key: cord-0989364-9khwum9a
authors: Hussein, M. R.; AlSulaiman, T.; Habib, M. F.; Awad, E. A.; Morsi, I.; Herbold, J. R.
title: The Relationship between Democracy embracement and COVID-19 reported casualties worldwide
date: 2021-01-13
journal: nan
DOI: 10.1101/2021.01.11.21249549
sha: ec5abec330b894d64f53024bca72ffe0fda57488
doc_id: 989364
cord_uid: 9khwum9a

Abstract: Background: The COVID-19 toll of cases and deaths followed an uneven pattern across the world. The literature has partly explained the observed discrepancy between the different countries by country-specific and systemic patterns worldwide. In this study, we propose an additional explanation that the magnitude of COVID-19 toll reported to the WHO could be influenced by the level of free speech and Democracy in the reporting countries. Methods: We constructed a longitudinal dataset including the daily COVID-19 count of cases and deaths worldwide and each country's respective score on the Freedom in the World index. We applied two Generalized Estimating Equation models to investigate if a country's reported toll count of COVID-19 cases and deaths is related to that country's freedom level. We controlled for factors identified in the current literature to affect the pandemic's spread. Results: A country's score on the Freedom In the World Index was associated with its reported COVID-19 cases count (57028.43, 95% CI 985.3619 - 113071.5, P= 0.0461) and deaths count (3473.273, 95% CI1217.12-5729.42, P=.002). Also, despite having almost equal shares of the world's population, countries at the bottom category of the Freedom index reported 21% and 11% of the COVID-19 toll cases and death counts reported by countries of highest scores on the index, respectively. Conclusions: The known magnitude of the COVID-19 pandemic's morbidity and mortality is likely as transparent about the reality only as much as the reporting countries uphold free speech and Democracy. This could potentially misguide international aid and global vaccine distribution plans.

Introduction: 25 Concurrent to the news on COVID-19 vaccines, the question has arisen on the order of priority in 26 distributing them. On the national level in the United States, the CDC was prompt to establish 27 broad vaccine distribution phases. 1 On the international level, the debate is escalating on balance 28 between some countries' financial ability to secure their vaccine supplies and the needs of mid 29 and low-income countries. 2 A critical, yet not fully verified, assumption basing many of the 30 involved public health and logistic considerations is that the information we have on the COVID19 31 global spread is independent and transparent enough to be an accurate representation of its real 32 impact. In this research, we examined the validity of this assumption on the global level. 33 Since the beginning of the epidemic, multiple factors cast doubt on the COVID-19 toll calculations' 34 accuracy in different countries. There was a lack of consistency in selecting high-risk population 35 groups that some countries initially monitored for COVID-19. 3 Government authorities 36 worldwide used various combinations of clinical, epidemiological, and laboratory confirmation 37 requirements to determine which cases constitute COVID-19 cases as the primary ailment. 4 The 38 types, availability, and accuracy of the testing kits used in screening for COVID - 

. CC-BY 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 13, 2021. ; https://doi.org/10.1101/2021.01.11.21249549 doi: medRxiv preprint Another observation, which the current literature has not fully explained yet, is the discrepancy 52 between countries in their counts of COVID-19 cases and deaths. 8 The full explanation of this 53 observation could reveal what makes a country more vulnerable to COVID-19 and which 54 countries are the hotspots of the epidemic and logistic priorities in vaccine distribution. 9 The 55 literature has proposed factors of weather, location, health care infrastructure, aging population, 56 and others. These explanations could only partly decipher the epidemic's spread pattern. 10 In 57 this study, we proposed an additional explanation that identifies a potential barrier to equitable CC-BY 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 13, 2021. ;

The observation unit was daily country. We collected records of confirmed COVID-19 impact 78 reported to the WHO from world countries. Our study dataset tracked 182 countries over 242 79 days from January 23, 2020, to September 20, 2020. 80 Outcome of Interest: 81 We examined the cumulative daily counts of confirmed COVID-19 cases and deaths from the For example, the currently available information led some research efforts to investigate a 153 perceived observation that the pandemic has not affected low-income countries as it did with 154 high-income countries. One explanation was that rich countries could afford broader screening 155 efforts, which will ultimately detect a higher number of cases than other countries. Yet, this 156 . CC-BY 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 13, 2021. ; https://doi.org/10.1101/2021.01.11.21249549 doi: medRxiv preprint study's findings could propose an entirely different explanation considering that many low-157 income countries also have low embracement of Democracy. 158 Another example is the apparent association between colder temperatures and the spread of the 159 virus, which led some to believe that the summer would restrain the epidemic early in the 160 epidemic's timeline. 19 Some researchers suggest that this misperception probably deterred the 161 COVID-19 response in the summer of 2020 by encouraging complacency in following social 162 distancing measures, at least in part. 20 Yet, in the light of the findings in this study, we could 163 consider the possibility that the low COVID-19 impact in hot countries in areas like Africa could 164 be partially coming from a lack of Freedom of speech and low Democracy. 165 In future consideration, the perceived impact of the epidemic could be a key element in allocating 166 international aid and vaccine quotas to developing countries. Considering the findings, the 167 international organizations and vaccine manufacturers will likely deprioritize aid to some 168 countries based on their low toll of COVID-19 cases and deaths, which could be, at least in part, 169 because of a lack of transparency in reporting the reality of the COVID-19 situation in them. This CC-BY 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 13, 2021. ; https://doi.org/10.1101/2021.01.11.21249549 doi: medRxiv preprint 8 political capital, which might not be fully representative of the weather in all that country's 185 regions. Fourth, the study's analysis does not divulge the causality considerations underlying the 186 findings, which could be an area for further research.

The authors declared no potential conflicts of interest with respect to the research, authorship, 189 and/or publication of this article. 190 . CC-BY 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 13, 2021. ; https://doi.org/10.1101/2021.01.11.21249549 doi: medRxiv preprint Figure 1 191 . CC-BY 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 13, 2021. ; https://doi.org/10.1101/2021.01.11.21249549 doi: medRxiv preprint . CC-BY 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 13, 2021. ; https://doi.org/10.1101/2021.01.11.21249549 doi: medRxiv preprint

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