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      Institutions and the uneven geography of the first wave of the COVID‐19 pandemic

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          Abstract

          This paper examines the uneven geography of COVID‐19‐related excess mortality during the first wave of the pandemic in Europe, before assessing the factors behind the geographical differences in impact. The analysis of 206 regions across 23 European countries reveals a distinct COVID‐19 geography. Excess deaths were concentrated in a limited number of regions—expected deaths exceeded 20% in just 16 regions—with more than 40% of the regions considered experiencing no excess mortality during the first 6 months of 2020. Highly connected regions, in colder and dryer climates, with high air pollution levels, and relatively poorly endowed health systems witnessed the highest incidence of excess mortality. Institutional factors also played an important role. The first wave hit regions with a combination of weak and declining formal institutional quality and fragile informal institutions hardest. Low and declining national government effectiveness, together with a limited capacity to reach out across societal divides, and a frequent tendency to meet with friends and family were powerful drivers of regional excess mortality.

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          Most cited references39

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          Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: a quick online cross-sectional survey

          Unprecedented measures have been adopted to control the rapid spread of the ongoing COVID-19 epidemic in China. People's adherence to control measures is affected by their knowledge, attitudes, and practices (KAP) towards COVID-19. In this study, we investigated Chinese residents' KAP towards COVID-19 during the rapid rise period of the outbreak. An online sample of Chinese residents was successfully recruited via the authors' networks with residents and popular media in Hubei, China. A self-developed online KAP questionnaire was completed by the participants. The knowledge questionnaire consisted of 12 questions regarding the clinical characteristics and prevention of COVID-19. Assessments on residents' attitudes and practices towards COVID-19 included questions on confidence in winning the battle against COVID-19 and wearing masks when going out in recent days. Among the survey completers (n=6910), 65.7% were women, 63.5% held a bachelor degree or above, and 56.2% engaged in mental labor. The overall correct rate of the knowledge questionnaire was 90%. The majority of the respondents (97.1%) had confidence that China can win the battle against COVID-19. Nearly all of the participants (98.0%) wore masks when going out in recent days. In multiple logistic regression analyses, the COVID-19 knowledge score (OR: 0.75-0.90, P<0.001) was significantly associated with a lower likelihood of negative attitudes and preventive practices towards COVID-2019. Most Chinese residents of a relatively high socioeconomic status, in particular women, are knowledgeable about COVID-19, hold optimistic attitudes, and have appropriate practices towards COVID-19. Health education programs aimed at improving COVID-19 knowledge are helpful for Chinese residents to hold optimistic attitudes and maintain appropriate practices. Due to the limited sample representativeness, we must be cautious when generalizing these findings to populations of a low socioeconomic status.
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            Why inequality could spread COVID-19

            Pandemics rarely affect all people in a uniform way. The Black Death in the 14th century reduced the global population by a third, with the highest number of deaths observed among the poorest populations. 1 Densely populated with malnourished and overworked peasants, medieval Europe was a fertile breeding ground for the bubonic plague. Seven centuries on—with a global gross domestic product of almost US$100 trillion—is our world adequately resourced to prevent another pandemic? 2 Current evidence from the coronavirus disease 2019 (COVID-19) pandemic would suggest otherwise. Estimates indicate that COVID-19 could cost the world more than $10 trillion, 3 although considerable uncertainty exists with regard to the reach of the virus and the efficacy of the policy response. For each percentage point reduction in the global economy, more than 10 million people are plunged into poverty worldwide. 3 Considering that the poorest populations are more likely to have chronic conditions, this puts them at higher risk of COVID-19-associated mortality. Since the pandemic has perpetuated an economic crisis, unemployment rates will rise substantially and weakened welfare safety nets further threaten health and social insecurity. Working should never come at the expense of an individual's health nor to public health. In the USA, instances of unexpected medical billings for uninsured patients treated for COVID-19 and carriers continuing to work for fear of redundancy have already been documented. 4 Despite employment safeguards recently being passed into law in some high-income countries, such as the UK and the USA, low-income groups are wary of these assurances since they have experience of long-standing difficulties navigating complex benefits systems, 4 and many workers (including the self-employed) can be omitted from such contingency plans. The implications of inadequate financial protections for low-wage workers are more evident in countries with higher levels of extreme poverty, such as India. In recent pandemics, such as the Middle East respiratory syndrome, doctors were vectors of disease transmission due to inadequate testing and personal protective equipment. 5 History seems to be repeating itself, with clinicians comprising more than a tenth of all COVID-19 cases in Spain and Italy. With a projected global shortage of 15 million health-care workers by 2030, governments have left essential personnel exposed in this time of need. Poor populations lacking access to health services in normal circumstances are left most vulnerable during times of crisis. Misinformation and miscommunication disproportionally affect individuals with less access to information channels, who are thus more likely to ignore government health warnings. 6 With the introduction of physical distancing measures, household internet coverage should be made ubiquitous. The inequitable response to COVID-19 is already evident. Healthy life expectancy and mortality rates have historically been markedly disproportionate between the richest and poorest populations. The full effects of COVID-19 are yet to be seen, while the disease begins to spread across the most fragile settings, including conflict zones, prisons, and refugee camps. As the global economy plunges deeper into an economic crisis and government bailout programmes continue to prioritise industry, scarce resources and funding allocation decisions must aim to reduce inequities rather than exacerbate them.
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              Correlation between climate indicators and COVID-19 pandemic in New York, USA

              This study analyzed the association between COVID-19 and climate indicators in New York City, USA. We used secondary published data from New York city health services and National weather service, USA. The climate indicators included in the study are average temperature, minimum temperature, maximum temperature, rainfall, average humidity, wind speed, and air quality. Kendall and Spearman rank correlation tests were chosen for data analysis. We find that average temperature, minimum temperature, and air quality were significantly associated with the COVID-19 pandemic. The findings of this study will help World Health Organization and health regulators such as Center for Disease Control (CDC) to combat COVID-19 in New York and the rest of the world.
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                Author and article information

                Contributors
                a.rodriguez-pose@lse.ac.uk
                Journal
                J Reg Sci
                J Reg Sci
                10.1111/(ISSN)1467-9787
                JORS
                Journal of Regional Science
                John Wiley and Sons Inc. (Hoboken )
                0022-4146
                1467-9787
                07 June 2021
                : 10.1111/jors.12541
                Affiliations
                [ 1 ] Cañada Blanch Centre, Department of Geography and Environment London School of Economics London UK
                [ 2 ] Social Sciences Gran Sasso Science Institute L'Aquila Italy
                Author notes
                [*] [* ] Correspondence Andrés Rodríguez‐Pose, Cañada Blanch Centre, Department of Geography and Environment, London School of Economics, London, UK.

                Email: a.rodriguez-pose@ 123456lse.ac.uk

                Author information
                http://orcid.org/0000-0002-8041-0856
                http://orcid.org/0000-0002-1914-8772
                Article
                JORS12541
                10.1111/jors.12541
                8242880
                34226760
                02ce37f3-7dde-4d1e-8c47-1c32e3cc6f3a
                © 2021 The Authors. Journal of Regional Science published by Wiley Periodicals LLC

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 29 March 2021
                : 21 April 2021
                Page count
                Figures: 5, Tables: 4, Pages: 25, Words: 11397
                Categories
                H75
                O43
                R58
                Research Article
                Research Articles
                Custom metadata
                2.0
                corrected-proof
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.2 mode:remove_FC converted:30.06.2021

                covid‐19,europe,institutions,pandemic,regions
                covid‐19, europe, institutions, pandemic, regions

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