Background Despite worldwide efforts, control of COVID-19 transmission and its after effects is lagging. As seen from the cases of SARS-CoV-2 and influenza, worldwide crises associated with infections and their side effects are likely to recur in the future because of extensive international interactions. Consequently, there is an urgent need to identify the factors that can mitigate disease spread. We observed that the transmission speed and severity of consequences of COVID-19 varied substantially across countries, signaling the need for a country-level investigation. Objective We aimed to investigate how distancing-enabling information and communications technology (ICT) infrastructure and medical ICT infrastructure, and related policies have affected the cumulative number of confirmed cases, fatality rate, and initial speed of transmission across different countries. Methods We analyzed the determinants of COVID-19 transmission during the relatively early days of the pandemic by conducting regression analysis based on our data for country-level characteristics, including demographics, culture, ICT infrastructure, policies, economic status, and transmission of COVID-19. To gain further insights, we conducted a subsample analysis for countries with low population density. Results Our full sample analysis showed that implied telehealth policy, which refers to the lack of a specific telehealth-related policy but presence of a general eHealth policy, was associated with lower fatality rates when controlled for cultural characteristics (P=.004). In particular, the fatality rate for countries with an implied telehealth policy was lower than that for others by 2.7%. Interestingly, stated telehealth policy, which refers to the existence of a specified telehealth policy, was found to not be associated with lower fatality rates (P=.30). Furthermore, countries with a government-run health website had 36% fewer confirmed cases than those without it, when controlled for cultural characteristics (P=.03). Our analysis further revealed that the interaction between implied telehealth policy and training ICT health was significant (P=.01), suggesting that implied telehealth policy may be more effective when in-service training on ICT is provided to health professionals. In addition, credit card ownership, as an enabler of convenient e-commerce transactions and distancing, showed a negative association with fatality rates in the full sample analysis (P=.04), but not in the subsample analysis (P=.76), highlighting that distancing-enabling ICT is more useful in densely populated countries. Conclusions Our findings demonstrate important relationships between national traits and COVID-19 infections, suggesting guidelines for policymakers to minimize the negative consequences of pandemics. The findings suggest physicians’ autonomous use of medical ICT and strategic allocation of distancing-enabling ICT infrastructure in countries with high population density to maximize efficiency. This study also encourages further research to investigate the role of health policies in combatting COVID-19 and other pandemics.

BACKGROUND Despite a worldwide effort, control of COVID-19 transmission and of its aftereffect is lagging. As can be seen from the case of SARS-CoV-2 and influenza, such worldwide crisis and its side effects are likely to recur in the future because of extensive international interactions. Consequently, there is an urgent need to find the determinants that can mitigate the disease diffusion. Meanwhile, we observed that the pace of diffusion and its consequences varied substantially across countries, signaling the need for country-level investigation. OBJECTIVE We conducted research on how (1) distancing-enabling ICT infrastructure and (2) medical ICT infrastructures and related policies have affected the cumulative confirmed cases, fatality rates, and initial diffusion speed across different countries. We analyze the determinants of COVID-19 diffusion during the relatively early days of the pandemic. METHODS Based on our data for country-level characteristics including demographics, culture, ICT infrastructure, policies, economic status, and diffusion of COVID-19, we conducted regression to analyze the dataset. To gain further insight, we conducted a subsample analysis for countries with low population density. RESULTS Contrary to expectations, our analysis indicated that the ICT infrastructure is mostly ineffective in reducing the COVID-19 transmission and fatality rate. Instead, our full sample analysis showed that implied telehealth policy is associated with lower fatality rates when controlled for cultural characteristics (p-value =.004). In particular, the fatality rate for countries with an implied telehealth policy was lower than that for others by 2.7 percentage point. Interestingly, explicit telehealth policy was found to be not effective in curbing the fatality rates (p-value =.299). Furthermore, countries with government health website had 36% fewer confirmed cases than those without it, when controlled for cultural characteristics (p-value=.03). To investigate their heterogeneous effects across countries, 1) interaction effect of both implied and explicit telehealth policy with other medical ICT infrastructure variables and 2) subsample regression for countries with lower population density were conducted. Our analysis further revealed that the interaction between implied telehealth policy and training ICT health was significant (p<0.01), suggesting that implied telehealth policy may be more effective when in-service training on ICT is provided to health professionals. In addition, a rate of credit card ownership, as an enabler of convenient e-commerce transactions and distancing, showed a negative associate with fatality rates only in full sample analysis (p-value =.04), but not in subsample analysis (p-value =.76), highlighting that distancing-enabling ICT is more useful in densely populated countries. CONCLUSIONS Our findings demonstrate important relationships between national traits and COVID-19 infections, suggesting guidelines for policymakers to minimize the negative consequences of pandemics. Especially, the findings suggest (1) physician’s autonomous use of medical ICT and (2) strategic allocation of distancing-enabling ICT infrastructure in high population density countries to maximize efficiency. This study also urges further research to investigate the role of health policies in combatting COVID-19 and other pandemics.