Finding Tentative Causes for the reduced impact of Covid-19 on the Health Systems of poorer and developing nations: An ecological study of the effect of demographic, climatological and health-related factors on the global spread of Covid-19

ObjectiveThe objective of this study is to evaluate the association with different factors empirically found to affect the spread and the severity of Covid-19. Evidently there is less likelihood of having one single and absolute solution to this pandemic. It is pragmatic to look for a multi-pronged and collaborative assembly of probable solutions, which is the higher objective of this study. DesignEcological study. SettingGlobal setting including 45 countries from all six inhabited continents PopulationTwo (2) or three (3) countries from each geographical region of the continents selected on the basis of population Main outcomemeasures correlation factors derived from comparisons between different sets of variables ResultsEmpirical trends suggested in the existing literature were quantified in a global setting establishing clear trends. Correlation between the proportion of the population affected and median age, prime climate zones, malaria and tuberculosis incidence, BCG coverage and mitigation measures were established. ConclusionsThe study findings suggest that demographic and climatological factors, high endemicity of TB and Malaria, and universal BCG programmes may have a cushioning effect in the impact of Covid-19 on health systems of poorer and developing nations. In the light of these findings more emphasis is necessary on the protective effects of BCG and antiviral properties of antimalarial drugs. BackgroundThe coronavirus disease (Covid-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected 213 countries as of 20th May 2020, with a total of 5,017,883 total cases reported globally, and has caused 325,624 reported deaths till date (worldometers.info). It began with the report of an outbreak of pneumonia of unknown cause in Wuhan, China on 31st December 2019. This outbreak was declared a Public Health Emergency of International Concern on 30th January 2020. Even as early as 18th February 2020, it was noted that inspite of lower case fatality rates Covid-19 had already resulted in more deaths than SARS and MERS combined.1 On the 11th of March the WHO made the assessment that Covid-19 could be classified as a pandemic. A systematic review found the basic reproduction number between 2.0 - 3.0.2 According to the WHO, the crude case fatality rate is 3%, with 15% of those affected suffering from severe disease and 5% critical.3 As developed countries with highly ranked health systems report high burden of cases straining health system capacities, concerns grow about the impact on resource constrained health systems in developing and underdeveloped nations. A better understanding of the disease epidemiology could help in planning the pandemic response, both in terms of resource allocation and mitigation measures in areas and populations more likely to be affected. In the second week of April, 2020, the IMF also was reported to be keen to know the reason behind the lower impact of Covid-19 in African and Asian countries; this also served as a driving factor behind this study.