COVID-19 has an unprecedented impact globally in terms of access to and the capacity of healthcare systems to respond. The health crisis is yet to peak in many countries and in low income contexts, the concern is that its impact will be severe where it is not physically possible to practice physical distancing. As we saw during Ebola in 2014 or in cholera outbreaks, physical distancing is a choice that only a minority can afford in low income countries.  It is anticipated that this crisis will result in significant numbers of households falling into poverty (or deeper into poverty) as a result of the enormous economic impacts of measures needed to contain this virus: recovery from the economic impact of this, will not be short term. Those most vulnerable to this are those without job security, small businesses, those in the informal economy and in unpaid care. We recognise that these roles are the backbone of many national economies. We recognise that a large burden will currently fall to communities to meet care and other needs to affected households.  The impact on women is particularly strong, given their role as caregivers, which puts them at particular health and economic risk due to their roles in both the informal sector and care economy and the additional care burden of the sick and also of children, now schools are closed. Governments should recognise too, that children and caregivers depended on breakfasts and/or lunches in schools to avoid going hungry. At the same time there are those excluded from society, stateless, displaced, refugees who are extremely vulnerable to the impact of the pandemic.