Zoltan Rihmer, M.D., Ph.D., D.Sc., Zsuzsanna Bélteczky, M.D., Leo Sher, M.D.

COVID-19 pandemic resulted in various levels of elevated mortality in every data reporting country. According to the report of the Johns Hopkins Coronavirus Resource Center on the national COVID-19 death rates (number of deaths per 100,000 of the population) on September 27, 2021 (1), 11 out of the 15 European countries with the highest COVID-19 mortality rates are Post-Sociailst countries (73%), but only 9 out of the 31 countries on place 16-46 (29%) are Post-Socialist states. However, because of the inconsistency of the definition of COVID-19 – related death, excess mortality in the total population, recorded from the beginning of COVID-19 pandemic, is a better indicator of pandemic-related mortality than COVID-19 mortality rate per 100,000 people.  According to the data reported on September 10, 2021, among the 20 European countries with highest excess mortality 19 are Post-Socialist (95%), and Italy is the only ’outlier’ (place 18) (2, Table 1). Post-Socialist countries are neighboring states and share a common political history. It appears that the border between the countries with high and low COVID-19 mortality rates in Europe almost coincides with the ’Iron Curtain’ border between East and West during the Cold War.

COVID-19 mortality rates are related to the age distribution of the population and the general state of health of the populations of a given country, including the prevalence of obesity and smoking, vaccination rates and other factors. In contrast to the former Western European (i.e., not-Socialist countries), a poor condition of health in the general population including high morbidity and mortality rates of cardiovascular disorders, stroke, malignancies, alcoholism, as well as high prevalence of obesity and smoking, etc., and traditionally relatively low financial support of the healthcare systems (3) in the former European Socialist countries may contribute to high COVID-19 mortality rates in these countries. It is important to note that, according to the 2016 data, all but one 20 European countries (95%) with the shortest life expectancy at birth are Post-Socialist states (4). In addition, the fact that all the 18 European countries (100%) with the lowest COVID-19 vaccination rates (as of September 26, 2021) are Post-Socialist states (5) indicates that the health-conscious behavior of the population in these countries is inferior.

Suboptimal health of the general population combined with the relatively low COVID-19 vaccination rates in Post-Socialist countries can significantly contribute to the higher COVID-19 mortality rates in these countries. There is a popular saying that “You never know what the past will bring…” It should be noted that factors unrelated to the sociopolitical history such as climate or ethnicity might possibly affect the COVID-19 related death rates.

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Table 1. Excess mortality per 100,000 of the population during the COVID-19 pandemic, September 10, 2021 (Ref. 2).

	Country	Excess mortality/100,000 of the population
1.	Bulgaria	525
2.	North-Macedonia	504
3.	Russia	446
4.	Serbia	445
5.	Moldova	419
6.	Lithuania	412
7.	Belarus	358
8.	Albania	354
9.	Romania	338
10.	Czechia	328
11.	Poland	324
12.	Slovakia	318
13.	Montenegro	306
14.	Bosnia-Herzegovina	304
15.	Hungary	289
16.	Croatia	266
17.	Ukraine	247
18.	Italy	246
19.	Kosovo	227
20.	Latvia	215

Acknowledgement: The authors thank Dr. Péter Döme for his helpful comments on the manuscript.

References

1. John Hopkins University & Medicine. Coronavirus Resourse Center. Mortality Analyses. URL: https://coronavirus.jhu.edu/data/mortality Accessed: September 27, 2021
2. The Economist. Tracking covid-19 excess deaths across countries. https://www.economist.com/graphic-detail/coronavirus-excess-deaths-tracker Accessed: September 10, 2021
3. OECD/European Union (2020), Health at a Glance: Europe 2020: State of Health in the EU Cycle, OECD Publishing, Paris. URL: https://ec.europa.eu/health/sites/default/files/state/docs/2020_healthatglance_rep_en.pdf
4. List of European countries by life expectancy. https://en.wikipedia.org/wiki/List_of_European_countries_by_life_expectancy  Accessed: September 10, 2021
5. The percentage of people vaccinated by counrtry. https://www.sortiraparis.com/news/coronavirus/articles/240384-vaccine-in-the-world-as-of-datadatestodayfrlatest-the-percentage-of-people-vacci/lang/en Accessed: September 26, 2021

 Correspondence: Dr. Zoltán Rihmer, rihmer.z@kronet.hu