key: cord-0919331-p4c6qqp8 authors: Asem, N.; Ramadan, A. M.; Hassany, M.; Ghazy, R. M.; Abdallah, M.; Gamal, E.; Hassan, S.; Kamal, N.; Zaid, H. title: Determinants of the incidence and mortality rates of COVID-19 during the first six months of the pandemic; A cross-country study date: 2021-01-25 journal: nan DOI: 10.1101/2021.01.21.21250226 sha: 853968aea1c86454c67efbaad26662fe8486ccbb doc_id: 919331 cord_uid: p4c6qqp8 COVID-19 pandemic raises an extraordinary challenge to the healthcare systems globally. The governments are taking key measures to constrain the corresponding health, social, and economic impacts, however, these measures vary depending on the nature of the crisis and country-specific circumstances. Objectives: Considering different incidence and mortality rates across different countries, we aimed at explaining variance of these variables by performing accurate and precise multivariate analysis with aid of suitable predictors, accordingly, the model would proactively guide the governmental responses to the crisis. Methods: Using linear and exponential time series analysis, this research aimed at studying the incidence and mortality rates of COVID-19 in 18 countries during the first six months of the pandemic, and further utilize multivariate techniques to explain the variance in monthly exponential growth rates of cases and deaths with aid of a set of different predictors: the recorded Google mobility trends towards six categories of places, daily average temperature, daily humidity, and key socioeconomic attributes of each country. Results: The analysis showed that changes in mobility trends were the most significant predictors of the incidence and mortality rates, temperature and humidity were also significant but to a much lesser extent, on the other hand, the socioeconomic attributes did not contribute significantly to explaining different incidence and mortality rates across countries. Conclusion: Changes in mobility trends across countries dramatically affected the incidence and mortality rates across different countries, thus, it might be used as a proxy measure of contact frequency. The World Health Organization (WHO) estimates that approximately one-third (e.g., 20 5 million) of the annual deaths worldwide were attributed to infectious diseases. Furthermore, the R 2 of the exponential models were occasionally relatively higher than that of the linear 1 0 2 models for confirmed cases and deaths, while in most models they were nearly equal. The growth rates for confirmed cases and deaths are presented in (Figure 1 and 2) , respectively. We remarked that the increase in exponential growth in cases and deaths in a given month implies 1 0 7 for an increase in linear growth in the next month, so the highest exponential growth in March 1 0 8 implied for the highest linear growth in April 2020. This is because the exponential growth 1 0 9 multiplies the counts over time, which in turn increases the absolute counts in the next month. The monthly change in mobility trends from baseline across different place categories are 1 1 2 presented in (Figure 3) . In February 2020, mobility trends almost did not change from the except for mobility trends towards residential places. Afterwards, an inflection has occurred and 1 1 5 the median values for mobility trends increased towards all place categories until the final 1 1 6 . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) timepoint in June 2020, in which most of median values were returned to the baseline. Interestingly, the median value of mobility trends toward parks, beaches and public gardens has 1 1 8 even exceeded the baseline in June 2020 (+25%). It is worth noting that changes in mobility trends affected the exponential growth of 1 2 0 incidence and deaths in the next month. So, we can notice a decrease in mobility trends from 1 2 1 baseline in March, whose median exponential growth is the highest for cases and deaths, but we 1 2 2 can further notice a decrease in exponential growth in the next month of April. This is because 1 2 3 the confirmed cases usually get infected in a given month and been reported in the next month assessing correlation between the exponential growth rates and mobility trends in the same month. The results are presented in (Table 1) , most of the correlations were week and 1 2 7 insignificant, while when mobility trends were tested for correlation with the exponential growth Monthly lagged exponential growth rates of cases showed intermediate positive trends to workplaces (r =0.77, P< 0.01), and mobility trends to retail and recreation (r=0.688, Monthly lagged Exponential growth rates of deaths showed intermediate significant . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 25, 2021. ; https://doi.org/10.1101/2021.01.21.21250226 doi: medRxiv preprint to about 6 degrees Celsius decline in temp (0.00398/0.000679) and about 16 degrees decline 1 7 5 in relative humidity (0.00398/0.000249) ( Table 4 ). Model 2 (mortality rates): The exponential growth rate of deaths was significantly different across different tested timepoints (P<0.01). The intercept of the model was estimated at 0.20 (CI: 0.14- P=0.009) ( Table 5) . In this research we tried to address different ecological factors that could affect the March implied for the highest median linear (β)in April 2020. This is because the exponential . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 25, 2021. is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 25, 2021. ; https://doi.org/10.1101/2021.01.21.21250226 doi: medRxiv preprint . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 25, 2021. ; https://doi.org/10.1101/2021.01.21.21250226 doi: medRxiv preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 25, 2021. ; https://doi.org/10.1101/2021.01.21.21250226 doi: medRxiv preprint *. Correlation is significant at the 0.05 level (2-tailed). . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 25, 2021. ; https://doi.org/10.1101/2021.01.21.21250226 doi: medRxiv preprint *. Correlation is significant at the 0.05 level (2-tailed). . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 25, 2021. *. Correlation is significant at the 0.05 level (2-tailed). . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 25, 2021. . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 25, 2021. ; https://doi.org/10.1101/2021.01.21.21250226 doi: medRxiv preprint b. Residual is weighted by Population Density (/km2). . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted January 25, 2021. ; https://doi.org/10.1101/2021.01.21.21250226 doi: medRxiv preprint Folkers GK, Fauci AS. 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