Table 1.

Situation-adapted COVID-19 in-hospital containment strategies in LMIC.

Recommended	Details	Likely to be available	Alternatives
Ventilation principles WHO	Ventilation Rate^a	+	Use of natural ventilation (open windows and doors) and simple interior-to-exterior fans situated at poorly ventilated sections Outdoor area for (mild) cases if possible Cohorting patients with similar complaints/disease
	Airflow Direction^a	-
	Air distribution/airflow pattern^a	-
Ventilation methods WHO	Natural ventilation (natural forces/winds)	++
	Mechanical ventilation (fans)	+
	Hybrid ventilation (mixed-mode)	-
Ventilation on wards WHO	Mild cases – natural ventilation	++
	Severe cases – 160L/s	-
	Critical cases – 160L/s	-
	Staff working area 60L/s	-
Accessible water source	Reliable source of clean water	+	Use of proper wells, cisterns and reservoir systems Water-saving practices
Location and Ground conditions	Easy access, good soil condition. Environment manipulation to meet desired criteria	-	Use of existing facilities Gravel if cement not available
Waste management	Cleaning and disinfection point, temporary waste storage, organic pit, sharp pit and incinerator with ash pit, toilets (private) and proper plumbing	+	Burn pit Locally made incinerators that use charcoal Cohorting patients Latrines
Laboratory services	Hematological studies	+	Proper history-taking Thorough physical examination Empirical treatment Lab studies just for documentation is not done Where possible stepping-up rapid test kit use (including HIV and Malaria)
	Biochemical studies	-
	Microbiology	-
Imaging services	Using various imaging modalities (e.g. CT scan, chest radiography, bedside USS) to orient case management	+	Some simple modalities may be available. However, most of the time clinicians have to perform a proper physical examination Imaging just for documentation is not done
Case management	Drugs	+	Use available options, often off-label use If no drugs available, use supportive or palliative care Treat other common (endemic) infections like malaria if no laboratory services to confirm disease.
	Oxygen Therapy and Artificial Ventilation	-	Use available options, many times using just the respiratory rate as monitoring Oxygen concentrators and oxygen cylinders can be used where available. Due to limited skills set and lack of drugs for sedation the risks associated with mechanical ventilation are increased. Exercises to increase breathing efficacy Prone-positioning If no response, use palliative care
	Rehabilitation Therapy	-	Family/Community engagement
	Isolation in single rooms	-	Cohorting patients
Infection Prevention Control	Liquid soap	+	Grating solid soap in water
	Chlorine	++	Use it if available and locally accepted
	Alcohol base Solution	+	Soap
	Personal Protective Equipment	+	Cohorting patients and using the same equipment Strict use of equipment
Healthcare Workers	High qualified with multiple specialties	-	Teaching people important skills (empowerment) Accept that sometimes you will have to use/apply not ‘the best’, but the best possible
	Staff to be replaced if quarantined	-	As there is a limited amount of HCW; strict quarantine policies Use of PPE protects patients and staff; HCW using adequate PPE are not contacts Staff that are primary contacts could be tested and if negative allowed to work
	Psychosocial support (psychotherapy, government policies)	-	Empathic, positive team working environment Peer support
	Financial Support	-	Raise problem awareness

Note.

According to WHO definitions, ventilation rate is defined as amount of outdoor air that is provided into the space, and the quality of the outdoor air, airflow direction as the overall airflow direction in a building which should be from clean zones to dirty zones, and air distribution/airflow pattern as the external air should be delivered to each part of the space in an efficient manner, and the airborne pollutants generated in each part of the space should also be removed in an efficient manner. Score for HIC and LMIC: ++ feasible, + potentially feasible, - not feasible.