State fragility and the coronavirus disease 2019 (COVID-19) pandemic: an ecologic analysis of data from 146 countries

Abstract

Background : Global spread and impact of the coronavirus disease 2019 (COVID-19) pandemic are determined to a large extent, by resistance to the pandemic and public response of all countries in the world; while a country's resistance and response are in turn determined by its political and socio economic conditions. To inform future disease prevention and control, we analyzed global data to exam the relationship between state vulnerabilities and COVID-19 incidences and deaths. Methods : Vulnerability was measured using the Fragile States Index (FSI). FSI is created by the Fund for Peace to assess levels of fragility for individual countries. Total FSI score and scores for 12 specific indicators were used as the predictor variables. Outcome variables were national cumulative COVID-19 cases and deaths up to September 16, 2020, derived the World Health Organization. Cumulative incidence rates were computed using 2019 National population derived from the World Bank, and case fatality rates were computed as the ratio of deaths/COVID-19 cases. Countries with incomplete data were excluded, yielding a final sample of 146 countries. Multivariate regression was used to examine the association between the predictor and the outcome measures. Results : There were dramatic cross-country variations in both FSI and COVID-19 epidemiological measurements. FSI total scores were negatively associated with both COVID-19 cumulative incidence rates (β = -0.0135, P < 0.001) and case fatality rates (β = -0.0147, P < 0.05). Of the 12 FSI indicators, three negatively associated with COVID-19 incidences were E1(Economic Decline and Poverty), E3 (Human Flight and Brain Drain), and S2 (Refugees and Internally Displaced Persons); two positively associated were P1 (State Legitimacy) and X1 (External Intervention). With regard to association with case fatality rates, C1 (Security Apparatus) was positive, and P3 (Human Rights and Rule of Law) and X1 was negative. Conclusions : With FSI measures by the Fund of Peace, overall, more fragile countries are less likely to be affected by the COVID-19 pandemic, and even if affected, death rates were lower. However, poor in state legitimacy and lack of external intervention are risk for COVID-19 infection and lack of security apparatus is risky for COVID-19 death. Implications of the study findings are discussed and additional studies are needed to examine the mechanisms underpinning these relationships.

Spatial clustering between socioeconomic inequalities and COVID-19 mortality rate in African continent

“…Similarly, other studies have shown the intricacy of epidemic distribution patterns characteristically triggered by various social factors, GDP, and other factors (Zhang et al, 2021). This study established that the urban population is associated with a proportion of the mortality rate of COVID-19 infectious diseases.…”

Exploring the effects of PM2.5 and temperature on COVID-19 transmission in Seoul, South Korea

“…Firstly, of several transmission dynamics of COVID-19 infectious disease discussed previously, this study partially focuses on environment and pollution-to-human transmission mechanisms, whereas the inclusion of various social factors associated with human-to-human transmission is not fully considered. Some studies show the complexity of pandemic's diffusion patterns typically caused by a multiplicity of social factors such as commercial exchanges ( Bontempi, 2020a ), GDP and other factors ( Duan et al, 2021 ), and human-to-human interactions ( Bontempi, 2021 ), requiring a multi-dimensional approach ( Bontempi et al, 2020 ). Since our study utilizes population density as a proxy of human interaction, it could be insufficient to reflect real human-to-human transmission mechanisms.…”

“…According to recent studies ( Belosi et al, 2021 ; Contini and Costabile, 2020 ), the probability of airborne virus transmission appears to be low in open environments and higher in closed ones, especially in hospitals or quarantine facilities. Therefore, to acquire in-depth understanding of COVID-19 diffusion process, it is required to consider interdisciplinary and multi-dimensional approaches, which entail virus transmission mechanisms, social acceptance of policy measures, socio-demographic features, and economic conditions ( Bontempi et al, 2020 ; Duan et al, 2021 ).…”

COVID-19 performance index for spatial assessment of pandemic management in India

“…al. [6] measured the vulnerability of coronavirus disease using Fragile States Index. It is a measure of vulnerability to COVID-19 pandemic situation, which reflects a country's responsiveness towards the dangerous events.…”