The impact of non-pharmaceutical interventions, demographic, social, and climatic factors on the initial growth rate of COVID-19: A cross-country study

On March 11, 2020 the World Health Organization announced that the COVID-19 disease developed into a global pandemic. In the present paper, we aimed at analysing how the implementation of Non-Pharmaceutical Interventions (NPI) as well as climatic, social, and demographic variables affected the initial growth rate of COVID-19. In more detail, we aimed at identifying and assessing all the predictors in a whole picture of the COVID-19 outbreak and the effectiveness of the response of the countries to the pandemic. It can be expected, indeed, that there is a subtle and complex interplay among the various parameters. As such, we estimated the initial growth rate of COVID-19 for countries across the globe, and used a multiple linear regression model to study the association between the initial growth rate and NPI as well as pre-existing country characteristics (climatic, social and demographic variables measured before the current epidemic began). We obtained a mean initial growth rate of 0.120 (SD 0.076), in the range 0.023-0.315. Ten (8 pre-existing country characteristics and 2 NPI) out of 29 factors considered (21 pre-existing country characteristics and 8 NPI) were associated with the initial growth of COVID-19. Population in urban agglomerations of more than 1 million, PM2.5 air pollution mean annual exposure, life expectancy, hospital beds available, urban population, Global Health Security detection index and restrictions on international movement had the most significant effects on the initial growth of COVID-19. Based on available data and the results we obtained, NPI put in place by governments around the world alone may not have had a significant impact on the initial growth of COVID-19. Only restrictions on international movements had a relative significance with respect to the initial growth rate, whereas demographic, climatic, and social variables seemed to play a greater role in the initial growth rate of COVID-19. (C) 2020 Elsevier B.V. All rights reserved.