Background: Despite worldwide efforts, control of COVID-19 transmission and of its aftereffect is lagging. As seen from the case of SARS-CoV-2 and influenza, such worldwide crisis and its side effects are likely to recur in the future because of extensive international interactions. Consequently, there is an urgent need to find the determinants that can mitigate the disease spread. Meanwhile, we observed that the transmission speed and severity of consequences varied substantially across countries, signaling the need for country-level investigation.
Objective: We aimed to investigate how distancing-enabling information and communication technology (ICT) infrastructure and medical ICT infrastructures and related policies have affected the cumulative confirmed cases, fatality rates, and initial speed of transmission across different countries.
Methods: We analyzed the determinants of COVID-19 transmission during the relatively early days of the pandemic by conducting regression analysis based on our data for country-level characteristics including their demographics, culture, ICT infrastructure, policies, economic status, and transmission of COVID-19. To gain further insights, we conducted a subsample analysis for countries with low population density.
Results: Our full sample analysis showed that implied telehealth policy, which refers to the lack of specific telehealth related policy but is referred to in general eHealth policy, was associated with lower fatality rates when controlled for cultural characteristics (p-value =.004). Particularly, the fatality rate for countries with an implied telehealth policy was lower than that for others by 2.7 percent. Interestingly, stated telehealth policy, which refers to existence of specified telehealth policy, was found not to be associated with lower fatality rates (p-value =.299). Furthermore, countries with government-run health website had 36% fewer confirmed cases than those without it, when controlled for cultural characteristics (p-value=.03). Our analysis further revealed that the interaction between implied telehealth policy and training ICT health was significant (p-value<0.01), suggesting that implied telehealth policy may be more effective when in-service training on ICT is provided to health professionals. In addition, a rate of credit card ownership, as an enabler of convenient e-commerce transactions and distancing, showed a negative association with fatality rates in full sample analysis (p-value =.04), but not in subsample analysis (p-value =.76), highlighting that distancing-enabling ICT is more useful in densely populated countries.
Conclusions: Our findings demonstrate important relationships between national traits and COVID-19 infections, suggesting guidelines for policymakers to minimize the negative consequences of pandemics. The findings suggest physicians' autonomous use of medical ICT and strategic allocation of distancing-enabling ICT infrastructure in countries with high population density to maximize efficiency. This study also encourages further research to investigate the role of health policies in combatting COVID-19 and other pandemics.