COVID-19 Death Toll: The Role Of The Nation'S Economic Development

BackgroundSeveral months into the novel coronavirus disease (COVID-19) pandemic, there is a limited understanding of the underlying country-specific factors associated with COVID-19 spread and mortality. This study aims to investigate the role of nations economic development in the death toll associated with COVID-19 in Europe and Israel. MethodsNumber of COVID-19 cases, deaths per million, and case fatality rate (CFR) in Israel and 39 countries in Europe were described across quintiles of gross domestic product (GDP) per capita. The association between GDP per capita and COVID-19 incidence, mortality, and CFR was investigated using generalized linear modeling adjusting for the proportion of elderly and density of the population. ResultsIn countries belonging to the three lower GDP quintiles, COVID-19 incidence rates per million (range 708-1134) were substantially lower compared to countries in the fourth (3939) and fifth (3476) quintiles. Major differences were also calculated in COVID-19 mortality rates per million (25-31 vs. 222-268). There was no significant (p=0.19) differences in CFR between GDP quintiles (range: 2.79-7.62%). ConclusionsCOVID-19 had a greater toll in more developed nations. Though comparisons are limited by differences in testing, reporting and lockdown policies, this association likely reflects increased spread from trade and tourism in wealthier countries, whereas limited health system capacity and lack of treatment and vaccination options contributed to higher than expected CFR in wealthier countries. This unique situation will probably encourage the stronger economies to invest the required financial capacity to respond to and recover from the current crisis.