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COVID-19 already caused more than 1,260,000 deaths around the world. However, mortality rates are not equal amongst the different countries. Mortality rates are ranging from less than 1 death per million in Taiwan, Vietnam and Thailand to 1,112 deaths per million in Belgium. In the present article, we report a striking difference in mean per million mortality between Asian and European countries (2.7 vs 197 deaths per million population, p < 0.001). In addition, we confirmed that the later a specific country was hit by the epidemic, the milder the impact on mortality during the first 50 days was. We analyzed several factors that may have contributed to this discrepancy including population age, previous experience of epidemics in the modern era, social acceptance of physical distancing and face masks, percentage of active smokers and lastly genetic prothrombotic mutations.

Introduction: In addition to the directly attributed mortality, COVID-19 is also likely to increase mortality indirectly. In this systematic review, we investigate the direct and indirect effects of COVID-19 on out-of-hospital cardiac arrests., Methods: We searched PubMed, BioMedCentral, Embase and the Cochrane Central Register of Controlled Trials for studies comparing out-of-hospital cardiac arrests occurring during the pandemic and a non-pandemic period. Risk of bias was assessed with the ROBINS-I tool. The primary endpoint was return of spontaneous circulation. Secondary endpoints were bystander-initiated cardiopulmonary resuscitation, survival to hospital discharge, and survival with favourable neurological outcome., Results: We identified six studies. In two studies, rates of return of spontaneous circulation and survival to hospital discharge decreased significantly during the pandemic. Especially in Europe, bystander-witnessed cases, bystander-initiated cardiopulmonary resuscitation and resuscitation attempted by emergency medical services were reduced during the pandemic. Also, ambulance response times were significantly delayed across all studies and patients presenting with non-shockable rhythms increased in two studies. In 2020, 3.9-5.9% of tested patients were SARS-CoV-2 positive and 4.8-26% had suggestive symptoms (fever and cough or dyspnoea)., Conclusions: Out-of-hospital cardiac arrests had worse short-term outcomes during the pandemic than a non-pandemic period suggesting direct effects of COVID-19 infection and indirect effects from lockdown and disruption of healthcare systems. Patients at high risk of deterioration should be identified outside the hospital to promptly initiate treatment and reduce fatalities. Study registration PROSPERO CRD42020195794., (Copyright © 2020 Elsevier B.V. All rights reserved.)