trying to help the weakest neighbours. Could you tell if something similar has happened in DRC o in other African countries?
      Thank you.

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        Mongongo Dosa Pacifique

        Comentó el 11/12/2020 a las 20:47:57

        Dear Guido Cimadomo,

        Thank you very much for your encouraging words and the information about the “Safety network” of citizens in favour of the weakest neighbours in Spain and in other European countries.

        Strictly speaking, nothing similar happened as a response to COVID-19 in DRC and in most African countries. However, it is worth noting that family members and close friends usually help each other in all critical events. It is a kind of a cultural social security system that compensates for the lack of a functional state social security. However, some countries such as Rwanda distributed food to the neediest but once again I do not see in that a “safety network” of citizens as they are government initiatives. To sum up, among neighbours NO but among families and close friends YES but it is not attributable exclusively to COVID-19.

        Those are some of the elements of response I can give to your question. Once again thank you very much.

        With best regards,
        Pacifique Mongongo Dosa

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      Rosa Mecha López

      Comentó el 10/12/2020 a las 14:18:11

      Dear Mr. Mondogo, an interesting research. The results are truly alarming. I believe that even confinement in developed countries has not been a good option, since the health crisis will be followed by an economic crisis throughout the world that will also cause poverty and death.
      However, in the case of Africa, it seems that the COVID-19 pandamia has not affected as much as in the rest of the world, or at least not much has been said about it in the media. What do you think is the cause? Thank you very much and best regards.

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        Mongongo Dosa Pacifique

        Comentó el 10/12/2020 a las 15:20:28

        Dear Mecha López,

        Thank you very much for your comment and question. Of course, I completely agree with your comment. Regarding your question, the statistics of the COVID-19 infection, transition, and fatality rates are negatively correlated with age. As you know, so far, medical experts argue that older people are more vulnerable than younger people. Drawing on that, one would argue that the relatively lower number of deaths in Africa is associated with its population which is relatively younger.

        Regarding the media focus, let me start with a short anecdote showing how people don’t consider COVID-19 as one of the worse issues they face: In DRC the population suspected the service in charge of COVID-19 response to pay families of deceased people of normal illnesses to bribe their relatives to agree that they died from COVID-19. The first official infected case of COVID-19 after being declared cured he publicly denied that he was infected and treated. So far, local medial still ask the service in charge of COVID-19 to show them where the infected people are treated without getting satisfactory responses. People most find that those in charge they exaggerating the COVID-19 issue to attract divert foreign aid and domestic budget. In DRC some people are prosecuted for that.

        From this anecdote, I would like to draw your attention to the fact that, given the above-mentioned comparative advantage in terms of age regarding the COVID-19 issue, most of the African people daily face much more complicated health, social, economic, security, and political issues. This would explain why they (and the local media) put relatively less focus on it. Intranational NGOs and some international media initially drew focus on Africa but, in my opinion, it could not last long for the same reason.

        Those are some of the elements of response I can give to your question. Once again thank you very much.

        With best regards,
        Pacifique Mongongo Dosa

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      Mongongo Dosa Pacifique

      Comentó el 07/11/2020 a las 15:23:07

      1. Please correct the typo at the end of the second line of the penultimate paragraph: replace (infect the ion to) by (infection to the). The full paragraph will become:

      The sixth section indicates that analysis is extendable to any country having, like DRC, the majority of its population under the age of a significant risk of getting complications and die in case of infection to the COVID-19 and facing, as in DRC, precarious economic and financial situations. The two conditions are met in most developing countries and not in developed countries.

      2. Change the typo of the first keyword (covid-19) by (COVID-19).

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