Deaths during the first year of the COVID-19 pandemic: insights from regional patterns in Germany and Poland.

BACKGROUND: Given the nature of the spread of SARS-CoV-2, strong regional patterns in the fatal consequences of the COVID-19 pandemic related to local characteristics such as population and health care infrastructures were to be expected. In this paper we conduct a detailed examination of the spatial correlation of deaths in the first year of the pandemic in two neighbouring countries - Germany and Poland, which, among high income countries, seem particularly different in terms of the death toll associated with the COVID-19 pandemic. The analysis aims to yield evidence that spatial patterns of mortality can provide important clues as to the reasons behind significant differences in the consequences of the COVID-19 pandemic in these two countries. METHODS: Based on official health and population statistics on the level of counties, we explore the spatial nature of mortality in 2020 in the two countries - which, as we show, reflects important contextual differences. We investigate three different measures of deaths: the officially recorded COVID-19 deaths, the total values of excessive deaths and the difference between the two. We link them to important pre-pandemic regional characteristics such as population, health care and economic conditions in multivariate spatial autoregressive models. From the point of view of pandemic related fatalities we stress the distinction between direct and indirect consequences of COVID-19, separating the latter further into two types, the spatial nature of which is likely to differ. RESULTS: The COVID-19 pandemic led to much more excess deaths in Poland than in Germany. Detailed spatial analysis of deaths at the regional level shows a consistent pattern of deaths officially registered as related to COVID-19. For excess deaths, however, we find strong spatial correlation in Germany but little such evidence in Poland. CONCLUSIONS: In contrast to Germany, for Poland we do not observe the expected spatial pattern of total excess deaths and the excess deaths over and above the official COVID-19 deaths. This difference cannot be explained by pre-pandemic regional factors such as economic and population structures or by healthcare infrastructure. The findings point to the need for alternative explanations related to the Polish policy reaction to the pandemic and failures in the areas of healthcare and public health, which resulted in a massive loss of life.

Worries about inadequate medical treatment in case of a COVID-19 infection: the role of social inequalities, COVID-19 prevalence and healthcare infrastructure.

BACKGROUND: This study investigates individual and regional determinants of worries about inadequate medical treatment in case of a COVID-19 infection, an important indicator of mental wellbeing in pandemic times as it potentially affects the compliance with mitigation measures and the willingness to get vaccinated. The analyses shed light on the following questions: Are there social inequalities in worries about inadequate medical treatment in case of a COVID-19 infection? What is the role of the regional spread of COVID-19 infections and regional healthcare capacities? METHODS: Based on data derived from the German Socioeconomic Panel (SOEP), a representative sample of the German population aged 18 years and over, we estimated multilevel logistic regression models with individual-level (level 1) and regional-level (level 2) variables. The regional variables of interest were (a) the number of COVID-19 infections, (b) the number of hospital beds as an overall measure of the regional healthcare capacities, and (c) the number of free intensive care units as a measure of the actual capacities for treating patients with severe courses of COVID-19. RESULTS: Women, older respondents, persons with migrant background and those with a lower socioeconomic status were more likely to report worries about inadequate medical treatment in case of a COVID-19 infection. Moreover, respondents with chronic illness, lower subjective health and those who consider COVID-19 as a threat for their own health were more likely to report worries. In addition, also regional characteristics were relevant. Worries were more common in poorer regions with higher COVID-19 infections and worse health infrastructure as indicated by the number of hospital beds. CONCLUSIONS: The analysis not only indicates that several social groups are more concerned about inadequate medical treatment in case of a COVID-19 infection, but also highlights the need for considering regional-level influences, such as the spread of the virus, poverty rates and healthcare infrastructure, when analyzing the social and health-related consequences of the pandemic.

[Changes in well-being and private support for older people: a closer look at the impact of the COVID-19 pandemic in early summer 2020]. / Veränderungen von Wohlbefinden und privater Unterstützung für Ältere: ein Blick auf die Auswirkungen der COVID-19-Pandemie im Frühsommer 2020.

BACKGROUND: The pilot study "Health and Support in Times of Corona" (TU Dortmund University) collected data on support and well-being of individuals aged 40 plus years in the light of the first wave of the COVID-19 pandemic from May to July 2020. OBJECTIVE: The aim was to study the social and mental effects of the pandemic. We focused on individuals living in private households aged 40 years and older. Participants were asked about pandemic-related changes in receiving and providing support (e.g. personal care, help with household chores), problems arising in taking care of older persons and changes in well-being. MATERIAL AND METHODS: We conducted descriptive and multivariate analyses to show how support changed, problems with support came up and well-being changed in the light of the pandemic and how all this was related. RESULTS: Due to the pandemic older respondents in particular were no longer able to provide the necessary support for others. Especially women reported problems in taking care of older individuals. We found a decrease in well-being for all respondents but most significantly for women and individuals aged 80 years and older. Moreover, problems in the provision of care due to the pandemic and lower well-being were clearly linked. CONCLUSION: Our study showed significant changes in support patterns and well-being due to the COVID-19 pandemic. A substantial part of the respondents reported more loneliness and lower life satisfaction compared to before the pandemic, especially women supporting others. In these pandemic times, informal caregiving is severely hampered. Future pandemic-related measures should be carefully planned bearing such issues in mind.