An Ecological Study Assessing the Relationship between Public Health Policies and Severity of the COVID-19 Pandemic

Background: The COVID-19 pandemic has claimed almost half a million deaths worldwide. Reliance on government-led policies have been heightened during the pandemic to mitigate the spread of disease. Which of these policies are associated with important outcomes other than mortality rates remains unknown. Hence, we aimed to determine the associations between government public health policies on the severity of the COVID-19 pandemic. Methods: This ecological study utilised publicly accessible data on seventeen policy indicators of Containment, Economic and Health systems and their respective Stringency Index described by the Blavatnik school of Government. Countries reporting >25 daily COVID-related deaths until end May 2020 were included. We assessed the association of individual SI with the profile of severity of COVID-19 by using several outcomes; mean mortality rate, time to peak, peak deaths per 100,000 population, cumulative deaths after peak per 100,000 population and ratio of the mean slope of the descending curve to the mean slope of the ascending curve. Analyses were stratified according to age, income and region. Spearman rank-order tests were employed to measure associations. Results were presented descriptively and direct comparisons were made. Findings: Twenty-two countries were included. Containment policies appeared more effective in younger populations and debt/contract relief in older populations. In European countries, containment policies were generally associated with good outcomes. In non-European countries, school closures alone had the strongest association with most of the outcomes examined. In high-income countries, health system policies such as public information campaigns and testing were generally effective, in contrast to low-income countries. Interpretation: Containment policies may be effective when targeted towards younger populations and occur in high-income or European countries. Health system policies have not been as effective in low-income and non-European countries.Funding Statement: None.Declaration of Interests: None.Ethics Approval Statement: Due to the ecological study design and the use of publicly accessible data, ethical approval was not required.