Why Eastern Europe had the highest Covid death rates

Eastern European countries had disproportionately high Covid-19 mortality rates. Countries are ranked by their Covid death rates below.

Among the top 10 countries, only Peru is not in Eastern Europe. The majority of the next 10 countries are Eastern European. A confluence of factors is hypothesised as the cause.

Eastern European countries have the lowest numbers of hospital beds, nurses, and doctors per capita compared to the other nation groups. The already under-resourced and under-staffed health care facilities were strained beyond expectation due to the pandemic.

Healthcare was privatised relatively recently in Eastern Europe. Following the fall of communist USSR in 1991, the newly independent states were privatising their industries and transitioning to market economies.

The government believed this would lead to more efficient resource allocation and improved healthcare quality.

The transition out of communism was turbulent and economically challenging leading to reduced healthcare expenditure by the state.

The privatisation, however, worsened healthcare inequality. Those who could afford private health care pursued it, whereas those who couldn’t had to rely on underfunded public healthcare.

Privatisation can also lead to a more fragmented healthcare infrastructure. The providers may not be well-coordinated in regards to information shared, measures adopted agains Covid, and logistics.

Covid further exacerbated circumstances. Turned away by hospitals brimming with the sick, people who sought care got sicker and were more exposed to negative health outcomes.

Some Eastern European countries have relatively older populations, who are more susceptible to severe outcomes from Covid. This is reflected in the high death rates.

I found it interesting that Asian countries with poorer health infrastructure and denser populations than in Eastern Europe had much lower death rates.

There are many hypotheses attempting to explain the discrepancy. One attributes this to the difference in social behaviour and customs of people – greeting in Western culture involves closer human contact whereas hugs and kisses aren’t as common in Asia.

Another theory hypothesises that the difference in viral susceptibility and Covid mortality could be explained by the fact that people living in East Asia may have evolved to be more resistant to viral infections, including those of novel corona viruses.¹

Agriculture started around 13000 years ago in East Asia, ~3000 years ahead of Europe. This led to an increase in population and urbanisation. However, with this came an increase in viral infections like measles and mumps. Over time, Asians developed better genetic resistance to viral illnesses.

It was found that the more a child is infected in their first year, the less likely they are to develop childhood leukaemia. Asia, generally, has had a worse hygienic condition. The immunity developed from this counters Covid infection and lowers the death rate.

There are several factors that interact to cause an especially precarious predisposition to Covid infections and deaths in Eastern Europe. Hypotheses need to be validated and substantiated to explain exactly the disparate impact of Covid across regions.

References:
1. Yamamoto et al, 2020