Healthcare Capacity, Health Expenditure, and Civil Society as Predictors of COVID-19 Case Fatalities: A Global Analysis

Abstract

Background: The rapid growth in cases of COVID-19 has challenged national healthcare capacity, testing systems at an advanced ICU, and public health infrastructure level. This global study evaluates the association between multi-factorial healthcare capacity and case fatality of COVID-19 patients by adjusting for demographic, health expenditure, population density, and prior burden of non-communicable disease. It also explores the impact of government relationships with civil society as a predictor of infection and mortality rates. Methods: Data were extracted from the Johns Hopkins University database, World Bank records and the National Civic Space Ratings 2020 database. This study used data from 86 countries which had at least 1,000 confirmed cases on 30th April 2020. Negative binomial regression model was used to assess the association between case fatality (a ratio of total number of confirmed deaths to total number of confirmed cases) and healthcare capacity index adjusting for other covariates. Findings: Regression analysis shows that greater healthcare capacity was related to lesser case-fatality [incidence rate ratio (IRR) 0.5811; 95% confidence interval (CI) 0.4727-0.7184; p < 0.001] with every additional unit increase in the healthcare capacity index associated with a 42% decrease in the case fatality. Health expenditure and civil society variables did not reach statistical significance but were positively associated with case fatalities. Interpretation: Based on preliminary data, this research suggests that building effective multidimensional healthcare capacity is the most promising means to mitigate future case fatalities. The data also suggests that government's ability to implement public health measures to a degree determines mortality outcomes.

The Effect of Country-level Factors and Government Intervention on the Incidence of COVID-19

“…Allel et al (2020) find that a delay in the government lockdown responses significantly affected the incidence rate ratios (IRR) of COVID-19 cases. Health care capacity of a country is another important determinant of pandemic preparedness (Chaudhry et al, 2020;Khan et al, 2020;Kraef et al, 2020;Mbunge, 2020). Health inequalities due to inadequate health capacity, directly affect vulnerable people (Bambra et al, 2020).…”

Demystifying the varying case fatality rates (CFR) of COVID-19 in India: Lessons learned and future directions

“…The other factors are occupational, socioeconomic and demographic characteristics, population density, the proportion of urban population, and migrant workers [6,7]. The different phases of the epidemic, the level of access to health services including testing, management of the epidemic, healthseeking behavior of the population, and efficiency of health systems are potential confounders that could affect the case fatality due to COVID-19 [8][9][10]. Screening and diagnostic testing strategies and data reporting systems adopted in countries could also play a major role in the estimation of CFR due to both, very high and low rate of identification of mild and asymptomatic cases, who have less risk of dying [11].…”

Effects of Early Mask Mandates and Other Policy Interventions on COVID-19 Infections

“…All models are estimated with robust standard errors clustered at the subcontinent level, which is at a greater geographical scale than a country, to avoid potential downward biases. 28 The rationale is that the error terms may not be perfectly independent of other neighboring countries in the same subcontinent given that there may be more signi cant virus transmission and policy diffusion among proximate countries. 29,30 We thus use 19 subcontinents: (1) North America, (2) the Caribbean and Central America,…”