Study suggests prolonged, strict restrictions did not necessarily reduce COVID-19 mortality

By Susha Cheriyedath, M.Sc.Jun 7 2021

Despite the fact that COVID-19 is in its second year, standardized data on COVID-19 is insufficient and is not readily available across countries or regions inside the same country.

Most governments have focused on tracking and predicting the pandemic within their own countries, and data are gathered differently in various countries, making international comparisons challenging.

From available international data, it is clear that COVID-19 mortality is relatively higher in some countries. Several factors contribute to this disparity, including different proportions of elderly people, access to and quality of healthcare, general health status, and socioeconomic status.

Comparing the impact of COVID-19 in different countries to understand the various factors leading to disparity

A multi-national team of researchers compared COVID-19-related data from different countries in order to better understand the various factors leading to the different results across the world. The multi-disciplinary team included data scientists, software developers, and an infectious diseases physician. This study is published on the preprint server, medRxiv.*

The researchers used large public databases and explored differences in COVID-19 mortality statistics by country. They challenged their projections with real-world data and numbers from countries across the world, thus refining their models and gaining a better understanding of the progression of the pandemic. All their findings and predictions were validated from a clinical viewpoint.

Study: Covid-19: Comparisons by Country and Implications for Future Pandemics. Image Credit: Cryptographer / Shutterstock

*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Prolonged, stringent restrictions were not associated with better COVID-19 mortality

The results showed that while lockdowns did not result in an increase in mortality, there was no significant difference between strict and lax lockdowns. Only 1 out of the top 44 countries had lengthy and strict restrictions. Also, stringent restrictions were more common in countries that were worst-performers in terms of COVID-19 mortality.

The US had the largest economic growth as well as the most significant mortality rate. Countries that did well economically had less pressure on the population and still had lower pandemic-associated mortality compared to their neighbors.

“Strict lockdown does not appear to serve a purpose. Neither does completely ignoring the epidemic.”

In conclusion, countries that had the least restrictions did best economically. Some of them were better in terms of mortality compared to neighboring countries having similar social structures and stricter restrictions. The high mortality rate in the US seemed to be associated with very high obesity rates in the country. While Norway and the northern European countries had less strict restrictions compared to the rest of Europe, they had lower mortality rates. The observations also revealed that COVID-19 mortality was associated with vitamin D status.

Countries with the least restrictions fared best economically compared to countries with more strict restrictions

Overall, most countries were affected in phases with a comparable outcome despite community mitigation strategies. Norway, Finland, and Iceland seemed to have successfully managed the pandemic with the help of targeted and limited mitigation strategies. They used masks in crowded places, mostly kept schools open, and never issued stay-at-home orders. Low population density and vitamin D supplementation may also have helped.

On a broader look, there is no evidence showing strict, long-term measures helped reduce mortality. Available data from across the world actually suggests the opposite. Countries with the least restrictions fared best economically, with some of them doing well even in terms of mortality compared to neighboring countries.

Developing countries with limited healthcare facilities and limited ability to implement restrictions seemed to have fared well. Egypt did well despite relatively high obesity rates, population-dense cities, and high co-morbidities among the elderly.

The authors believe that further investigation is necessary to determine the reasons for the wide variations in the impact of COVID-19 among countries.

According to them, considering the possibility of future pandemics, countries that focus on improving indoor ventilation in large buildings, rapid identification and quarantining of super-spreader cases, enhancing ventilation in public transit systems, offering opportunities for outdoor activities, increasing fitness and reducing obesity, and supplementing with vitamin D may be more successful in controlling the pandemic.

Such measures would help control droplet and airborne transmission and benefit the health of populations by keeping them fit.

*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.