Black Sea Bulletin: COVID-19 in the Black Sea region

The spread of novel coronavirus COVID-19 has resulted in global pandemics, followed by an abrupt economic crisis, as economies stood still in order to overcome the threat to people’s lives. In this bulletin, we overview the readiness to the healthcare and economic crisis, the evolution of the pandemic, and characteristics of the lockdown for the six countries in the Black Sea Region.

Preparedness for the crisis

First, it is interesting to observe how prepared the countries were for a healthcare emergency like current pandemic. The Global Health Security (GHS) Index is a comprehensive assessment and a benchmarking tool of health security and related capabilities across 195 countries, and it can be used as a proxy of countries’ readiness to the healthcare crisis. The average GHS index score for the whole world in 2019 was 40.2, which is bettered by each country in the region, except Ukraine, meaning that the Black Sea region overall can be thought to have an adequate heath preparedness compared to the world. However, as the best-ranked country in the region (Turkey) is ranked 40th, the region is still far from advanced in its readiness for a healthcare crisis.

In a sub-pillar of the index called “Rapid response to and mitigation of the spread of an epidemic”, which potentially indicates how successful the countries would be in tackling COVID-19, Turkey ranks the highest in the region, with a world rank of 30, followed by Bulgaria (ranked 39th) and Georgia (ranked 45th). Russia and Romania are ranked 50th and 55th respectively, while Ukraine is doing the worst in the region, ranked 97th in the world on this metric.

Based on the EBRD monitor, which assessed both healthcare and the economic resilience of their members using a matrix tool, Bulgaria, Georgia, Russia and Ukraine have a high number of physicians per 100K people, while Romania and Turkey have a “moderate” score on this metric. This implies that the number of healthcare workers are adequate for each country in the region.

Another measure which shows the readiness of the healthcare sector is the public sector health expenditure as a share of GDP, which measures how prioritized the healthcare sector is for the country. Georgia is one country which scores low on this metric, while Russia and Ukraine have a moderate score and the remaining countries in the region (Bulgaria, Romania, Turkey) score high.

Spread of the virus

It is of paramount importance to track the spread of the virus over time in the Black Sea region, as lockdown measures and economic impacts of the pandemic highly depend on the capacity of the healthcare system to take care of the infected at each point in time.

Instead of looking at cumulative cases, it is more interesting to analyze new cases per day, which shows the exact shape of the expansion of the virus, adjusted for millions of population, in order to make the figures comparable to each other, and presented as a 7-day rolling average, in order to smooth the curve. Please note that even though this analysis is useful for tracking the evolution of the virus, the number of confirmed cases are correlated with testing rates and are always fewer than the actual cases.

Turkey was a country which had the quickest emergence of the virus; however, in April, it managed to bend the curve and, by the start of May, limited new cases per million to 20, remaining stabilized at this number since then. Russia was the second country with a sharp rise in the number of cases, and its peak of 75 new cases per million in May has been unmatched so far. Despite having managed to bend the curve quickly, the decline in the number of cases has been slow. In July, it stabilized at somewhat higher, around the 30-40 new cases per day interval.

Romania and Ukraine managed to keep new cases relatively low until the start of July. Romanian figures jumped up to around 60 new cases per million people per day in July and has been stable at this high level since, while in Ukraine growth was more gradual, peaking at around 65 in September.

Bulgaria was relatively successful in its efforts to tackle the spread of the virus, peaking at 30 new cases per million in July, and managing to get down to around 20 cases per day in September.

Georgia was extremely successful, keeping the new cases per day under 5 until the end of August; however, a sharp growth has been observed since the start of September, but the figure is still relatively low at around 25 new cases per million per day.

Georgia, unsurprisingly, is also leading in terms of low total deaths (19) and low death rates when adjusted to the population in millions (5 cumulative deaths per million people).

As of September 15th, Russia has the most registered deaths from COVID-19 (18,635), followed by Turkey (7,119).

However, it is Romania which has the highest death rate in the region, as about 215 people have died from COVID-19 per 1 mln people. Romania is followed by Russia (129 deaths per million).

Even though Bulgaria managed to keep the absolute number of deaths relatively low and is in 5th place in this regard, it has the 3rd highest death rate per million (104).

As for Ukraine, it is ranked 4th in terms of cumulative deaths (3,211) and 4th in terms of deaths per million (72).

Government response and mobility

In order to keep the cases low, the governments had to act strictly and induce harsh lockdown measures for extended periods of time. The Government Response Stringency Index assesses the overall strictness of the lockdown in 185 countries on a scale of 0-100 on a daily basis, by combining multiple criteria for strictness.

Average Stringency Index scores for Black Sea countries were calculated and analyzed for the period from February to August.

Georgia, which has the highest average score (64.6) in the region, and ranks 32nd in the world, managed to keep cases low by turning to strict containment measures.

However, not turning to the most stringent measures does not always translate to an elevated number of deaths: Bulgaria’s case is a good example, as it has the lowest Stringency Index score in the region (ranking 153rd in the world), but at the same time is second in terms of lowest deaths and active cases.

Since February, Google has been tracking the mobility of people in different types of locations, and in order to see the impact of the COVID-19, has been comparing the figures to the baselines taken over the 5-week period in January-February for each day of the week. These mobility estimates can provide early insights into how huge the containment of economic activity was.

As the data does not account for seasonality, there is a huge growth in mobility in park areas for most countries, mostly attributable to improved weather compared to the baseline.

Turkey recorded the highest decline in the region in mobility of retail and recreation (-30.7%) and transit stations (-29.5%). Turkey also recorded the highest growth in residential mobility (7.9%), implying that time spent at home increased by the most.

Mobility in groceries and pharmacies did not rise on average over the period. In fact, apart from Russia and Ukraine, which registered a slight increase, the mobility saw a small decline.

Georgia had the highest decline in workplace mobility on average over the period (-29.4%); however, each of the six countries recorded a decline of more than 20%.

The decisions about the measures taken by the government were made by keeping in mind a major trade-off between two priorities: people and the economy, or in other words, it was the question about saving more lives or more livelihoods. It is quite likely that gains in lives could be offset by losses in livelihoods, and vice versa. In the upcoming Black Sea bulletin, the economic implications of the spread of the virus and government responses to the virus, as well as the measures taken for the recovery from the economic crisis, will be explored in more depth for each country of the region.