2020 04 15 20066068v1 Full

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The socio-economic determinants of the coronavirus

disease (COVID-19) pandemic∗
†
Viktor Stojkoski1,2, , Zoran Utkovski3,2 , Petar Jolakoski1 ,
Dragan Tevdovski1 , and Ljupco Kocarev2,4
1 Faculty
of Economics, Ss. Cyril and Methodius University in Skopje
2 Macedonian Academy of Sciences and Arts
3 Fraunhofer Heinrich Hertz Institute
4 Faculty of Computer Science and Engineering, Ss. Cyril and Methodius University
April 15, 2020
Abstract
The magnitude of the coronavirus disease (COVID-19) pandemic has an enormous impact
on the social life and the economic activities in almost every country in the world. Besides
the biological and epidemiological factors, a multitude of social and economic criteria also
govern the extent of the coronavirus disease spread in the population. Consequently, there is an
active debate regarding the critical socio-economic determinants that contribute to the resulting
pandemic. In this paper, we contribute towards the resolution of the debate by leveraging
Bayesian model averaging techniques and country level data to investigate the potential of
35 determinants, describing a diverse set of socio-economic characteristics, in explaining the
coronavirus pandemic outcome.
1 Introduction
The coronavirus pandemic began as a simple outbreak in December 2019 in Wuhan, China. How-
ever, it quickly propagated to other countries and became a primary global threat. It seems that
most countries were not prepared for this pandemic. As a consequence, hospitals were over-
crowded with patients and death rates due to the disease skyrocketed. In particular, as of the time
of this writing (11th April 2020), there have been over 1.5 million cases and over 100 thousand
deaths worldwide as a cause of the coronavirus induced disease, COVID-191 .
∗
This is a preliminary report which includes data gathered up to 11th April 2020. It will be updated weekly so as
to only include results based on data that is not older than two weeks.
†
Corresponding author: [email protected]
1 Source: Worldometers coronavirus tracker: https://www.worldometers.info/coronavirus/
1
NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.
medRxiv preprint doi: https://doi.org/10.1101/2020.04.15.20066068; this version posted April 17, 2020. The copyright holder for this preprint
Figure 1: Histogram based on probability density estimation for the cases and deaths per million
population using country level data. The x-axis describes the observed value, whereas the y-axis is the
estimated probability density. Data taken on 11th April 2020.
In order to reduce the impact of the disease spread, most governments implemented social dis-
tancing restrictions such as closure of schools, airports, borders, restaurants and shopping malls [1].
In the most severe cases there were even lockdowns – all citizens were prohibited from leaving their
homes. This subsequently lead to a major economic downturn: stock markets plummeted, inter-
national trade slowed down, businesses went bankrupt and people were left unemployed. While
in some countries the implemented restrictions had a significant impact on reducing the expected
shock from the coronavirus, the extent of the disease spread in the population greatly varied from
one economy to another, as illustrated in Fig 1.
A multitude of social and economic criteria have been attributed as potential determinants for
the observed variety in the coronavirus outcome. Some experts say that the hardest hit countries
also had an aging population [2, 3], or an underdeveloped healthcare system [4, 5]. Others em-
phasize the role of the natural environment [6, 7]. In addition, while the developments in most
of the countries follow certain common patterns, several countries are notably outliers, both in
the number of documented cases and in the disease outcome.Having in mind the ongoing debate, a
comprehensive empirical study of the critical socio-economic determinants of the coronavirus pan-
demic would not only provide a glimpse on their potential impact, but would also offer a guidance
for future policies that aim at preventing the emergence of epidemics.
Motivated by this observation, here we perform a detailed statistical analysis on a large set
of potential socio-economic determinants and explore their potential to explain the variety in the
observed coronavirus cases/deaths among countries. To construct the set of potential determi-
nants we conduct a thorough review of the literature describing the social and economic factors
which contribute to the spread of an epidemic. We identify a total of 35 potential determinants
2
that describe a diverse ensemble of social and economic factors, including: healthcare infrastruc-
ture, societal characteristics, economic performance, demographic structure etc. To investigate
the performance of each variable in explaining the coronavirus outcome, we utilize the technique
of Bayesian model averaging (BMA). BMA allows us to isolate the most important determinants
by calculating the posterior probability that they truly regulate the process. At the same time,
BMA provides estimates for their relative impact, while also accounting for the uncertainty in the
selection of potential determinants [8–10].
Based on the current data, we observe patterns that suggest that there are only few determinants
(factors) that have explanatory power for the coronavirus outcome. As we will discuss in more
detail in the sequel, we observe that some of these factors are strongly related to the level of
economic development and to the effect of population size in social interactions. However, we
stress that at this point in time, our observations require a careful interpretation for several reasons,
including the following: (i) the analysis is based on aggregate quantities, i.e. averages across
geographic locations. As such, it does not include spatial inhomogeneity and hence can not capture
(potentially) significant interactive local dynamics; (ii) the parameters governing the time evolution
of the disease spread and pandemic outcome are themselves dynamic, and depend on the stage of
the country’s epidemic and on the changing social response efforts. While being aware of these
potential shortcomings of our formulation, in the absence of realistic models that adequately cover
all relevant aspects, this study provides the first step towards a more comprehensive understanding
of the socio-economic factors of the coronavirus pandemic. We expect that, with the availability
of new data and the improved understanding of the dynamics of the coronavirus pandemic, some
of these shortcomings will be overcome, yielding a more reliable interpretation of the results.
2 Results
2.1 Preliminaries
In a formal setting, both the log of registered COVID-19 cases and the log of COVID-19 deaths
are a result of a disease spreading process [11, 12]. The extent to which a disease spreads within a
population is uniquely determined by its reproduction number. This number describes the expected
number of cases directly generated by one case in a population in which all individuals are sus-
ceptible to infection [13, 14]. Obviously, its magnitude depends on various natural characteristics
of the disease, such as its infectivity or the duration of infectiousness [15], and the social distanc-
ing measures imposed by the government [1]. Also, it depends on a plethora on socio-economic
factors that govern the behavioral interactions within a population [16, 17].
In general, we never observe the reproduction number, but instead its outcome, i.e. the number
of cases/deaths. Hence, we can utilize the known properties of the reproduction number to derive
a linear regression model Mm for the coronavirus outcome as
yi = β0 + βmT Xm
i + γsi + δ di + ui ,
where for simplicity we denote both the log of registered COVID-19 cases per million population
and the log of COVID-19 deaths per million population of country i as yi . We focus on regis-
tered quantities normalized on per capita basis for the dependent variable instead of raw values
3
as a means to eliminate the bias in the outcome arising as a consequence of the discrepancies
in the sizes of the studied countries. In the equation, Xm i it is a km dimensional vector of socio-
economic explanatory variables that determine the dependent variable, βm is the vector describing
their marginal contributions, β0 is the intercept of the regression, and ui is the error term. The si
term controls for the impact of social distancing measures of the countries, and γ is its coefficient.
Finally, we also include the term di , with δ capturing its marginal effect, that measures the dura-
tion of the pandemics within the economy. This allows us to control for the possibility that the
countries are in a different state of the disease spreading process.
A central question which arises is the selection of the independent variables in Mm . While
the literature review offers a comprehensive overview of all potential determinants, in reality we
are never certain of their credibility. In order to circumvent the problem of choosing a model and
potentially ending up with a wrong selection, we resort to the technique of Bayesian Model Aver-
aging (BMA). BMA leverages Bayesian statistics to account for model uncertainty by estimating
each possible model, and thus evaluating the posterior distribution of each parameter value and
probability that a particular model is the correct one [18].
2.2 Baseline model

The BMA method relies on the estimation of a baseline model M0 that is used for evaluating the
performance of all other models. In our case, M0 is the model which encompasses only the effect
of government social distancing measures and the duration of the pandemics in the country.
We measure the duration of pandemics in a country simply as the number of days since the
first registered case, whereas in order to assess the effect of government restrictions we construct
a stringency index. Mathematically, the index quantifies the average daily variation in government
responses to the pandemic dynamics. As a measure for the daily variation we take the Oxford
Covid-19 stringency index2 . The Oxford Covid-19 stringency index is a composite measure that
combines the daily effect of policies on school closures, reduction of internal movement, travel
bans and other similar restrictions. For each country, we construct a weighted average of the index
from all available data since their first registered coronavirus case up to the last date of data gath-
ering. To emphasize the effect of policy restrictions implemented on an earlier date in calculating
the average value, we put a larger weight on those dates. This is because earlier restrictions have
obviously a bigger impact on the prevention of the spread of the virus. The procedure implemented
to derive the average government stringency index is described in greater detail in Section S2.1 of
the Supplementary Material (SM).
Fig 2 visualizes the results from the baseline model. We observe that the countries which had
stringer policies also had less COVID-19 cases and deaths, as expected. In addition, the countries
with longer duration of the crisis registered more cases and deaths per million population, though,
the effect of this variable is negligible.
2 More
about the index developed by the Oxford group can be read at
www.bsg.ox.ac.uk/research/publications/variation-government-responses-covid-19
4
yi = 4.47 − 1.26si + 0.00di yi = −0.00 − 0.70si + 0.03di

6
log of deaths per million population

R 2 = 0.16
log of cases per million population 8 R 2 = 0.21
6
2
4
0
2 -2
0 -4
-4 -2 0 2 -4 -2 0 2
log of government stringency log of government stringency
Figure 2: Explained variation in COVID-19 cases due to government stringency.
2.3 Socio-economic determinants

It is apparent that the baseline model can explain only a certain amount of the variations in reg-
istered covid cases/deaths. A fraction of the rest, we believe, can be attributed to various socio-
economic determinants present within a society. To derive the set of potential determinants we
conduct a comprehensive literature review. From the literature review we recognize a total of 35
potential socio-economic determinants, listed in Table 1. For a detailed description of the potential
effect of the determinants we refer to the references given in the same table, and the references
therein. In what follows, we only describe in short the potential determinants on the basis of the
socio-economic characteristic they exhibit.
Healthcare Infrastructure: The healthcare infrastructure essentially determines both the quan-
tity and quality with which health care services are be delivered in a time of an epidemic. As
measures for this determinant we include 4 variables which capture the quantity of hospital beds,
nurses and medical practitioners, as well as the quality of the coverage of essential health ser-
vices. On the one hand, studies report that well structured healthcare resources positively affect
a country’s capacity to deal with pandemic emergencies [19–25]. On the other hand, the health-
care infrastructure also greatly impacts the country’s ability to perform testing and reporting when
identifying the infected people. In this regard, economies with better structure are able to easily
perform mass testing and more detailed reporting [26–28].
National health statistics: The physical and mental state of a person play an important role in the
degree to which the individual is susceptible to a disease. It is expected that a nation composed of
unhealthy individuals should also experience greater consequences of an emergent epidemics [29–
32]. Specifically, metabolic disorders such as diabetes may intensify pandemic complications [33,
34], whereas it has been observed that communicable diseases account for the majority of deaths in
5
complex emergencies [35]. In addition, there is empirical evidence that adequate hygiene greatly
reduces the rate of mortality [36, 37]. To quantify the national health characteristics we include 6
variables that asses the level of healthiness among the studied countries.
Economic performance: We evaluate the economic performance of a country through 6 vari-

ables. This performance often mirrors the country’s ability to intervene in a case of a public
health crisis [38–42]. Variables such as GDP per capita have been used in modeling health out-
comes, mortality trends, cause-specific mortality estimation and health system performance and
finances [43, 44]. For poor countries, economic performance appears to improve health by provid-
ing the means to meet essential needs such as food, clean water and shelter, as well access to basic
health care services. However, after a country reaches a certain threshold of GDP per capita, few
health benefits arise from further economic growth. It has been suggested that this is the reason
why, contrary to expectations, the economic downturns during the 20th century were associated
with declines in mortality rates [45,46]. Observations indicate that what drives the health in indus-
trialized countries is not absolute wealth or growth but how the nation’s resources are shared across
the population [47]. The more egalitarian income distribution within a rich country is associated
with better health of population [48–51]. Nevertheless, it is also known that in better economies
the trade interactions and mobility of people is faster, which may enhance the propagation of an
transmitted disease [17, 19, 42, 52, 53].
Societal characteristics: The characteristics of a society often reveal the way in which people
interact, and thus spread the disease. In this aspect, properties such as education and media usage
reflect the level of a person’s reaction and promotion of self-induced measures for reducing the
spread of the disease [54–58]. Governing behavior such as control of corruption, rule of law or
government effectiveness further enhance societal responsibility [59,60]. There are findings which
identify the religious view as a critical determinant in the health outcome [61, 62]. Evidently,
the religion drives a person’s attitudes towards cooperation, government, legal rules, markets, and
thriftiness [63]. Finally, the way we mix in society may effectively control the spread of infectious
diseases [17, 53, 64–66]. To measure the characteristics of a society we identify 9 variables.
Demographic structure: Similarly to the national health statistics, the demographic structure
may evaluate the susceptibility of the population to a disease. Certain age groups may simply have
weaker defensive health mechanisms to cope with the stress induced by the disease [67–69]. In
addition, the location of living may greatly affect the way in which the disease is spread [70, 71].
To express these phenomena we collect 6 variables.
Natural environment: A preserved natural environment ensures healthy lives and promotes
well-being for all at all ages. In contrast, countries where natural sustainability is deteriorated
and observables such as air pollution are of immense magnitude, are also more vulnerable to epi-
demic outbreak [6, 7, 72, 73]. However, healthy natural environments also attract a plethora of
tourists and thus may help in an easier transformation from epidemic to a pandemic. We gather the
data for 4 variables which capture the essence of this socio-economic characteristic [26].
6
Determinant Measure Source Refs.

Healthcare Infrastructure
Number of physicians Physicians p.c. WDI [19–28]
Number of nurses Nurses and midwives p.c. WDI [19–28]
Number of hospital beds Hospital beds p.c. WDI [19–28]
Health coverage UHC service coverage index WDI [19–28]
National health statistics
Birth Rate Birth rate, crude p.c. WDI [29–32]
Death Rate Death rate, crude p.c. WDI [29–32]
Life expectancy Life expectancy at birth, (years) WDI [29–32]
Mortality from diabetes Mortality rate from diabetes WDI [33, 34]
Mortality from communicable diseases Mortality rate from com. diseases WDI [35]
Mortality from hygiene Mortality rate from lack of hygiene WDI [36, 37]
Economic performance
Economic development GDP p.c., PPP $ WDI [38–41, 43, 44]
Labor market Employment to population ratio (%) WDI [19, 38, 42]
Government spending Gov. health spending p.c., PPP $) WDI [26, 38–41]
Government debt Government gross debt(% of GDP) IMF [38–41, 45, 46]
Income inequality GINI index WDI [47–51]
Trade Trade (% of GDP) WDI [19, 42, 52]
Societal characteristics
Media usage % of population using internet WDI [19, 54–58]
Education Human capital index WDI [29, 54–58]
Government efectiveness Government efectiveness WGI [59, 60]
Rule of law Rule of law WGI [59, 60]
Control of corruption Control of corruption WGI [59, 60]
Religion 60%+ catholic population NM [61–63]
60%+ christian population NM [61–63]
60%+ muslim population NM [61–63]
Household size Avg. no. of persons in a household UN [17, 53, 64–66]
Demographic structure
Elderly population Population age 65+ (% of total) WDI [67–69]
Young population Population ages 0-14 (% of total) WDI [67–69]
Population size Population, total WDI [70, 71]
Rural population Rural population (% of total) WDI [70, 71]
Migration Int. migrant stock (% of population) WDI [70, 71]
Population density People per sq. km WDI [70, 71]
Natural environment
Sustainable development Ecological Footprint (gha/person) GFN [6]
Air Pollution Yearly avg P.M. 2.5 exposure SGA [7, 72, 73]
Air transport Yearly passengers carried WDI [26]
International Tourism Number of tourist arrivals WDI [26]
Table 1: List of Potential determinants of the COVID–19 pandemic.
7
2.4 BMA estimation

We use this set of determinants and estimate two distinct BMA models. In the first model the
dependent variable is the log of COVID-19 cases per million population, whereas in the second
model we investigate the critical determinants of the log of the mortality rate due to the coron-
avirus. The data gathering and preprocessing procedure is described in Section S1, whereas the
mathematical background of BMA together with our inference setup is given in Section S2.2.
Tables 2 and 3 display the respective results. In both tables, the determinants are ordered ac-
cording to their posterior inclusion probabilities (PIP), given in the second column. PIP quantifies
the posterior probability that a given determinant belongs to the “true” linear regression model.
Besides this statistic, we also provide the the posterior mean (Post mean) and the posterior stan-
dard deviation (Post Std). Post mean is an estimate of the average magnitude of the effect of a
determinant, whereas the Post Std evaluates the deviation from this value.
In the estimation procedure we a priori assume that the “true” model consists of the baseline
model and 3 additional independent variables. This implies that the prior inclusion probability of
each potential determinant is around 0.09. Hence, we can divide the determinants into four groups
according to their posterior inclusion probability value [74].
Determinants with strong evidence: (PIP > 0.5). The first group describes the determinants
which have by far larger posterior inclusion probability than the prior one, and thus there is strong
evidence to be included in the true model. We find two variables for which there is such evidence
in explaining the coronavirus cases: population size and GDP per capita (p.c.). The population size
is negatively related to the number of registered COVID-19 cases per million population, whereas
the GDP p.c. exhibits a positive effect on the same variable. In the situation of coronavirus deaths,
however, only the GDP p.c. remains a strong predictor, with a positive magnitude.
Determinants with medium evidence: ( 0.5 > PIP > 0.1). One variable displays medium ev-
idence for being a crucial socio-economic determinant of the registered COVID cases 19 – the
government health spending, with a positive impact. When looking at the BMA estimation of
COVID-19 deaths, besides this determinant, government effectiveness also shows a medium PIP
size.
Determinants with weak evidence: (0.1 >PIP> 0.01). These are determinants which have a
lower posterior than the prior probability to be included in the true model, but still may account
for some of the variations in the coronavirus outcome. For the cases per million population there
are 5 such determinants, out of which 2 have a negative impact: the percentage of the population
using internet and the mortality rate from lack of hygiene. The results suggest that life expectancy,
population density and a population consisting of majorly catholic population, have a low evidence
for having a negative marginal effect on the observed COVID-19 cases.
There are 7 determinants for which there is low evidence to be included in the true model
describing the coronavirus deaths. Four of them have a negative Post Mean: population size, rule
of law, control of corruption and mortality rate from lack of hygiene; whereas the presence of
catholic religion and the number of physicians pr capita exhibit a positive Post Mean value.
8
Determinants with negligible evidence: (PIP< 0.01). In total, we find negligible evidence for
explaining the coronavirus cases in 27 potential determinants and for explaining the coronavirus
deaths in 25 potential determinants.
Determinant PIP Post Mean Post Std

Population, total 0.9783 −0.3797 0.0976
GDP p.c., PPP 0.6696 0.4126 0.3021
Gov. health spending p.c., PPP 0.2898 0.1812 0.2896
% of population using internet 0.0285 −0.0096 0.0616
Life expectancy at birth, (years) 0.0276 0.0120 0.0785
Mortality rate from lack of hygiene 0.0234 −0.0121 0.0839
People per sq. km 0.0194 0.0029 0.0232
60%+ catholic population 0.0146 0.0021 0.0193
Population age 65+ 0.0083 0.0032 0.0414
Physicians p.c. 0.0067 0.0019 0.0299
Trade (% of GDP) 0.0056 −0.0006 0.0111
Nurses and midwives p.c. 0.0048 −0.0007 0.0136
Number of tourist arrivals 0.0043 0.0004 0.0134
Ecological Footprint (gha/person) 0.0042 −0.0005 0.0184
Yearly passengers carried 0.0039 0.0000 0.0111
Rural population (% of total) 0.0038 0.0003 0.0084
60%+ christian population 0.0037 −0.0002 0.0062
Int. migrant stock (% of population) 0.0034 0.0003 0.0093
Yearly avg P.M. 2.5 0.0033 0.0003 0.0091
Government gross debt(% of GDP) 0.0030 0.0001 0.0050
Avg. no. of persons in a household 0.0030 −0.0002 0.0078
Mortality rate from com. diseases 0.0029 −0.0002 0.0083
Mortality rate from diabetes 0.0029 −0.0001 0.0063
UHC service coverage index 0.0028 −0.0002 0.0086
Employment to population ratio (%) 0.0027 −0.0001 0.0044
GINI index 0.0027 0.0000 0.0048
Death rate, crude p.c. 0.0027 0.0000 0.0051
Government effectiveness 0.0027 0.0000 0.0073
Human capital index 0.0026 0.0001 0.0118
Population ages 0-14 0.0026 −0.0002 0.0091
Birth rate 0.0026 −0.0001 0.0086
60%+ muslim population 0.0026 0.0000 0.0043
Rule of law 0.0026 0.0000 0.0061
Control of corruption 0.0025 0.0000 0.0062
Hospital beds p.c. 0.0025 0.0000 0.0058
Table 2: BMA results with COVID-19 cases per million population as dependent variable.
9
Determinant PIP Post Mean Post Std

GDP p.c., PPP 0.7797 0.5456 0.3327
Gov. health spending p.c., PPP 0.1189 0.0735 0.2068
Government effectiveness 0.1032 −0.0485 0.1516
Physicians p.c. 0.0760 0.0436 0.1560
Rule of law 0.0583 −0.0218 0.0940
60%+ catholic population 0.0500 0.0121 0.0566
Population, total 0.0303 −0.0068 0.0417
Control of corruption 0.0298 −0.0102 0.0635
Mortality rate from lack of hygiene 0.0146 −0.0073 0.0650
Population age 65+ 0.0100 0.0048 0.0533
Yearly passengers carried 0.0077 −0.0014 0.0190
Life expectancy at birth, (years) 0.0061 0.0023 0.0354
Ecological Footprint (gha/person) 0.0059 −0.0012 0.0333
People per sq. km 0.0047 0.0006 0.0115
Number of tourist arrivals 0.0046 −0.0008 0.0144
Employment to population ratio (%) 0.0039 −0.0005 0.0094
% of population using internet 0.0038 −0.0002 0.0213
Nurses and midwives p.c. 0.0035 −0.0007 0.0156
Government gross debt(% of GDP) 0.0029 0.0003 0.0078
UHC service coverage index 0.0029 0.0007 0.0198
Human capital index 0.0028 0.0004 0.0189
60%+ christian population 0.0027 −0.0002 0.0071
Birth rate 0.0026 −0.0005 0.0183
Mortality rate from diabetes 0.0026 −0.0002 0.0089
Mortality rate from com. diseases 0.0024 −0.0004 0.0145
60%+ muslim population 0.0022 0.0001 0.0058
Avg. no. of persons in a household 0.0021 0.0000 0.0085
Int. migrant stock (% of population) 0.0021 0.0001 0.0067
Population ages 0-14 0.0021 0.0000 0.0164
Trade (% of GDP) 0.0019 0.0000 0.0048
GINI index 0.0019 0.0001 0.0055
Yearly avg P.M. 2.5 0.0019 0.0000 0.0071
Hospital beds p.c. 0.0018 0.0000 0.0068
Death rate, crude p.c. 0.0017 0.0000 0.0043
Rural population (% of total) 0.0016 0.0000 0.0049
Table 3: BMA results with COVID-19 deaths per million population as dependent variable.
3 Discussion
The preliminary analysis suggests that only a handful of socio-economic determinants are able to
explain the current extent of the coronavirus pandemic. The sole determinant strongly related to
10
both coronavirus cases and coronavirus deaths is the level of economic development. Wealthier
countries display larger susceptibility to the disease. Interestingly, besides the level of economic
development, the population size is also a credible predictor of the registered coronavirus cases per
million population, with more populated economies showing greater resistance to being infected
by the virus.
A plentiful of reasons can be used as a possible interpretation for these results. For instance,
it is known that in structured populations, the degree of epidemic spread scales inversely with
population size [75]. This is because, everything else considered, in larger populations it is easier
to identify and target the critical individuals that are susceptible to the disease [76]. In a similar
fashion, various explanations can be found for the observed effect of economic development, such
as increased population mobility and aging population. However, it could also be the case that more
developed countries have a bigger testing power and provide better evidence for the coronavirus
situation. In fact, this may be suggested by our discovery that there is a medium evidence for past
government health expenditure to be positively associated with the coronavirus outcome.
Clearly, the interpretation of our analysis requires a more detailed background due to sev-
eral reasons. Among these reasons is the fact that we include several potential determinants only
through crude approximations. In particular, the level of social mixing is given simply as the aver-
age number of persons in a household or the dominant religion in the country. We do not follow the
exact social network structures within a population. It is evident that the inhomogeneous nature of
these spatial patterns has an essential role in propagation of diseases [17]. In this regard, in future
versions of this study we aim to incorporate more detailed measures which capture the essence
of social connectedness [77] the degree of individualism [78] and/or community mobility data3 .
In addition, the spread of the coronavirus is obviously still in a transient regime. Even though,
we include a proxy for the duration of the coronavirus pandemic in each country, this essentially
hinders the development of a coherent modeling framework.
These underexpressed effects may play a significant role in the final outcome of the coronavirus
pandemic. Nonetheless, in the absence of a unifying framework covering all relevant aspects, our
investigation acts as the starting point for the development of a more comprehensive understanding
of the socio-economic factors of the coronavirus pandemic. We believe that with the availability
of new data and the improved understanding of the dynamics of the coronavirus pandemic, some
of these shortcomings will be overcome, yielding a more reliable interpretation of the results.
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17
Supplementary material
S1 Data description
The data for the dependent variable are taken from Worldometer’s 2019-20 Coronavirus tracker.
The tracker offers live coverage of country coronavirus statistics, by collecting data from sources
which include Official Websites of Ministries of Health or other Government Institutions and Gov-
ernment authorities’ social media accounts. Because national aggregates often lag behind the re-
gional and local health departments’ data, an important part of the data collection process consists
in monitoring thousands of daily reports released by local authorities. The current results were
made with data gathered on 11th April 2020.
The data used for calculation of the stringency index and the days since the first regisrered
COVID-19 case are gathered from Oxford’s COVID-19 government response tracker. Finally,
the data used for measuring the possible socio-economic determinants are gathered from 7 var-
ious sources. In particular, the collection is as follows: 25 determinants are from the World
Bank’s World Development Indicators (WDI), 3 determinants are respectively from the Nation-
master database (NM) and the World Governance Indicators (WGI), and there is 1 determinant
from the International Monetary Fund’s (IMF), the State of Global Air (SGA), the Global footprint
network (GFN) and from the United Nations (UN) database. The list of sources together with links
to their websites is given in Table S1.
Source Link
Covid cases/deaths www.worldometers.info/coronavirus
GFN data.footprintnetwork.org
Gov. Stringency covidtracker.bsg.ox.ac.uk
IMF www.imf.org/en/data
NM www.nationmaster.com
SGA www.stateofglobalair.org/engage
UN data.un.org
WDI data.worldbank.org/
WGI info.worldbank.org/governance/wgi
Table S1: List of data sources.
To reduce the noise from the data we restrict to using only countries with population above 1
million. In addition, we only use countries for which there is data on all of the potential socio-
economic determinants. Table S2 gives the countries for which all of these data was available.
18
Country
Argentina Finland Malaysia Slovakia
Australia France Mauritius Slovenia
Austria Germany Mexico South Africa
Bangladesh Gyana Morocco Spain
Belgium Greece Myanmar Switzerland
Bolivia Guatemala Netherlands Tanzania
Brazil Honduras New Zealand Thailand
Bulgaria Hungary Nigeria Turkey
Cameroon India Norway United Kingdom
Canada Indonesia Pakistan United States
Chile Iraq Panama Uganda
China Ireland Paraguay Ukraine
Columbia Israel Peru Venezuela
Costa Rica Italy Philippines Vietnam
Croatia Japan Poland Zambia
Czech Republic Jordan Portugal Zimbabwe
Dominican Rep. Kazakhstan Russia
Ecuador Kenya Rwanda
El Salvador Madagascar Serbia
Table S2: List of countries.
Altogether, we end up with data on 35 variables and 72 countries. Table S3 reports the summary
statistics of each variable. We hereby point out that as a measure of the determinant the log of the
last observed value is taken, unless otherwise stated in Table S3.
19
Variable Measure Mean Std.

Coronavirus outcome Coronavirus cases p.m.c. 4.74 2.15
Coronavirus deaths p.m.c. 1.18 2.27
Government stringency Stringency index −0.31 0.88
Epidemic duration Days since first registered casea 47.14 19.12
Healthcare Infrastructure
Number of physicians Physicians p.c. 0.31 1.18
Number of nurses Nurses and midwives p.c. 1.04 1.19
Number of hospital beds Hospital beds p.c. 0.84 0.85
Health coverage UHC service coverage index 4.23 0.22
National health statistics
Birth Rate Birth rate, crude p.c. 2.75 0.46
Death Rate Death rate, crude p.c. 2.02 0.32
Life expectancy Life expectancy at birth, (years) 4.31 0.09
Mortality from diabetes Mortality rate from diabetes 2.75 0.33
Mortality from communicable diseases Mortality rate from com. diseases 2.38 0.96
Mortality from hygiene Mortality rate from lack of hygiene 0.03 2.02
Economic performance
Economic development GDP p.c., PPP $ 9.74 0.96
Labor market Employment to population ratio (%) 4.04 0.19
Government spending Gov. health spending p.c., PPP $b 6.12 1.61
Government debt Government gross debt(% of GDP) 3.96 0.51
Income inequality GINI index 3.62 0.21
Trade Trade (% of GDP)b 4.22 0.49
Societal characteristics
Media usage % of population using internet 4.02 0.51
Education Human capital index −0.51 0.25
Government effectiveness Government effectivenessa 0.30 0.92
Rule of law Rule of lawa 0.18 1.01
Control of corruption Control of corruptiona 0.12 1.01
Religion 60%+ catholic population 0.40 0.49
60%+ christian population 0.32 0.47
60%+ muslim population 0.12 0.33
Household size Avg. no. of persons in a household 1.21 0.30
Demographic structure
Elderly population Population age 65+ (% of total) 2.21 0.72
Young population Population ages 0-14 (% of total) 3.13 0.37
Population size Population, total 17.11 1.39
Rural population Rural population (% of total) 3.36 0.68
Migration Int. migrant stock (% of population) 1.05 1.62
Population density People per sq. km 4.43 1.19
Natural environment
Sustainable development Ecological Footprint (gha/person) 1.02 0.61
Air Pollution Yearly avg P.M. 2.5 2.95 0.62
Air transport Yearly passengers carried 8.98 2.47
International Tourism Number of tourist arrivals 15.66 1.41
Table S3: Summary statistics.

a Raw values.
b 10 year averages.
20
S2 Methods
S2.1 Stringency index
To calculate our government stringency measure we make use of Oxford’s daily government strin-
gency index. Oxford’s daily government stringency index measures on a scale of 1-100 the varia-
tion in daily government responses to COVID-19 by accumulating ordinal data on country social
distancing measures on school, workplace and public transport closure; cancellation of public
events; restrictions of internal movement; control of international travel and promotion of public
campaigns on prevention of coronavirus spread.
To calculate the overall index stringency index ci (di ) at a final date di from the provided daily
indexes we implement the following procedure. Let ci (t) represent the government stringency on
day t, then our index can be estimated as
di
ci (di ) = ∑ wi(s)ci(s), (S1)
s=1
where wi (s) are the weights given to each day and s = 1 is the day of the first registered case. We
use a simple inverse weight procedure by giving larger weights to earlier dates, i.e.,
1 di 1
wi (s) = / ∑ . (S2)
s k=1 k
S2.2 Bayesian model averaging

BMA leverages Bayesian statistics to account for model uncertainty by estimating each possible
model, and thus evaluating the posterior distribution of each parameter value and probability that a
particular model is the correct one [18]. More precisely, in BMA, the posterior probability for the
parameters g(βm |y, Mm ) is calculated using Mm as:
f (y|βm , Mm )g(βm |Mm )

g(βm |y, Mm ) = . (S3)
f (y|Mm )
It is clear that the posterior probability is proportional to f (y|βm , Mm ), - the likelihood of seeing the
data under model Mm with parameters βm , and g(βm |Mm ) – the prior distribution of the parameters
included in the proposed model. By assuming a prior model probability P(Mm ) we can implement
the same rule to evaluate the posterior probability that model Mm is the true one, as
f (y|Mm )P(Mm ) f (y|Mm )P(Mm )

P(Mm |y) = = k . (S4)
f (y) ∑2n=1 f (y|Mn )P(Mn )
The term f (y|Mm ) is called the marginal likelihood of the model and is used to compare differ-
ent models to each other. The posterior model probability can also be written as
Bm0 P(Mm )
P(Mm |y) = k , (S5)
∑2n=1 Bn0 P(Mn )
21
where Bm0 is the Bayes information criterion between model Mm and the baseline model M0 . In
our case this is the model including government social distancing measures and the length of the
coronavirus crisis in the country.
With this setup, we can define the posterior distribution of β as a weighted average of the
posterior distributions of the parameters under each model using the posterior model probabilities
as weights
2k
g(β |y) = ∑ g(β |y, Mm)P(Mm|y). (S6)
j=1
Here, we are interested only in some parameters of the posterior distribution, such as the pos-
terior mean and variance of each parameter. Using equation (S6) we can calculate the posterior
mean as:
2k
E [(β |y] = ∑ E [(β |y, Mm] P(Mm|y), (S7)
m=1
and the posterior variance as:
2k 2k 2
var [(β |y] = ∑ var [(β |y, Mm] P(Mm|y) + ∑ P(Mm |y) E [(β |y, Mm ] − E [(β |y, ] . (S8)
m=1 m=1
Since the posterior mean is a point estimate of the average marginal contribution, we use it as
our measure of the effect of the determinant on the COVID-19 impact.
Another interesting statistic is the posterior inclusion probability PIPh of a variable h, which
measures the posterior probability that the variable is included in the ‘true’ model. Mathematically,
PIPh is defined as the sum of the posterior model probabilities for all of the models that include
the variable:
2k
PIPh = (P(βh 6= 0) = ∑ P(Mm |y). (S9)
m:βh 6=0
Posterior inclusion probabilities offer a more robust way of determining the effect of a variable
in a model, as opposed to using p-values for determining statistical significance of a model coef-
ficient because they incorporate the uncertainty of model selection. According to equations (S3)
and (S4), it is clear that we need to specify priors for the parameters of each model and for the
model probability itself. To keep the model simple and easily implemented here we use the most
often implemented priors. In other words, for the parameter space we elicit a prior on the error
variance that is proportional to its inverse, p(σ 2 ) ≈ 1/σ 2 , and a uniform distribution on the inter-
cept, p(α) → 1, while the Zellner’s g-prior is used for the βm parameters, and for the model space
we utilise the Beta-Binomial prior. To estimate the posterior parameters we use a Markov Chain
Monte Carlo (MCMC) sampler, and report results from a run with 200 million recorded drawings
and after a burn-in of 100 million discarded drawings. The theoretical background behind our
setup can be read in Refs. [18, 79–81].
22

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The socio-economic determinants of the coronavirus

April 15, 2020

2.2 Baseline model

yi = 4.47 − 1.26si + 0.00di yi = −0.00 − 0.70si + 0.03di

log of deaths per million population

Figure 2: Explained variation in COVID-19 cases due to government stringency.

2.3 Socio-economic determinants

Economic performance: We evaluate the economic performance of a country through 6 vari-

Determinant Measure Source Refs.

Table 1: List of Potential determinants of the COVID–19 pandemic.

2.4 BMA estimation

Determinant PIP Post Mean Post Std

Determinant PIP Post Mean Post Std

[18] Enrique Moral-Benito. Model averaging in economics: An overview. Journal of Economic

Table S1: List of data sources.

Table S2: List of countries.

Variable Measure Mean Std.

Table S3: Summary statistics.

S2.2 Bayesian model averaging

f (y|βm , Mm )g(βm |Mm )

f (y|Mm )P(Mm ) f (y|Mm )P(Mm )

and the posterior variance as:

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