Why Have Belarus and Other Eastern European Countries Seen Relatively Few COVID-19 Deaths?

And is their luck running out?


Belarus, whose autocratic president has barely acknowledged the coronavirus pandemic, let alone imposed a lockdown in response to it, nevertheless has seen fewer COVID-19 deaths per capita than most European countries. A recent BMJ article suggests several possible explanations, including the country's unpopularity as a vacation destination, high levels of testing in the early months of the epidemic, a large hospital capacity that made isolating COVID-19 patients easier, few nursing homes, and widespread voluntary precautions such as social distancing and mask wearing. While those hypotheses seem plausible, they do not necessarily explain trends in other Eastern European countries that, like Belarus, have seen relatively few COVID-19 deaths.

According to Worldometer's tallies, the current COVID-19 death rate in Belarus is 84 per 1 million people, less than one-tenth the rate in Belgium, about one-eighth the rate in Spain, and about one-seventh the rate in the U.K. But several other Central and Eastern European countries have similarly low rates, including Serbia (85 per million), Ukraine (83), Hungary (72), Slovenia (68) Croatia (62), Poland (61), the Czech Republic (49), and Estonia (48). Unlike Belarus, all of those countries imposed broad social and economic restrictions last spring in an attempt to reduce virus transmission.

Trends in newly identified COVID-19 cases vary widely among these countries:

• In Belarus, the seven-day average peaked in mid-May and has since fallen by 77 percent.

• In Serbia, there was an early peak in April, followed by a decline until early June, then an ascent to a new, higher peak in late July. Since then the seven-day average has fallen by 83 percent.

• Ukraine is seeing more daily new cases than ever before, following a rise that began in late July.

• In Hungary, daily new cases have risen more than 20-fold since late August.

• Slovenia has seen a sharp rise since mid-August, although not nearly as big as Hungary's.

• Croatia saw a similar upward trend until late August, when the average reached record levels. Daily new cases have fallen since then.

• In Poland, the seven-day average rose in July and August, fell in early September, and is now rising again, reaching record highs in the last few days.

• The Czech Republic saw a sharp rise in daily new cases to record levels this month, followed by a sharp drop in the last few days.

• In Estonia, daily new cases peaked in early April, fell into the single digits by early May, and have been climbing more or less steadily since late August.

COVID-19 death trends in these countries also vary widely. In Croatia, the Czech Republic, Estonia, Hungary, and Poland, the seven-day average of daily deaths peaked in April. In Belarus and Serbia, that happened in early July. Deaths reached record highs in Ukraine and Croatia last week.

Several Eastern European countries have seen substantially more COVID-19 deaths per capita, including Bulgaria (110 per million residents), Bosnia and Herzegovina (237), and Romania (234). But so far they are still doing substantially better than wealthier Western European countries such as France, the U.K., Italy, Spain, and the Netherlands.

A preprint paper published in May argued that lower COVID-19 mortality in Eastern Europe might be explained by later introduction of the virus. "Countries in Europe which observed the earliest COVID-19 circulation suffered the worst consequences in terms of health outcomes, specifically mortality," Albanian public health researcher Alban Ylli and four co-authors wrote. "The drastic social isolation measures, undertaken especially in Eastern European countries, where community circulation started after March 11th, may have been timely. This may explain their significantly lower COVID-related mortality compared with the Western European countries."

In an essay published last Friday on The Conversation, University of Cambridge sociologist Olga Löblová and two co-authors worry that recent trends suggest Eastern Europe's luck is running out: "Central and eastern Europe managed the first wave of COVID-19 in the spring well—to general surprise—but governments have since struggled. They have found it politically difficult to reintroduce restrictions after months of letting their populations live normally."

That hypothesis is consistent with the declines in daily new cases that some of these countries saw in the spring and the increases some have seen this summer. But it seems inconsistent with the experience in Belarus, which never had a lockdown but still has a relatively low fatality rate and has not seen recent increases in cases and deaths like those in Hungary, Ukraine, Croatia, and the Czech Republic. It also seems inconsistent with the findings of a recent study that looked at COVID-19 trends in 23 countries and 25 U.S. states that had seen more than 1,000 deaths from the disease by late July. UCLA economist Andrew Atkeson and his two co-authors found little evidence that variations in government policy account for the course of the epidemic in different places.