Available evidence indicates that while anyone can become infected and become ill with COVID-19, older people and those with chronic conditions are most susceptible to serious complications or death. This raises important questions, a priori, about the vulnerability of European populations to COVID-19 based on their age-demographics and disease.
Figure 1 presents a heat map showing which countries are most vulnerable in terms of their share of the population over age 60, 70 and 80, as well as the age-standardized prevalence of non-communicable diseases, chronic respiratory diseases, cardiovascular disease and diabetes. Red signifies the most at risk (in the bottom quartile), orange is next at-risk (2nd quartile), yellow is the third-quartile and green indicates least risk (4th quartile).
Figure 1. Heat map of population vulnerability based on age demographics and prevalence of chronic disease
Source: UN population data, projected for 2020; IHME Global Burden of Disease, 2017
It is clear from the heat map that while there is variability in the size of vulnerable populations in European countries, all countries have population groups that are at-risk in one form or another. Countries with the highest share of their population over age 80 – the age group at highest risk of serious complications – include Greece, Italy and Germany. Adjusting for population age, Tajikistan, Kyrgyzstan and Bosnia and Herzegovina have the highest NCD rates per 100,000 population. Looking at specific chronic conditions that are likely to increase susceptibility to COVID-19, the United Kingdom, Iceland and Sweden have the highest rates of chronic respiratory conditions, while Bulgaria, Czech Republic and Albania have the highest CVD rates.
The extent to which COVID-19 will result in major crisis in European countries depends not only on population characteristics but on health system preparedness and ability to manage the outbreak. Although it would appear that many countries with comparatively less developed health systems have less population vulnerability, without adequate preparation, including testing and treatment capacity, they may still experience high rates of illness and mortality.