5Ferguson N, Laydon D, Nedjati-Gilani G, et al. Report 9: impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand. March 16, 2020. https://www.imperial.ac.uk/ media/imperial-college/medicine/sph/ide/ gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf (accessed April 1, 2020). 6 Dahab M, van Zandvoort K, Flasche S, et al. COVID-19 control in low-income settings and displaced populations: what can realistically be done? March 20, 2020. https://www.lshtm.ac. uk/newsevents/news/2020/covid-19-controllow-income-settings-and-displacedpopulations-what-can (accessed April 1, 2020).12 months of background mortality risk, averaged across all age groups. By contrast, in Malawi this risk is equivalent to 4 months of background mortality (appendix). This reflects higher background mortality rates in Malawi, underscoring the fragility of health under normal circumstances. Malawi (median age 17 years) also has relatively few older citizens, with 6•6% of the population older than 60 years. This makes alternative strategies potentially safer and more feasible than lockdown-eg, community-led approaches to support older people to self-isolate with provision of food, medicine, and wellbeing support. 6 Although we fully agree that macroeconomic arguments against lockdown cannot justify widespread loss of life in Europe and Asia, the considerations are very different in Africa, where lockdown could cost many lives. We urge African governments to carefully contextualise safe physical distancing policies that maximise likely benefits. Without a context-specific, ethical approach to physical distancing, unintended harms from stringent lockdown could pose more harm than the direct effects of COVID-19 itself.We declare no competing interests.