Flexible societies excelled in saving lives in the first phase of the COVID-19 pandemic.

Background: Previous studies have shown that national cultural traits, such as collectivism-individualism and tightness-looseness, are associated with COVID-19 infection and mortality rates. However, although East Asian countries have outperformed other countries in containing COVID-19 infections and lowering mortality in the first pandemic waves, no studies to date have examined flexibility-monumentalism, a cultural trait that uniquely distinguishes East Asia from the rest of the world. Moreover, none of the previous studies have explored mechanisms underpinning the association between national culture and COVID-19 mortality. Aims: Our study fills in these gaps by examining the association between flexibility-monumentalism and COVID-19 mortality, adjusting for important covariates and by analyzing mask wearing and fear of COVID-19 during the first weeks of the pandemic as plausible mechanisms underpinning this association. Methods: We constructed and analyzed a dataset including 37 countries that have valid information on flexibility-monumentalism, COVID-19 deaths as of 31 October 2020 (before the start of vaccination campaigns), and relevant covariates including two other national cultural traits (individualism-collectivism and tightness-looseness) and other national characteristics (economic, political, demographic and health). Multiple linear regression with heteroscedasticity-consistent standard errors was used to assess the independent effect of flexibility-monumentalism on COVID-19 mortality. Mediation was assessed by examining the indirect effects of flexibility through mask wearing and fear of COVID-19 and determining the statistical significance through bootstrapping. Graphical and delete-one analysis was used to assess the robustness of the results. Results: We found that flexibility was associated with a significant reduction in COVID-19 mortality as of 31 October 2020, independent of level of democracy,