An international team of scientists from Italy, Austria and Spain has found that the higher number of COVID-19 cases and higher lethality registered in some European countries cannot be clearly attributed to more prevalent intergenerational co-residence and contacts in those countries.

The study, published in Proceedings of the National Academy of Sciences (PNAS), warns against simplistic interpretations of country-level associations to explain the differential spread and fatality rates of COVID-19 observed in different countries.

The findings at subnational or regional level contradict previous hypotheses on the role of intergenerational relationships in explaining the lethality of COVID-19 in several geographic areas.

The authors of the study are the researchers Bruno Arpino, of the Department of Statistics, Computer Science, Applications of the University of Florence, and former UPF professor; Valeria Bordone, of the Department of Sociology at the University of Vienna, and Marta Pasqualini, a postdoctoral researcher at the UPF Department of Political and Social Sciences and member of the University’s Sociodemography Research Group (DemoSoc).

Analysis of the relationship between lethality and the incidence of COVID-19 in 19 European countries

The rapid spread of SARS-CoV-2 meant there was an urgent need to understand what factors contribute to the spread of the virus. The disease associated with the virus, COVID-19, is particularly deadly for older people and it has been argued that the high prevalence of infected older people is crucial to understand the high Case Fatality Rate (CFR) observed in some countries, such as Italy.

Previous studies have also hinted at intergenerational relationships (co-residence and contacts) as a driver of COVID-19 cases, especially among older people. Using data from 19 European countries, the authors of the new PNAS study analysed the association between lethality (case-fatality rate, CFR) and the number of cases of COVID-19 per 100,00 inhabitants with several indicators of intergenerational relationships.

When data were analysed at country level, positive associations prevailed. For example, in countries where it is more common for adult children to live with their parents, COVID-19 lethality and the prevalence of cases tended to be higher.

Such a pattern of association was reversed when examining data at subnational level. For example, in Italy, the regions most seriously hit by the COVID-19 pandemic were among those where intergenerational co-residence was the lowest.

The findings at subnational or regional level contradict previous hypotheses on the role of intergenerational relationships in explaining the lethality of COVID-19 in several geographic areas.

The authors argue that their analyses highlight the risks of overinterpreting associations at the country level.

Correct identification of the factors that explain the spread of COVID-19

Correct identification of the factors that contribute explaining the spread and lethality of COVID-19 is of paramount importance for their policy implications. The authors stress that, at the moment, there is no empirical evidence to support the idea that intergenerational relationships are a key factor in the COVID-19 pandemic in different areas. Therefore, policies devoted to limiting this type of contacts in particular are not grounded on scientifically solid evidence.

Policies devoted to limiting this type of contacts in particular are not grounded on scientifically solid evidence.

Additionally, the authors note that the debate around intergenerational relationships has so far focused on the risks of transmission of the virus due to (physical) contact among family members. This debate overlooks the fundamental role of family relationships as a source of emotional and instrumental support. Theoretically, this support may even favour compliance with the restrictions imposed during lockdown and post-lockdown, thus limiting the spread and lethality of COVID-19.

Also, stronger family support may reduce the likelihood of older people living in nursing and care homes, which have been found to have a crucial role in the spread of COVID-19 cases.

In this sense, the case of the Lombardy region in Italy is prototypical: this region is characterized for having one of the highest CFR of COVID-19 in Italy and a comparatively low prevalence of intergenerational co-residence and contacts, and at the same time with a relatively high prevalence of older people living in care residences.

Intergenerational relationships, key to good mental health

The authors also argue that political interventions should take into account that intergenerational relationships are not just a potential vehicle for the transmission of the virus, but also an important source of support: intergenerational contacts, even when kept at a distance via mobile phones or the internet, may help counterbalance the negative consequences on mental health due to policy responses to the outbreak.

In conclusion, given that social contacts do not necessarily require physical co-presence, and that at the same time physical co-presence does not imply social contacts, the authors suggest replacing the term “social distancing” with the more appropriate term “physical distancing” when referring to the measures devoted to limiting the risk of transmitting the virus.

Reference article: B. Arpino, V. Bordone and M. Pasqualini (July 2020). “No clear association emerges between intergenerational relationships and COVID-19 fatality rates from macro-level analyses”. PNAS https://doi.org/10.1073/pnas.2008581117