Why countries had such different COVID death rates in spite of similar policies

COVID icons. Vector illustration.

January 29, 2024 – In countries that saw lower death rates during the beginning of the COVID-19 pandemic, it wasn’t so much the policies those countries instituted that kept rates low, but how quickly and flexibly they responded to the emerging outbreak, according to a new study. The researchers found that in these countries, governments and their populations more readily adopted and adhered to measures to curb transmission than in countries with higher death rates.

The study, led by Tse Yang Lim, postdoctoral research fellow in Harvard T.H. Chan School of Public Health’s Center for Communicable Disease Dynamics, was published December 4 in Health Affairs. Lim spoke about the study in a video abstract from Health Affairs as well as in a January 23 episode of the journal’s podcast, “A Health Podyssey.”

For the study, Lim and colleagues looked at data from more than 100 countries around the world. They found that, during the first two years of the pandemic, countries generally implemented similar policies, such as lockdowns, school closures, social distancing, and masking, but there was huge variation in mortality rates between countries. Factors such as wealth, health care capacity, or age distribution of the population in particular countries did not explain the divergent outcomes. Rather, the differences were largely due to how sensitive different societies were to the threat of COVID-19, how quickly they responded, and how open they were to following recommended safety measures.

“Greater responsiveness indicates a community’s willingness to adopt and adhere to various nonpharmaceutical interventions even at lower levels of perceived risk,” the co-authors wrote. They noted that variations in responsiveness were partly influenced by social and cultural factors such as greater tolerance for uncertainty—for instance, being more flexible about intermittent school closings—and being more willing to follow the mandates of a centralized government or experts.

In the podcast, Lim said the main takeaway of the study is that responding quickly to an evolving pandemic is crucial, since there is a finite set of tools countries can use to curb transmission and all of the countries in the study wound up using similar tools at some point.

“If you’re proactive—if you try to get out in front of an emerging outbreak—you get through it with relatively few cases, infections, and deaths,” said Lim. “Whereas if you are slow—if you wait until things get really bad before your hand is forced—ultimately you still need to take the same set of policy actions anyway, but…you suffer far more deaths as a result.”

Read the study: Why Similar Policies Resulted In Different COVID-19 Outcomes: How Responsiveness And Culture Influenced Mortality Rates

Watch the video abstract

Listen to the podcast: Tse Yang Lim on How Different Societal Responses Elicited Very Different Mortality Rates During COVID-19

Photo: iStock/artideadee