The Relationship between Democracy embracement and COVID-19 reported casualties worldwide

Hussein, M. R.; AlSulaiman, T.; Habib, M. F.; Awad, E. A.; Morsi, I.; Herbold, J. R.

Abstract: Background: The COVID-19 toll of cases and deaths followed an uneven pattern across the world. The literature has partly explained the observed discrepancy between the different countries by country-specific and systemic patterns worldwide. In this study, we propose an additional explanation that the magnitude of COVID-19 toll reported to the WHO could be influenced by the level of free speech and Democracy in the reporting countries. Methods: We constructed a longitudinal dataset including the daily COVID-19 count of cases and deaths worldwide and each country's respective score on the Freedom in the World index. We applied two Generalized Estimating Equation models to investigate if a country's reported toll count of COVID-19 cases and deaths is related to that country's freedom level. We controlled for factors identified in the current literature to affect the pandemic's spread. Results: A country's score on the Freedom In the World Index was associated with its reported COVID-19 cases count (57028.43, 95% CI 985.3619 - 113071.5, P= 0.0461) and deaths count (3473.273, 95% CI1217.12-5729.42, P=.002). Also, despite having almost equal shares of the world's population, countries at the bottom category of the Freedom index reported 21% and 11% of the COVID-19 toll cases and death counts reported by countries of highest scores on the index, respectively. Conclusions: The known magnitude of the COVID-19 pandemic's morbidity and mortality is likely as transparent about the reality only as much as the reporting countries uphold free speech and Democracy. This could potentially misguide international aid and global vaccine distribution plans.