








key: cord-324650-rsp72rx8
authors: Teixeira da Silva, Jaime A.; Tsigaris, Panagiotis
title: Policy determinants of COVID-19 pandemic-induced fatality rates across nations
date: 2020-08-18
journal: Public Health
DOI: 10.1016/j.puhe.2020.08.008
sha: 
doc_id: 324650
cord_uid: rsp72rx8

Abstract Objectives COVID-19 is the most devastating pandemic to affect humanity in a century. In this paper, we assessed tests as a policy instrument and policy enactment to contain COVID-19 and potentially reduce mortalities. Study design A model was devised to estimate the factors that influenced the death rate across 121 nations and by income group. Results Nations with a higher proportion of people age 65+ had a higher fatality rate (p = 0.00014). Delaying policy enactment led to a higher case fatality rate (p = 0.0013). A 10% delay time to act resulted in a 3.7% higher case fatality rate. This study found that delaying policies for international travel restrictions, public information campaigns, and testing policies increased the fatality rate. Tests also impacted the case fatality rate, and nations with 10% more cumulative tests per million people resulted in a 2.8% lower mortality rate. Citizens of nations who can access more destinations without the need to have a prior visa have a significant higher mortality rate than those that need a visa to travel abroad (p = 0.0040). Conclusion Tests, as a surrogate of policy action and earlier policy enactment, matter for saving lives from pandemics as such policies reduce the transmission rate of the pandemic.

million people, causing 658,861 mortalities globally. 1 The majority of deaths have occurred in the 65+ age 25 group, most having medical preconditions. 2,3 Policies for social distancing, lockdowns, testing, isolating and 26 tracking are necessary to contain the spread of the virus, although they come with a cost of an economic 27 recession with its negative side effects. 4

Here, we assessed tests as a policy instrument and the start of policy enactment to contain 29 and potentially reduce mortalities across 121 nations. To achieve this, a cross-sectional ecological study was 30 conducted for numerous nations around the world, and a model was estimated to explain the pattern of the 31 crude case fatality rate (CFR) 5 as of 21 July 2020. The objective was to estimate, using regression analysis, 32 the direction and strength of the association between the death rate, as the response variable, controlling for: 

High-income nations conducted significantly more tests per million people than the other two income 59 groups, (i.e., 3.87 and 9.9 times more than upper-middle income and low-income nations, respectively). In 

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Estimating case fatality rates of COVID-19



