Which are factors determining a low COVID-19 mortality in society? High health expenditure and lower exposure of population to air pollution as critical factors for an effective strategy to cope with future pandemics similar to COVID-19

One of the problems hardly clarified in the scientific field of Coronavirus Disease 2019 (COVID-19) is inter-related factors associated with a lower mortality of COVID-19 to design effective strategies to cope with unforeseen pandemic crises. The main goal of this study is to explain these factors determining a lower fatality rate of the Coronavirus disease 2019 (COVID-19) in society with a global analysis based on more than 160 countries worldwide. This study reveals a novel finding: countries with a low average COVID-19 mortality have high investments in health sectors as % of GDP (>7.5%), high health expenditures per capita (>$2,300) associated with a lower exposure of population to days exceeding safe levels of particulate matter (PM 2.5 ), reinforcing these factors with a policy response of lockdown. In addition, these countries have lower fatality rates of COVID-19, regardless a higher percentage of population aged more than 65 years in these countries. Overall, then, this study must conclude that an effective strategy to reduce the negative impact of future epidemics similar to COVID-19 has to be based on a reinforcement of healthcare sector to have an efficient organization prearranged to cope with pandemics of new viral agents and to be able to minimize fatality rates in a context of sustainable environment having low air pollution.