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200:oral How countries and governments tackle the COVID-19 pandemic – an analysis of the effect of COVID-19 indicators on countries’ stringency
  1. Vera Pinheiro1,2,
  2. João Vasco Santos2,3,4,
  3. Jon Cylus5
  1. 1Public Health Unit, ACES Arco Ribeirinho, ARS Lisboa e Vale do Tejo, Portugal
  2. 2Public Health Unit, ACES Grande Porto VIII – Espinho/Gaia, ARS Norte, Portugal
  3. 3MEDCIDS, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
  4. 4CINTESIS, Centre for Health Technology and Services Research, Porto, Portugal
  5. 5London School of Economics and Political Science


Introduction The global spread of COVID-19 has led to a wide range of pandemic response measures, with great heterogeneity between countries, varying mostly in time and duration of implementation. The stringency level of measures was based on different epidemiological and health services indicators. In this work, we aimed to assess the association between these indicators and the stringency level imposed by countries.

Methods We performed a retrospective observational and methodological study, using daily data on 22 EU countries between April and December 2020. The main outcome used was a composite indicator on the level of stringency of government response measures from the Oxford COVID-19 Government Response Tracker which comprises information on containment and health measures, economic response measures, health systems measures and vaccine policies measures. Lagged independent variables used were death rate, hospital bed occupancy rate, ICU occupancy rate and 14-day cumulative COVID-19 incidence. A panel data random-effects regression analysis was performed.

Results COVID-19 death rate showed the largest effect on the level of stringency of these EU countries, followed by ICU occupancy rate, hospitalization rate and COVID-19 incidence.

Discussion We show that epidemiological and health services indicators impacted the adoption of response measures to the COVID-19 pandemic differently. This highlights the different relative importance of incidence, death and pressure on health services when choosing between health and economic growth.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: .

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