In LMICs, a focused testing on selected patients instead of a random screening would be less stressful for the healthcare system [
10]. COVID-19 tests should target patients with coexisting diseases or atypical presentations, pregnant women, and health workers. For other patients, a clinical case definition based on symptoms and radiology results should be adopted, such as that proposed by the Haitian Ministry of Public Health and Population [
11].
Other problems are the lack of a country-based testing plan, the lack of sufficiently trained staff for performing RT-PCR, and insufficient supplies of the reagents and kits for nucleic acid extraction and molecular detection, needed to perform a high number of tests for SARS-CoV-2 [
7]. Rapid test kits are an option to allow LMICs to perform diagnostic tests faster [
10].
In 2009, the World Health Organization Regional Office for Africa (WHO AFRO) launched the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) program with the aim to strengthen laboratories’ compliance with international standards through training and mentoring [
12]. Nevertheless, the mode of testing for COVID-19 in Africa is through reference laboratories and central laboratory testing. Sub-Saharan Africa (SSA) countries can take advantage of GeneXpert
®, a multi-disease diagnostic platform used initially to test tuberculosis (TB) and later adapted for human immunodeficiency virus (HIV) and Ebola [
13]. The GeneXpert
® is a molecular testing platform which can be located in all laboratories for immediate diagnostics [
14]. It processes samples onsite, reducing transportation time and test waiting times to only 45 min. It has been successfully used in Madagascar, showing that the use of the GeneXpert
® platform to screen patients with SARS-CoV-2 in LMICs is relevant and achievable and should be adopted in countries with difficult access to laboratories and an already pre-existing GeneXpert
® network [
15]. In order to slow down the spread of COVID-19, the WHO recommends infection control interventions to reduce the risk of transmission, in particular, avoiding close contact with people suffering from acute respiratory infections, frequent hand washing especially after direct contact with infected people or their environment, and avoiding unprotected contact with farm or wild animals [
16]. Worldwide, governments have established regulations that require social distancing, the closure of non-essential businesses, travel restrictions and, in many cases, quarantine. Although these measures are necessary for public health, social restrictions are difficult to realize in LMICs due to money-related livelihood problems [
17]. Furthermore, a complete commercial shutdown like those imposed in China, Europe, or the United States is not feasible when a day without work is tantamount to a day without food [
11].
Appropriate personal protective equipment (PPE) is required by all available guidelines for the management of COVID-19 patients. PPE is in enormous demand around the world, and its procurement will thus prove especially difficult in LMICs [
18]. Some low-cost suggestions were proposed for creating or extending PPE. In emergency situations, raincoats and windcheaters were used as gowns, while swimming caps, goggles, and transparent paper were used as PPE [
19].