Czech Republic and Low COVID-19 Mortality in the Heart of Europe: Possible Explanations

Jiri Benes, M.D., PhD; Alexander M. Celko, M.D., PhD; Petr Widimsky, MD., DrSc., FESC., FACC

Eur Heart J. 2020;41(40):3876-3879.

Public Health and Epidemiology System

The country has a long tradition of regional stations for public health (hygiene) and epidemiology. Every county (with 0.5–1 million inhabitants) is served by one such station led by a professional with board certification in public health and epidemiology. These professionals organized many activities from the very beginning, especially tracing and systematic quarantine of all contacts.

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Cite this: Czech Republic and Low COVID-19 Mortality in the Heart of Europe: Possible Explanations - Medscape - Oct 21, 2020.

Abstract and Introduction
Lockdown Timing
Facemasks
Public Health and Epidemiology System
Thousands of Medical Students: Volunteers
Hospital Admissions for COVID-19
BCG Vaccine
Conclusions
References

Table 1. Possible explanation for the low COVID-19 burden in the Czech Republic
Healthcare services	Political decisions	Czech population
Hospitals restructured quickly (before the first death in the country occurred) to prepare for the COVID-19 epidemic.	Strict government regulations declared 8 days after the first confirmed case and 13 days before the first COVID-19 death.	Lack of face protection masks quickly resolved by thousands of volunteers, who produced large amounts of textile masks in a few days
Hospital beds 6.6 per 1000 inhabitants is twice more than in Italy, Spain, or the UK (Table 2).	Very early state border closure	People trust the healthcare system and do not hesitate to visit a facility as such a visit does not result in any financial burden
Public health and epidemiology services in every region immediately started tracing all positive patients.	Obligatory face protection mask wearing since day 1	While watching the news from Italy in early March, fear spread among the population and social distancing, hand washing, and facemask wearing started soon after.
Healthcare is free and widely available.		90% of population live in places with <500 000 citizens. The only large city of >1 million (Prague) has no densely populated 'ghetto'.
Over 2000 medical students as volunteers at all possible levels (first contact, population testing, hospitals, etc.)

Table 2. Hospital beds per 1000 inhabitants
Country	Hospital beds per 1000 people
Germany	8
Austria	7.4
Hungary	7
Czech Republic	6.6
Poland	6.6
France	6
Belgium	5.6
Switzerland	4.5
Greece	4.2
Portugal	3.4
The Netherlands	3.3
Italy	3.2
Spain	3
UK	2.5
Sweden	2.2

Source: https://ourworldindata.org/coronavirus.

Table 3. Relationship between lockdown timing and COVID-19 mortality
Country	No. of COVID-19 deaths per million at 6 weeks after the first COVID-19 death in the country	No. of days between the first COVID-19 case in the country and closure of schools	No. of days between the first COVID-19 death in the country and closure of schools
Greece	11.61	15	1
Czech Republic	22.88	8	–13
Hungary	28.98	6	–5
Norway	33.20	15	0
Finland	42.00	42	–10
Denmark	73.72	15	–4
Portugal	92.97	13	–2
France	166.51	51	30
UK	234.86	49	14
Italy	254.08	38	15
Spain	404.09	45	11
Belgium	540.31	39	2

Source: https://ourworldindata.org/coronavirus.

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Czech Republic and Low COVID-19 Mortality in the Heart of Europe: Possible Explanations

Public Health and Epidemiology System

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