Social Cohesion in Different Periods of the Pandemic: What Works in Reducing COVID-19 Mortality

Abstract Background Inconsistent results were reported regarding the effects of social cohesion dimensions on COVID-19 mortality rate (MR). Most studies have indicated that trust in civil services, but not participating in social activities, reduces COVID-19 MR, possibly because of the highly contagious nature of this disease. In this study, we investigated how the effects of various dimensions of social cohesion on COVID-19 MR vary across different phases of the pandemic. Methods This longitudinal study was conducted using data from 86 countries that participated in the 2017-2020 World Values Survey. The measures of social cohesion were identified by aggregating survey responses to the country level. COVID-19 MR was calculated-using data from the European Centre for Disease Prevention and Control-separately for three distinct periods during the pandemic (January 2021-June 2022). A factor analysis was conducted to identify the dimensions of social cohesion, and negative binomial regression models were constructed to analyze data for each period. Results The factor analysis revealed three dimensions of social cohesion: social participation and inclusion, health service equality, and trust in civil services and democracy. Our findings suggest that each dimension of social cohesion uniquely affected COVID-19 outcomes in different periods of the pandemic. Trust in civil services and a positive attitude toward democracy are strongly associated with a low COVID-19 MR. However, this association was observed only in the early and middle stages of the pandemic. By contrast, our study demonstrated that in the late stage of the pandemic, increased social participation and inclusion helped combat COVID-19. Conclusions This study underscores the importance of collective cohesion and solidarity in mobilizing public responses against pandemic situations. This study emphasizes that preventive or regulatory interventions should be tailored to different phases of a pandemic. Key messages • COVID-19 mortality rate was negatively associated with trust in civil services during the early two periods and with social participation and social inclusion during the late period of the pandemic. • This study emphasizes that preventive or regulatory interventions should be tailored to different phases of a pandemic.