Country-level factors associated with the early spread of COVID-19 cases at 5, 10 and 15 days since the onset.

The COVID-19 pandemic is causing a significant global health crisis. As the disease continues to spread worldwide, little is known about the country-level factors affecting the transmission in the early weeks. The present study objective was to explore the country-level factors, including government actions that explain the variation in the cumulative cases of COVID-19 within the first 15 days since the first case reported. Using publicly available sources, country socioeconomic, demographic and health-related risk factors, together with government measures to contain COVID-19 spread, were analysed as predictors of the cumulative number of COVID-19 cases at three time points (t = 5, 10 and 15) since the first case reported (n = 134 countries). Drawing on negative binomial multivariate regression models, HDI, healthcare expenditure and resources, and the variation in the measures taken by the governments, significantly predicted the incidence risk ratios of COVID-19 cases at the three time points. The estimates were robust to different modelling techniques and specifications. Although wealthier countries have elevated human development and healthcare capacity in respect to their counterparts (low- and middle-income countries) the early implementation of effective and incremental measures taken by the governments are crucial to controlling the spread of COVID-19 in the early weeks.