Application of distributed lag models and spatial analysis for comparing the performance of the COVID-19 control decisions in European countries.

Over the past three years, the COVID-19 outbreak has become a major worldwide problem, affecting the health systems and economies of countries. The mean delays, the expected time to observe the average effect of the number of new cases on the number of deaths, are gold times for decision-making regarding disease control and treatment facilities to reduce the fatality rate. The interest of the present study is estimating the mean delays and adjusted fatality rates of COVID-19 with the new application of Distributed Lag Models (DLM) and their spatial distributions. The daily cases and deaths data of COVID-19 for 39 European countries was obtained from two sources; the "European Centre for Disease Prevention and Control" and the "Our World in Data" database. The mean delay and the Adjusted Fatality Rate (AFR) for each country at three-time intervals; the first and subsequent peaks before and after vaccination were estimated by the Distributed Lag Models. The spatial analysis was applied to find the spatial correlation of the mean delays and adjusted fatality rates among European countries. In the three-time intervals, the first and the subsequent peaks before vaccination, and after vaccination, the median and interquartile range of the mean delays; and AFRs were: 1.1 (0.4, 3.2); 0.024 (0.016, 0.044), 9.2 (6.2, 12.40); 0.013 (0.005, 0.020) and 7.3 (4.4, 11.0); 0.001 (0.001, 0.005), respectively. In the subsequent peaks before vaccination, the mean delays considerably increased, and the AFRs decreased for most European countries. After vaccination, the AFRs decreased considerably. Except for the first peak, the spatial correlations of AFRs were not significant among neighboring countries. Consecutive outcomes will occur with delays in outbreaks of infectious disease. Also, the fatality rates for these outcomes should be adjusted on delays. Estimating the mean delays and adjusted fatality rates by Distributed lag Models and the spatial distributions of theme in outbreaks showed that prevention and medical policies after the first peak as well as vaccination were effective to reduce the fatality rate of COVID-19, but these effects were different between countries. These results recommended policymakers and governments assign prevention and medical resources more effectively.