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The COVID-19 pandemic: diverse contexts; different epidemics—how and why?
  1. Wim Van Damme1,
  2. Ritwik Dahake2,
  3. Alexandre Delamou3,
  4. Brecht Ingelbeen1,
  5. Edwin Wouters4,5,
  6. Guido Vanham6,7,
  7. Remco van de Pas1,
  8. Jean-Paul Dossou1,8,
  9. Por Ir9,
  10. Seye Abimbola10,11,
  11. Stefaan Van der Borght12,
  12. Devadasan Narayanan13,
  13. Gerald Bloom14,
  14. Ian Van Engelgem15,
  15. Mohamed Ali Ag Ahmed16,
  16. Joël Arthur Kiendrébéogo1,17,18,
  17. Kristien Verdonck1,
  18. Vincent De Brouwere1,
  19. Kéfilath Bello8,
  20. Helmut Kloos19,
  21. Peter Aaby20,
  22. Andreas Kalk21,
  23. Sameh Al-Awlaqi22,
  24. NS Prashanth23,
  25. Jean-Jacques Muyembe-Tamfum24,
  26. Placide Mbala24,
  27. Steve Ahuka-Mundeke24,
  28. Yibeltal Assefa25
  1. 1Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
  2. 2Independent Researcher, Bengaluru, India
  3. 3Africa Centre of Excellence for Prevention and Control of Transmissible Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
  4. 4Department of Sociology and Centre for Population, University of Antwerp, Antwerpen, Belgium
  5. 5Centre for Health Systems Research and Development, University of the Free State—Bloemfontein Campus, Bloemfontein, Free State, South Africa
  6. 6Biomedical Department, Institute of Tropical Medicine, Antwerpen, Belgium
  7. 7Biomedical Department, University of Antwerp, Antwerpen, Belgium
  8. 8Public Health, Centre de recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
  9. 9National Institute of Public Health, Phnom Penh, Cambodia
  10. 10School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  11. 11The George Institute for Global Health, Sydney, New South Wales, Australia
  12. 12Board Member, Institute of Tropical Medicine, Antwerpen, Belgium
  13. 13Health Systems Transformation Platform, New Delhi, India
  14. 14Health and Nutrition Cluster, Institute of Development Studies, Brighton, UK
  15. 15European Commission Directorate General for Civil Protection and Humanitarian Aid Operations, Kinshasa, Democratic Republic of Congo
  16. 16University of Sherbrooke, Sherbrooke, Quebec, Canada
  17. 17Public Health, University of Ouagadougou Health Sciences Training and Research Unit, Ouagadougou, Burkina Faso
  18. 18Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
  19. 19Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
  20. 20INDEPTH Network, Bandim Health Project, Bissau, Guinea-Bissau
  21. 21Bureau GIZ à Kinshasa, Kinshasa, Democratic Republic of Congo
  22. 22Center for International Health Protection, Robert Koch Institute, Berlin, Germany
  23. 23Health Equity Cluster, Institute of Public Health, Bengaluru, India
  24. 24Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
  25. 25School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
  1. Correspondence to Professor Wim Van Damme; wvdamme{at}


It is very exceptional that a new disease becomes a true pandemic. Since its emergence in Wuhan, China, in late 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, has spread to nearly all countries of the world in only a few months. However, in different countries, the COVID-19 epidemic takes variable shapes and forms in how it affects communities. Until now, the insights gained on COVID-19 have been largely dominated by the COVID-19 epidemics and the lockdowns in China, Europe and the USA. But this variety of global trajectories is little described, analysed or understood. In only a few months, an enormous amount of scientific evidence on SARS-CoV-2 and COVID-19 has been uncovered (knowns). But important knowledge gaps remain (unknowns). Learning from the variety of ways the COVID-19 epidemic is unfolding across the globe can potentially contribute to solving the COVID-19 puzzle. This paper tries to make sense of this variability—by exploring the important role that context plays in these different COVID-19 epidemics; by comparing COVID-19 epidemics with other respiratory diseases, including other coronaviruses that circulate continuously; and by highlighting the critical unknowns and uncertainties that remain. These unknowns and uncertainties require a deeper understanding of the variable trajectories of COVID-19. Unravelling them will be important for discerning potential future scenarios, such as the first wave in virgin territories still untouched by COVID-19 and for future waves elsewhere.

  • public health

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  • Contributors WVD, RD, EW and YA conceived and designed the study. RD, GV, YA and WVD searched the literature and screened for new emerging evidence. WVD, RD and YA drafted successive versions of the manuscript and coordinated inputs from all coauthors. YA, SA, KV, BI, RvdP and HK contributed to writing the manuscript. AD, J-PD, PI, SVdB, DN, GB, IVE, MAAA, JAK, VDB, KB, PA, AK, SA-A, NSP, J-JM-T, PM and SA-M reviewed successive versions of the manuscript and oriented it, with a field-based and local gaze from Guinea, Benin, Cambodia, Belgium, India, the UK, Mali, Canada, Burkina Faso, Germany, the USA, Guinea-Bissau, the Democratic Republic of Congo, Yemen and Australia. All authors commented on subsequent versions of the manuscript and approved the final version. WVD attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No additional data are available.

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