COVID-19: Comparisons by Country and Implications for Future Pandemics

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Lewis Mehl-Madrona
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Background. We set out in this paper to compare Covid-19 results by country to better understand the factors leading to the differing results found internationally.


Methods. We used publicly available large datasets to explore differences by country for Covid-19 mortality statistics. We continuously challenged our projections with reality and numbers from countries around the world, allowing us to refine our models and better understand the progression of the epidemic.  All our predictions and findings were discussed and validated from a clinical viewpoint.  


Results. While no lockdown resulted in higher mortality, the difference between strict lockdown and lax lockdown was not terribly different and favored lax lockdown. Only one of the top 44 countries had long and strict restrictions. Strict restrictions were more common in the worst performing countries in terms of Covid mortality. The United States had both the largest economic growth coupled with the largest rate of mortality.  Those who did well economically, had lower mortality and less pressure on their population. Yet they had less mortality than average and less than their neighbors.


Conclusions. Countries with the least restrictions fared best economically. Some of them fared well in terms of mortality, even better than neighboring countries with similar social structures and more severe restrictions. The mortality rates in the USA, however, appeared to suffer from very high obesity rates. Norway and the northern European countries have less strict restrictions from the rest of Europe and had lower mortality rates. COVID-19 mortality was associated with vitamin D status.


Strengths and Limitations.


Comparing countries by results and policies can provide important insights into how the policies affect outcome.


The study is limited by its reliance upon reported data by countries, some of which could be reported differently.  Within large data analysis we are limited by the quality of data which countries report, which may vary in quality and methods.


Causality cannot be proven by correlations though they can provide important hypotheses for further exploration.


Summary of findings:


1. Countries with the least restrictions fared best economically.  Some fared well in terms of mortality even though neighboring countries did not. 
2. Obesity rates are correlated with mortality rates in countries.
3. Mortality rates are correlated with vitamin D status.
4. Lockdown and strict confinement are not necessarily related to mortality statistics.


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