The lower COVID-19 related mortality and incidence rates in Eastern European countries are associated with delayed start of community circulation

  1. Alban Ylli
  2. Yan Yan Wu
  3. Genc Burazeri
  4. Catherine Pirkle
  5. Tetine Sentell

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

The purpose of this analysis was to assess the variations in COVID-19 related mortality in relation to the time differences in the commencement of virus circulation and containment measures in the European Region.

Methods

The data for the current analysis (N = 50 countries) were retrieved from the John Hopkins University dataset on the 7 th of May 2020, with countries as study units. A piecewise regression analysis was conducted with mortality and cumulative incidence rates introduced as dependent variables and time interval (days from the 22 nd of January to the date when 100 first cases were reported) as the main predictor. The country average life expectancy at birth and outpatient contacts per person per year were statistically adjusted for in the regression model.

Results

Mortality and incidence were strongly and inversely intercorrelated with days from January 22, respectively -0.83 ( p <0.001) and -0.73 ( p <0.001).

Adjusting for average life expectancy and outpatients contacts per person per year, between days 33 to 50 from the 22 nd of the January, the average mortality rate decreased by 30.1/million per day (95% CI: 22.7, 37.6, p <0.001). During interval 51 to 73 days, the change in mortality was no longer statistically significant but still showed a decreasing trend. A similar relationship with time interval was found for incidence. Life expectancy and outpatients contacts per person per year were not associated with mortality rate.

Conclusion

Countries in Europe that had the earliest COVID-19 circulation suffered the worst consequences in terms of health outcomes, specifically mortality. The drastic social isolation measures, quickly undertaken in response to those initial outbreaks appear effective, especially in Eastern European countries, where community circulation started after March 11 th . The study demonstrates that efforts to delay the early spread of the virus may have saved an average 30 deaths daily per one million inhabitants.

Article activity feed

  1. Version published to 10.1371/journal.pone.0243411
  2. Version published to 10.1101/2020.05.22.20110148v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2020.05.22.20110148: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study is subject to several limitations. Our model may explain some important country differences; for example, the slope in the first regression segment is apparently driven by lower mortality in countries with community circulation reported during 8-11th March (from Austria to Czech Republic). It does not explain all observed differences, such as that between Belgium and Germany or Sweden and Norway. Further research, focused on comparing specific country situations, is needed in the future. We examine mortality and cumulative incidence as they are reported by countries. The data may have issues which can be only partially validated. While incidence is highly affected by country testing strategies, the reported mortality has been used as a valid health outcome in other studies (7,8) We also use the date of first 100 cases, as they are reported by countries health authorities. Similar sources of data have been considered valid to systematically document community COVID 19 cases (14). We know that silent community circulation of the virus started before initial detection. Nonetheless, the observation of country epidemic curves seem to generally confirm the ranking of reported initiation dates (32). Further genetic sequencing methodology has been used to track early outbreaks in Europe and the USA and it supports the timeline pattern provided by early documented cases (33) We acknowledge that the ecological study method used in the analyses has limitations and does not all...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  4. Version published to 10.1101/2020.05.22.20110148v1 on medRxiv