Reciprocal association between participation to a national election and the epidemic spread of COVID-19 in France: nationwide observational and dynamic modeling study.

Objective: To investigate possible reciprocal associations between the intensity of the COVID-19 epidemic in France and the level of participation at national elections. Design: Observational study and dynamic modelling using a sigmoidal mixed effects model. Setting: All hospitals where patients were admitted for COVID-19. Participants: All admitted patients from March 18, 2020 to April 17, 2020. Main outcome measures: Abstention and admission rate for COVID-19. Results: Mean abstention rate in 2020 among departments was 52.5%+/-6.4 and had increased by a mean of 18.8% as compared with the 2014 election. There was a high degree of similarity of abstention between the two elections among the departments (p<0.001). Among departments with a high outbreak intensity before the election, those with a higher participation were not affected by a significantly higher number of COVID-19 admissions after the elections. The sigmoidal model fitted the data from the different departments with a high degree of consistency. The covariate analysis showed that a significant association between participation and number of admitted patients was observed for both elections (2020: B=-5.36, p<1e-9 and 2014: B=-3.15, p<1e-6) contradicting a direct specific causation of the 2020 election. Participation was not associated with the position of the inflexion point suggesting no effect in the speed of spread. Conclusions: Our results suggest that the surrounding intensity of the COVID-19 epidemic in France did not have any local impact on citizens participation to a national election. The level of participation to the 2020 election had no impact on the spread of the pandemic.