The predictors of COVID-19 mortality among health systems parameters: an ecological study across 203 countries.

BACKGROUND: Health systems responsiveness is the key to addressing infectious disease threats such as pandemics. The paper outlines an assessment of health systems resilience by exploring the association of health systems and Global Health Security (GHS) parameters with case load and mortality resulting from COVID-19 across 203 countries using an ecological design. METHODOLOGY: Correlation analysis was performed to assess the relationship of each of the indicators with COVID 19 cases and deaths per million population. Stepwise multiple regression models were developed to determine the predictors of COVID-19 cumulative cases and deaths per million population separately. RESULTS: Global health security indicators seemed to have a strong association when analyzed individually but those did not necessarily translate into less burden of cases or deaths in the multivariable analysis. The predictors of cumulative deaths per million population included general government expenditure on health as a proportion of general government expenditure, responsiveness of the system to prevent the emergence and release of pathogens and governance related voice and accountability. CONCLUSION: To conclude, health financing parameters and preventive activities with regard to emergence of pathogens were better predictors of cumulative COVID-19 cases and deaths per million population compared to other health systems and global health security indicators.

Post-lockdown spread of COVID-19 from cities to vulnerable forest-fringe villages in Central India

Seasonal migration to cities is a common livelihood strategy for forest-fringe households in central India. Based on a previously collected household survey of 5000 villages across 500 forest-fringe villages in 32 dis-tricts of central India, we identify migration patterns over the last 5 years. Villages with seasonal workers are widely dispersed (75% of surveyed villages) and 81% of destination cities had reported COVID-19 cas-es at the beginning of the lockdown. Using a disease spread model to assess distancing strategies if return-ing migrants carry the virus to villages, we find that lenient restrictions for people within a village com-bined with maximal restrictions between villages could reduce the number of people exposed compared with moderate restrictions both within and between villages. Such a 'village bubble' strategy could reduce the risk of spread among vulnerable populations and requires that essential goods reach villages.

Assessing health systems' responsiveness in tackling COVID-19 pandemic.

Health systems' responsiveness is the key to addressing infectious disease threats such as pandemics. The article outlines an assessment of health systems based on World Health Organization's building blocks for select countries. It also compares these with the findings from a more comprehensive analysis of Global Health Security (GHS) Index, which assesses the preparedness of the health system for such pandemics. The GHS report (2019) spelt out very objectively that none of the countries of the world was prepared to effectively handle such emergencies, should they arise. Observations emerging from different countries highlight these findings although some of them seem to be discordant. Overall, it appears that Asian countries could fight the battle better than most developed nations in the Europe and America during the current pandemic, despite having poor GHS scores. Experiences of these countries in facing similar crisis in the past probably sensitized their strained health systems for a greater good. There are several lessons to be learned from such countries.