Restriction or containment policies (e.g., business and workplace closures, travel bans and restrictions, compulsory facemask coverings, mandatory vaccinations, etc.) can prevent high numbers of Coronavirus Disease 2019 (COVID-19) related infected individuals and deaths. However, one of the critical questions is varying degrees of strictness in containment policies to cope with negative effects of COVID-19 pandemic crisis in environment and society. This study confronts the question here by developing a comparative analysis between countries with high and low levels of strictness in containment measures to assess the effectiveness of their policy responses to cope with high numbers of infections and deaths of COVID-19 in society. A homogenous sample of 31 countries having a level of Gross Domestic Product (GDP) per capita higher than U$16,000 are categorized in two sets: countries with high or low containment index (100 = highest restrictions and strictness). The findings here seem to be that countries with a containment index lower than 50 (i.e., lower degree of strictness) have average COVID-19 confirmed cases on population (24.69% vs. 26.06%) and fatality rates (74.33% vs = 76.38%) lower than countries with high level of containment index (about 60). This empirical evidence reveals that government responses based on high degrees of strictness seem to be ineffective to cope with COVID-19 pandemic crisis because can create socioeconomic issues. This study suggests that one of the best strategy of prevention of high numbers of deaths of new airborne diseases generating respiratory disorders is based on high levels of investment in health sector and in particular, high investments in new sustainable technology of medical ventilators that can reduce negative effects of emerging infectious diseases similar to COVID-19, when specific drugs lack and/or need months or years for process of drug discovery.
Research Article
Restriction policies and effects of COVID-19 pandemic in environment: analysis and role of sustainable technology to cope with future pandemics
https://doi.org/10.21203/rs.3.rs-1566878/v1
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COVID-19
Non-Pharmaceutical Interventions
Containment Policy
Health Policy
Containment Index
Stringency Index
Infections
Fatality Rate
Medical Ventilation
Sustainable Technology
Vaccinations
In the presence of a temporary emergency, such as Coronavirus Disease 2019 (COVID-19) pandemic crisis, countries apply health policies based on varying degrees of containment measures having the objective to mitigate and/or stop transmission dynamics of infections and consequently reduce the numbers of deaths (Anttiroiko, 2021; Bontempi et al., 2021; Bontempi and Coccia, 2021; Coccia, 2020, 2022; Nicoll and Coulombier, 2009; Vinceti et al., 2021). Government responses to cope with COVID-19 can range from a low degree of restrictions to a high degree of restrictions and strictness, such as a long period of full lockdowns and quarantines, travel bans and restrictions at domestic and international level, compulsory facemask coverings, temporary impositions to circulate that reduce public and private life of people in society, etc. (Allen, 2022; Askitas et al., 2021; Flaxman et al., 2020; Wieland, 2020). The strictness of policy responses to face COVID-19 pandemic crisis is measured with different indicators that can be combined in complex indices, such as the stringency index that measures the impositions in countries with duration of stay-at-home requirements, level of workplace and business closures, of cancellation of social, cultural and sporting events, etc. (Hale et al., 2021; Stringency Index, 2022). However, it is unknown if a high degree of restrictions measured with a high score of these containment and/or stringency indices implies a better effectiveness of country’s response to cope with COVID-19 than countries implementing lower restrictions and obligations, and lower score of these measures (Barro, 2020; Wood, 2021). This question has a critical role to design appropriate strategies of prevention and control of pandemic threats to improve best practices of crisis management that reduce the risk factors on the health of people and, consequently, on socioeconomic system and total environment (Coccia, 2021,2021a, 2022a). The goal of the study here is to confront this vital question by analyzing and assessing if high degrees of containment policies in countries, applied in 2020 and 2021, to cope with COVID-19 pandemic crisis are effective to reduce the diffusion of this new infectious disease and high numbers of deaths. In particular, the idea here is to find evidence of the effectiveness of health policy based on high degrees of restrictions and compulsory measures, widely applied by many countries, to reduce infections and fatality rates of COVID-19 compared to policy responses based on little restrictions to mitigate the pandemic impact. Findings can support the design of a new effective health policies for prevention of next evolutionary phases of COVID-19 and of future pandemics in society.
1.1 Sample
The sample is based on 31 countries belonging to the Organisation for Economic Co-operation and Development (OECD, 2022) and having a Gross Domestic Product (GDP) per capita higher than U$16,000 to have a homogenous framework for statistical analyses. Countries of the sample here are: Australia, Austria, Belgium, Canada, Czechia, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Japan, Latvia, Lithuania, Netherlands, New Zealand, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden, Switzerland, United Kingdom, United States.
1.2 Measures for statistical analyses
- Degree of strictness of health policies. Containment and Health Index, provided by The Oxford Coronavirus Government Response Tracker project, is based on thirteen indicators of government responses by countries to face COVID-19 pandemic, such as school closures, workplace and business closures, quarantines, domestic and international travel reductions, testing and tracing policies, wearing face masks, restrictions of events with gatherings (e.g., sportive and music events), cancellation of public and private events, vaccination policies, etc. This index has a range from 0=min to 100=max level of restrictions and strictness. A higher score of containment and health index does not imply a higher effectiveness of government response to cope with COVID-19 than countries with a low degree of strictness (Hale et a., 2021; Stringency Index, 2022). Average values of Containment and Health Index over January 2020 - January 2022 period.
- Wealth of nations. Gross domestic product (GDP) is the value added created through the production of goods and services in a country in a specific period. This study considers GDP per capita in 2020, constant 2010US$ (The World Bank, 2022).
- Economic growth. GDP (annual) growth rate % in 2020. It indicates the GDP volume – annual growth rate in percentage. Sources: OECD Data (2022a).
- Economic growth nominal. GDP (nominal) annual growth % in 2021. It is based on changes in real economic activity and in prices (International Monetary Fund World Economic Outlook, 2021).
- Health expenditure (% of GDP). It includes healthcare goods and services consumed during a certain year, but it does not contain health expenditures in capital, such as equipment. Period 2008-2018 (last year available). The Word Bank (2022a).
- Population total of the year 2020 is formed by all residents. Source: The World Bank (2022b).
- Vaccination is measured by percent share of people fully vaccinated against COVID-19 on 14 February 2022. The data here consider all types of COVID-19 vaccines used in different countries to protect population against this novel infectious disease and its variants. Source: Our World in Data (2022).
- COVID-19 infected individuals (%) is measured with confirmed cases of COVID-19 on 21 February 2022 divided by population. Source of data: Johns Hopkins Center for System Science and Engineering (2022).
- Mortality is measured with Case Fatality Ratio (CFR) % (on 21 February 2022). It assesses the impact of COVID-19 in society and the quality of healthcare system because a lower CFR suggests lower negative effects on health of people and also a better effectiveness of healthcare system (Coccia, 2021a; Lau et al., 2021; WHO, 2020; Wilson et al., 2020). Case Fatality Ratio (CFR) is given by:
Angelopoulos at al. (2020) maintain that Case Fatality Ratio (CFR) between countries is a critical indicator to support governments in the decision making of crisis management to cope with COVID-19 pandemic. Source of data: Johns Hopkins Center for System Science and Engineering (2022).
- Medical ventilators. Ventilators (total number, variable time span: 2015 – 2020). Source: Our World in Data (2022a).
1.3 Data analysis procedure
Firstly, the containment index (2022) of countries under study is used to categorize the sample in two sets:
- Group 1: Countries with a high degree of restrictions and mandatory measures in society to cope with COVID-19: average containment index (2022) over 2020-2022 period here is about 60 points (100=max of restrictions)
- Group 2: Countries with a low degree of restrictions and impositions for people: average containment index (2022) has a score lower than 48 points.
Secondly, descriptive statistics given by arithmetic mean and standard error of the mean of variables are calculated for two groups just mentioned. Results show a preliminary comparative analysis of the effectiveness of countries’ policy responses based on a higher /lower level of containment policies implemented in socioeconomic systems (Coccia, 2018).
Thirdly, follow-up investigation is performed with bivariate Pearson correlation and partial correlation (controlling health expenditure as % of GDP) to assess the sample correlation coefficient, r, which measures the strength and direction of linear relationships between pairs of continuous variables under study.
Fourthly, the study applies the Independent Samples T-test to determine whether there is statistical evidence that the arithmetic means of variables between groups are significantly different and that countries having a high degree of containments policies and strictness, they have also a higher effectiveness to cope with COVID-19 pandemic crisis: i.e., lower numbers of infections and total deaths.
The arithmetic mean (M) of the containment index of countries under study generates the following categorization in two groups for a comparative analysis:
-
Countries with a Low degree of restrictions and compulsory measures, average containment index over 2020–2022 (January) period = 47.821 (Std. Error 0.99)
-
Countries with a High degree of obligations and compulsory measures (higher strictness), average containment index over 2020–2022 (January) period = 59.61 (Std. Error 1.05)
| Countries with LOW restrictions | Countries with HIGH restrictions | |||
|---|---|---|---|---|
| Description of variables | M | Std. Error Mean | M | Std. Error Mean |
| Containment Index over 2020–2022 period | 47.823 | 0.987 | 59.606 | 1.054 |
| Current health expenditure % of GDP, 2008–2018 | 8.578 | 0.490 | 9.800 | 0.593 |
| Share of people fully vaccinated against COVID-19, February 2022 | 69.460 | 0.020 | 72.856 | 0.023 |
| Confirmed Cases/population (%) | 24.69 | 3.42 | 26.06 | 2.24 |
| Fatality rates %, February 2022 | 74.333 | 0.177 | 76.375 | 0.082 |
| GDP growth (annual %), 2020 (§) | -3.059 | 0.489 | -5.174 | 1.083 |
| GDP growth Nominal (annual %), 2021 (§) | 4.692 | 0.967 | 5.203 | 0.361 |
Note: M = arithmetic mean; (§) these data have missing values of some countries.
Table 1 shows that countries with high strictness of restrictions and obligations in society (average containment index of about 60) have a high level of vaccinations but also confirmed cases on population (%) and fatality rates (%) are higher than countries with a low strictness of restrictions and mandatory measures (confirmed cases 26.06% vs. 24.69% and fatality rates 76.38% vs. 74.33%, respectively in countries with high and low strictness). In addition, GDP growth (annual %), 2020 of countries with a high score of restrictions is −5.2%, a higher reduction (and lower economic growth) than countries with a low degree of restrictions and strictness (that is −3.1%), vice versa in 2021 using GDP growth nominal (annual %), though the variation is a small (0.5). This finding reveals how a high strictness of compulsory measures can block the operation of socioeconomic systems without reducing negative effects of COVID-19 pandemic crisis in society (cf., Barro, 2020). Comparative analysis of these two groups of countries also shows that average health expenditure (% of GDP) is 8.58% vs. 9.8% in countries with low vs. high levels of restrictions. In general, policy responses of high restrictions and compulsory measures seem to be ineffective to cope with COVID-19 pandemic and mitigate high numbers of infections and deaths, though a high share of vaccinations, whereas the effects on economic growth are ambiguous and deserve further investigations.
Figure 1 shows how countries with a high strictness of restrictions and compulsory measures have a higher negative impact of pandemic in society and deterioration of economic systems, though a higher level of vaccinations. This result can be explained with the fact that restrictions and mandatory measures to cope with COVID-19 are not a sufficient strategy to reduce the negative societal impact of the novel coronavirus, because there are manifold social, institutional, and environmental factors that support the diffusion and mortality of this pandemic in environment (Atkeson, 2021; Coccia, 2022b; Yao et al., 2022).
| Log Average Containment Index 2020–2022 | Log Full Vaccinated people February 2022 | Log Confirmed Cases 21 February 2022 | Log Fatality Rate 21 February 2022 | GDP growth (annual %), 2020 | |
|---|---|---|---|---|---|
| Log Average Containment Index 2020–2022 | 1 | 0.496** | 0.263 | 0.336* | −0.324* |
Note: ** Correlation is significant at the 0.01 level (1-tailed)., * Correlation is significant at the 0.05 level (1-tailed).
Table 2 shows a high positive correlation between containment index and fatality rate (r = .34, p-value .05) and full vaccinated people (r = .50, p-value .01), whereas correlation is negative with GDP growth (annual %), 2020. These results are confirmed with partial correlation, controlling average health expenditure (Table 3).
| Log Full Vaccinated people, February 2022 | Log Confirmed Cases, 21 February 2022 | Log Fatality Rate, 21 February 2022 | GDP growth (annual %), 2020 | |
|---|---|---|---|---|
| Log Average Containment Index 2020–2022 | 0.465 | 0.289 | 0.381 | −0.300 |
| Significance (1-tailed) | 0.006 | 0.064 | 0.021 | 0.057 |
Note: Control variable Log Average Health Expenditure 2008–2018
| Levene’s Test for equality of variances | T-test for equality of Means | |||||||
|---|---|---|---|---|---|---|---|---|
| F | Sig. | t | df | Sig. 2-tailed | Mean Difference | Std. Error Difference | ||
| Log Full Vaccinated people Feb. 2022 | •Equal variances assumed | 0.075 | 0.786 | -3.022 | 28 | 0.005 | -1.434 | 0.474 |
| •Equal variances not assumed | -2.99 | 25.818 | 0.006 | -1.434 | 0.479 | |||
| Log Confirmed cases 21 Feb. 2022 | •Equal variances assumed | 3.888 | 0.058 | -1.085 | 29 | 0.287 | -0.757 | 0.698 |
| •Equal variances not assumed | -1.051 | 14.606 | 0.31 | -0.757 | 0.721 | |||
| Log Fatality Rate 21 Feb. 2022 | •Equal variances assumed | 3.4 | 0.075 | -1.094 | 29 | 0.283 | -0.323 | 0.295 |
| •Equal variances not assumed | -1.075 | 21.632 | 0.294 | -0.323 | 0.301 | |||
| GDP growth (annual %), 2020 | •Equal variances assumed | 4.825 | 0.036 | 1.74 | 29 | 0.093 | 2.114 | 1.215 |
| •Equal variances not assumed | 1.78 | 20.809 | 0.09 | 2.114 | 1.188 | |||
Independent Samples T-test in Table 4 suggests a significant difference of the arithmetic means between groups of countries with high and low restrictions for full vaccinated people (p-value 0.01), whereas GDP growth (annual %) has a low significance (p-value = .1), finally fatality rate and confirmed cases have not a significant difference. In general, the statistical evidence above seems in general to support that high degree of strictness of restrictions and obligations in society are statistically insignificant because strict measures do not improve the management of COVID-19 pandemic compared to countries with little restrictions in terms of reduction of fatality rates, confirmed cases of infections and also negative effects on socioeconomic systems.
Many countries applied harsh and pervasive health policy of restrictions with the objective to reduce negative effects of COVID-19 pandemic in health and socioeconomic systems (Askitas et al., 2021; Flaxman et al., 2020). However, critical findings of this study are that the effectiveness of policy responses of countries with high degree of strictness of restrictions is statistically insignificant because the spread of COVID-19 and negative effects in terms of infections and deaths are due to a variety of factors associated with environment, good governance, investments in healthcare goods and services, infrastructures, new technology, IT and stocks of vaccines and antiviral drugs for emergencies (Coccia, 2021a, 2021b). Barro (2020) analyses non-pharmaceutical interventions and mortality in US cities during the pandemic of 1918–1919 period and shows that the estimated effect on total deaths is small. Many studies show that hard restriction policies, such as full lockdown, did not significantly reduced the number of cases and deaths (Allen, 2022; Homburg, 2020; Wieland, 2020). Moreover, health policies based on a high degree of restrictions create social and economic insecurity that negatively affect organizational and managerial behavior of firms and nations, reducing investments in capital and human resources, decreasing consumer spending and deteriorating supply-chain (Goolsbee and Syverson, 2021). In general, the containment of COVID-19 pandemic crisis depends not only on the strictness of health policies, but how these policies are applied in society, such that delayed, and poorly targeted regulatory measures can reduce the appropriateness also of the most reasonable policies of crisis management, generating a collapse of social and economic activities (Coccia, 2021b). Sweden and other Scandinavian countries adopted in 2020 and 2021 relaxed strategies of containment to cope with COVID-19 that avoided long period of lockdown and quarantine, and little hard impositions for circulation of people (Ball, 2021). In 2022, when the COVID-19 pandemic is steadily disappearing in environment and society, Sweden shows ex-post lower total fatality rates and also a higher economic performance than countries that have focused on a high degree of strictness in health policies (e.g., Italy; cf., Johns Hopkins Center for System Science and Engineering, 2022). The UK has also applied low restrictions anti-COVID/19 and in 2022 average economic performance is better and fatality rate of COVID-19 is similar or lower than countries with more restrictions (Birch, 2021, Johns Hopkins Center for System Science and Engineering, 2022). In addition, countries with manifold restrictions and obligations tend to generate complex and ambiguous rules, which constantly change with pandemic evolution, increasing fear and social insecurity that further damage people and organizations, and leading to a social and economic decline (Ball, 2021; Gore, 1994; Kufel et al., 2022). In fact, contradictory policies of containment and scientific recommendations have created confusion in many countries because a lot of initial claims were subsequently proved to be false or misleading. Many countries have showed low preparedness of crisis management for pandemic threats, applying health policies with a high degree of strictness, such as Italy, with the hope to reduce the negative impact of COVID-19 pandemic crisis but results here show that a strategy of harsh rules of containment are ineffective to cope with COVID-19, also generating negative effects on health of people and socioeconomic system (Coccia, 2021b, 2022c; Gupta et al., 2022). Moreover, policy responses based on hard restrictions cannot be fully effective if people do not trust in institutions and cannot afford to adhere to them (Raleigh, 2020; Green et al., 2021). The effectiveness of health policy responses to cope with COVID-19 is not associated with high strictness of restrictions to oblige people to certain behaviors with mandatory measures, but effective strategies depend on clear and honest communication, and on the ability to overcome aspects of misinformation for compliance with restrictions and also of vaccination campaigns (Ball, 2021; Murphy et al., 2021; Vergara et al., 2021). In general, efficient governance can support the preparedness of health system in turbulent scenarios of pandemic crisis without the necessity to apply a high degree of strictness of restrictions over public and private life (Phelan, 2020; Sagan et al., 2020). A main factor of preparedness of pandemic crisis is constant investments in health system that reinforce and prepare healthcare infrastructure to emergency in order to mitigate mortality, morbidity and stress among the population during and after a pandemic crisis (Kluge et al., 2020).
Overall, then, restriction policies and compulsory measures are directed to cope with negative effects of COVID-19 pandemic. However, statistical evidence here shows that strict measures of containment have a nonpositive effects of reduction in infections and deaths, and a negative impact that generates economic, social and psychological decline. In fact, some countries in Europe have used hard obligations to penalize people (such as those without vaccination), reducing individual freedoms, increasing the discrimination, inducing tensions between different social groups without any benefits to reduce negative effects of COVID-19 in society (Brown et al., 2021; Waitzberg et al., 2021). Saban et al. (2021) maintain, in the presence of pandemics, that policymakers should use a balanced approach to protect public health with minimum infringement on citizens' rights (cf., Luster et al., 2021).
In the presence of a global pandemic threat, one of the goals of nations is to mitigate mortality and support economic growth with appropriate health policies of varying degrees of strictness (cf., Coccia, 2021b). The results of this analysis here seem to be that a high degree of strictness in health policies (based on many restrictions and obligations) does not reduce negative effects of COVID-19 pandemic in society in terms of lower level of infections and mortality, and it can deteriorate social and economic systems.
A different strategy of prevention of future negative effects of a pandemic crisis, not based on strict policies of containments, it should be focused on high levels of investments in healthcare sectors and in particular in R&D investment in modern technologies of high-tech medical ventilator noninvasive that support the preparedness of countries to face pandemic threats but also to face the increasing incidence of chronic respiratory diseases (e.g., chronic obstructive pulmonary disease), asthma, bronchitis, and other lung disorders, the growth of smoking population and geriatric population prone to respiratory emergencies. In fact, a main factor of preparedness of pandemic crisis is constant investments in health system that reinforce and prepare healthcare infrastructure with new technologies to emergency, when effective drugs lack, in order to mitigate mortality, morbidity and stress among the population during a pandemic crisis.
In fact, an exploratory research based on a small sample of countries shows in Fig. 2 that countries with a high average number of medical ventilators per 100,000 people, they have low average fatality rates (1.46%), also with a lower percent share of people fully vaccinated against COVID-19 compared to countries with low technological equipment of medical ventilators.
These conclusions are of course tentative. There is need for much more research in these topics because not all the possible confounding factors that affect the policy responses against COVID-19 (e.g., socioeconomic and demographic elements, etc.) are taken into consideration and in future studies new factors deserve to be investigated for supporting results here (cf., Angelopoulos et al., 2020). Results here have also to be reinforced with a much more follow-up investigation based on a large sample of countries for additional analyses of the relations under study here.
Overall, therefore, the increase in the strictness of mandatory measures as a strategy of public health to cope with COVID-19 pandemic can have little effectiveness for addressing the negative effects of the pandemic and for improving economic performance of countries, also directing nations towards a flawed democracy with long-run socioeconomic issues. Although Ball (2021) argues that the diversity of pandemic outcomes and responses throughout the world makes it hard to draw any general conclusions about how science, government, policy and society can and should interact in contexts of pandemic crisis management (cf., Shattock et al., 2022). These findings bring us to suggest a different public health policy of crisis management for future pandemic threats: a general strategy implemented with little restrictions, transparent and consistent communication of rules, low sources of misinformation in social media and especially high levels of investments in healthcare sectors focused on new infrastructures and modern technologies of medical ventilators to really improve the preparedness of countries for mitigating negative effects of emergencies in society. To conclude, this study encourages further investigations to clarify the effectiveness of different levels of strictness in containment measures to cope with COVID-19 to design appropriate strategies for future pandemic threats more technology oriented that really reduce negative effects on health of people without damaging socioeconomic system.
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Authors Contributions: Mario Coccia, in the role of main author, has totally developed the following intellectual content of the paper: Conceptualization, Data curation, Formal analysis, Scientific investigation, Designed research, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing - original draft, Writing – review and editing.
Funding: none
Competing Interests: none
Availability of data and material: Data derived from public domain resources that are in references.
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