The demographic and geographic impact of the COVID pandemic in Bulgaria and Eastern Europe in 2020

Abstract

Background: The COVID-19 pandemic followed a unique trajectory in Eastern Europe compared to other heavily affected regions, with most countries there only experiencing a major surge of cases and deaths towards the end of 2020 after a relatively uneventful first half of the year. However, the consequences of that surge have not received as much attention as the situation in Western countries. Bulgaria, even though it has been one of the most heavily affected countries, has been one of those neglected cases. Methods: We use mortality and mobility data from Eurostat, official governmental and other sources to examine the development and impact of the COVID-19 pandemic in Bulgaria and other European countries. Results: We find a very high level of excess mortality in Eastern European countries measured by several metrics including excess mortality rate (EMR), P-scores and potential years of life lost. By the last metric Eastern Europe emerges as the hardest hit region by the pandemic in Europe in 2020. With a record EMR at ~0.25% and a strikingly large and mostly unique to it mortality rate in the working age demographics, Bulgaria emerges as one of the most affected countries in Eastern Europe. The high excess mortality in Bulgaria correlates with insufficient intensity of testing and with delayed imposition of lockdown measures. We also find major geographic and demographic disparities within the country, with considerably lower mortality observed in major cities relative to more remote areas (likely due to disparities in the availability of medical resources). Analysis of the course of the epidemic revealed that individual mobility measures were predictive of the eventual decline in cases and deaths. However, while mobility declined as a result of the imposition of a lockdown, it already trended downwards before such measures were introduced, which resulted in a reduction of deaths independent of the effect of restrictions. Conclusions: Large excess mortality and high numbers of potential years of life lost are observed as a result of the COVID pandemic in Bulgaria, as well as in several other countries in Eastern Europe. Significant delays in the imposition of stringent mobility-reducing measures combined with a lack of medical resources likely caused a substantial loss of life, including in the working age population.

SARS-CoV-2 reinfections during the first three major COVID-19 waves in Bulgaria

“…In this work, we analyze available reinfection data in Bulgaria prior to the emergence of the Omicron variant, when largely homologous antigenically variants were circulating. Bulgaria has been one of the most seriously affected by the pandemic countries 186 , having experienced three major COVID-19 waves in 2020-2021 and exhibiting excess mortality approaching 1% of its population within that period 187 . In the same time, only a small portion of the population has been fully vaccinated (≤30% by the end of 2021), meaning that the country provides a unique context in which the clinical impact of reinfections can be observed in a previously severely impacted population with an age structure skewed towards the elderly individuals, but without the confounding factor of high vaccination coverage.…”