Figure 2 - uploaded by Antoni Rangachev
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Ratio between excess mortality and official COVID-attributed deaths in European countries in 2020. Note that the high EMR/PFR ratios for 2020 in countries like Finland and Estonia might be an artifact of overall low both excess and COVID-attributed mortality.
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Background: The COVID-19 pandemic followed a unique trajectory in Eastern Europe compared to other heavily affected regions, with most countries there only experiencing a major surge of cases and deaths towards the end of 2020 after a relatively uneventful first half of the year. However, the consequences of that surge have not received as much att...
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Context 1
... amounts to an EMR of 2,496 DPM, or ∼0.25%, for the year and ranks the country as the most highly affected within the EU ( Figure 1A; Supplementary Table 1; according to P-scores Spain, Poland and Belgium rank higher). COVID mortality is in most countries higher in males than in females 32 , and this is also what is observed in Bulgaria and most other EU countries (Figure 1B-C; Supplementary Tables 2-3). For females, an EMR of 2,178 DPM is observed (P-score of 18.79), compared to an EMR of 3,198 DPM for males (P-score of 23.99) across all ages. ...
Context 2
... observed EMR values are much higher than the officially reported COVID-attributed population fatality rate (PFR), by a factor of ∼2.3×. Examination of the EMR/PFR ratios in Europe showed that excess deaths are higher than official COVID death tolls in most countries ( Figure 2). However, a clear dichotomy emerges between Eastern and Western Europe, with the EMR/PFR ratio being considerably higher in countries in Eastern Europe such as Bulgaria, Romania, Poland, Slovakia, Lithuania, and others. ...
Context 3
... 18% of all excess deaths in Bulgaria are of people under the age of 65, in particular in the 40-64 age group (Supplementary Figure 4). Calculation of WYLL values, which show the loss of working years of life, showed Bulgaria to have incurred the highest such loss within the set of examined countries (Figure 2D-E; note that the high total WYLL value for Iceland is possibly an artifact of the small population of the country). In contrast, in countries such as Italy, France and Spain, only 18% − 19% of excess deaths are under 75 years of age. ...
Context 4
... Bulgaria, we find an average PYLL value of 13.46 ± 0.11 in total, 12.56 ± 0.03 for males, and 13.68 ± 0.24 per female (Figure 2). Excluding outliers (note that average PYLL values based on excess mortality are very high in countries such as Iceland, Luxembourg due to stochasticity associated with the very low number of excess deaths), these values are generally higher than what is seen in Western Europe. ...
Context 5
... observed EMR values are much higher than the officially reported COVID-attributed population fatality rate (PFR), by a factor of ∼2.3×. Examination of the EMR/PFR ratios in Europe showed that excess deaths are higher than official COVID death tolls in most countries (Figure 2). However, a clear dichotomy emerges between Eastern and Western Europe, with the EMR/PFR ratio being considerably higher in countries in Eastern Europe such as Bulgaria, Romania, Poland, Slovakia, Lithuania, and others. ...
Context 6
... standardized ASYR and PYLL values (per 100,000 population; Supplementary Figures 2A-C and 1), we find that the highest total loss of life among the examined countries occurred in Bulgaria, for both males and females, followed by Romania, Poland, Hungary and Czechia. This higher loss of life burden in Eastern European countries is explained not only by their high EMRs but also by a large numbers of deaths in younger age groups. ...
Context 7
... 18% of all excess deaths in Bulgaria are of people under the age of 65, in particular in the 40-64 age group (Supplementary Figure 4). Calculation of WYLL values, which show the loss of working years of life, showed Bulgaria to have incurred the highest such loss within the set of examined countries (Figure 2D-E; note that the high total WYLL value for Iceland is possibly an artifact of the small population of the country). In contrast, in countries such as Italy, France and Spain, only 18% − 19% of excess deaths are under 75 years of age. ...
Context 8
... Bulgaria, we find an average PYLL value of 13.46 ± 0.11 in total, 12.56 ± 0.03 for males, and 13.68 ± 0.24 per female (Figure 2). Excluding outliers (note that average PYLL values based on excess mortality are very high in countries such as Iceland, Luxembourg due to stochasticity associated with the very low number of excess deaths), these values are generally higher than what is seen in Western Europe. ...
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The COVID-19 pandemic followed a unique trajectory in Eastern Europe compared to other heavily affected regions, with most countries there only experiencing a major surge of cases and deaths towards the end of 2020 after a relatively uneventful first half of the year. However, the consequences of that surge have not received as much attention as th...
Citations
... An analysis of COVID-19 impact in Bulgaria confirms that excess mortality characterises more peripheral and remote areas than highly populated areas such as Plovdiv, Varna, Burgas and the city of Sofia. In fact, after a first phase where better connected territories were affected more, the spread of coronavirus to peripheral areas put these latter areas under a much greater pressure because of fewer resources 'to test, track and treat COVID-19 patients' (Rangachev et al., 2020). ...
... In addition, the analysis found that excess mortality in 2020 characterises working-age people and females in particular. This is potentially explained by the fact that several recorded outbreaks occurred at garment, textile and shoe workplaces, i.e. in plants with a mainly female workforce (Rangachev et al., 2020). In Blagoevgrad and Smolyan provinces, where excess mortality was 25% and 27%, respectively, these types of factories represent an important component of the local economy. ...
... Among the drivers of excess mortality, the analysis of Rangachev et al. (2020) mentions the limited testing, the delayed adoption of control and restriction measures, the high incidence of comorbidities, in particular related to cardiovascular diseases, and the low availability and/or accessibility of health facilities in remote areas. The data in the influencing factors' matrix ( Figure 8) 21 confirm the high incidence of comorbidities in the two Bulgarian provinces but also highlight very high shares of people at risk of poverty and social exclusion, especially in Yuzhen tsentralen (38% versus an EU average of 21%) where the fatality rate is as high as 5.3%. ...
The focus of this research is on highlighting differences among regions in terms of health impact suffered from the COVID-19 pandemic and capability of regional health systems to learn and react. Differences are discussed in terms of exposure, resilience and progress in the rollout of COVID-19 vaccinations. Special emphasis is given to identify a potential rural/urban divide. The study concludes highlighting recommendations for enhancing the resilience of regional health systems in line with the creation of a European Health Union. Several working hypotheses are made in this research which was challenged by the need to work on almost real-time data at the regional level.
The COVID-19 pandemic has resulted in more than 282 million cases and almost 5.5 million deaths (WHO Coronavirus Disease (COVID-19) Dashboard, 2022). Its impact, however, has not been uniform. This analysis examines differences in COVID-19 cases and mortality rates amongst different welfare states within the first three waves of the pandemic using repeated measures Multivariate Analysis of Covariance (MANCOVA). Liberal states fared much better on the number of COVID-19 cases, deaths, and excess deaths than the Conservative/Corporatist welfare democracies. Social Democratic countries, in turn, did not fare any better than their Conservative/Corporatist counterparts once potential confounding economic and political variables were accounted for: countries’ economic status, healthcare spending, availability of medical personnel, hospital beds, pandemic-related income support and debt relief, electoral events, and left-power mobilization. The pandemic-related welfare responses after the first wave were similar across all three types of western democracies, but the differences in pandemic outcomes remained. The somewhat better outlook of the Liberal states could be attributed to the so-called social democratization of the Anglo-American democracies, but also to the fact that neoliberalism could have flattened the previous differences between the welfare states typologies and could have brought states closer to each other, ideologically speaking, in terms of welfare provision.
