Relative performance of countries in fighting COVİD-19: Two-stage bootsrap data envelopement analysis

Epidemics are type of disease that infects a large part of human population and other living beings in a short period of time. With their deadly consequences and heavy costs, it is known that epidemics are as old as humanity. While the Covid-19 pandemic, which we have been experiencing recently, affects all countries with its rapid spread, it creates severe conditions for countries that are not prepared for the pandemic. The Covid-19 pandemic has had significant impacts on the health systems and health infrastructures of the countries. Each country's response to the epidemic process has been different depending on the health system they practice. While some countries implement stricter radical measures, some countries follow milder and more democratic strategies. It is known that the success of these strategies depends on the level of administrative capacity, as well as the health infrastructure of the countries for the fight against the pandemic. In order to control the epidemic, countries have also implemented some public measures to prevent the further spread of the disease, simultaneously with processes such as the detection and treatment of cases. Taken measures and restrictions have brought the economic and social life to a standstill in many countries. Disruptions in the supply chain, restrictions that limit economic and social interactions and decreasing demand conditions have adversely affected economic and social life. It has been observed that the effective implementation of public measures during the epidemic process is closely related to the economic and social conditions of these countries. The effective and decisive continuation of the measures taken by the governments to prevent the spread of the epidemic and the reaction of the public and businesses to the measures, affect the success performance of the countries in the fight against the epidemic. In this study, the relative performance of countries in the fight against the Covid-19 pandemic was compared. In addition, the effects of public measures and restrictions carried out during the epidemic on the country's performance were determined. The study aims to evaluate the performance of the health systems of the countries against the epidemic on the one hand, and to measure whether the restrictions and measures implemented by the countries are effective on the success of the health system on the other. It is thought that the comparable and meaningful information obtained as a result of the study will contain arguments that will strengthen the scientific basis for the development of health policies to be applied at both national and international levels. "Two Stage Bootstrap Estimation Data Envelopment Analysis" was used to measure the relative performance of countries in the fight against Covid-19. In the first stage, the performance of countries in the fight against Covid-19 was analyzed with two models. In the first model, new cases and new deaths per million were determined as output variables, while the number of new tests, the number of hospitalized Covid patients and the number of patients in the intensive care unit were determined as input variables. In the second model, the number of recovered patients was used as the output variable. According to the technical efficiency scores obtained from both models, successful and unsuccessful countries in the fight against Covid-19 were listed. In the second stage of the analysis, the Simar Wilson Method was taken as a basis. At this stage, the technical efficiency scores obtained in the first stage were used as the dependent variable. Internal (health-oriented measures) and external (public measures) parameters for determining the activity levels were used as independent variables in the model. Internal parameters are the contagion coefficient, positivity rate and contact tracing variables. The external parameters that are thought to affect the success levels of countries are the stringency index including public measures, government response index, limitation and health index, elderly protection index, public information index and workplace closure index variables. As a result of the first stage analysis, it was determined that the three most successful countries in minimizing the number of deaths and cases in the fight against Covid-19 are Austria, Denmark and Lithuania, respectively. In terms of the number of recovered patients, the three most successful countries are the USA, Denmark and Austria. In the second stage, it was understood that the most important parameters affecting the performance of countries in the fight against Covid-19 are the stringency index, government response index, elderly protection index and workplace closure index. It has been determined that governments' increasing stringency on public measures has contributed positively to the success of countries in the fight against the epidemic. Keywords: Covid-19, Two Stage Data Envelopment Analysis, Public Restriction and Measures