• Banafsheh Sadeghi, Rex C Y Cheung, and Meagan Hanbury.
• Health Bridge Analytics, Davis, California, USA.
• BMJ Open. 2021 Nov 9; 11 (11): e049844.

ObjectiveTo rank and score 180 countries according to COVID-19 cases and fatality in 2020 and compare the results to existing pandemic vulnerability prediction models and results generated by standard epidemiological scoring techniques.SettingOne hundred and eighty countries' patients with COVID-19 and fatality data representing the healthcare system preparedness and performance in combating the pandemic in 2020.DesignUsing the retrospective daily COVID-19 data in 2020 broken into 24 half-month periods, we applied unsupervised machine learning techniques, in particular, hierarchical clustering analysis to cluster countries into five groups within each period according to their cumulative COVID-19 fatality per day over the year and cumulative COVID-19 cases per million population per day over the half-month period. We used the average of the period scores to assign countries' final scores for each measure.Primary OutcomeThe primary outcomes are the COVID-19 cases and fatality grades in 2020.ResultsThe United Arab Emirates and the USA with F in COVID-19 cases, achieved A or B in the fatality scores. Belgium and Sweden ranked F in both scores. Although no African country ranked F for COVID-19 cases, several African countries such as Gambia and Liberia had F for fatality scores. More developing countries ranked D and F in fatality than in COVID-19 case rankings. The classic epidemiological measures such as averages and rates have a relatively good correlation with our methodology, but past predictions failed to forecast the COVID-19 countries' preparedness.ConclusionCOVID-19 fatality can be a good proxy for countries' resources and system's resilience in managing the pandemic. These findings suggest that countries' economic and sociopolitical factors may behave in a more complex way as were believed. To explore these complex epidemiological associations, models can benefit enormously by taking advantage of methods developed in computer science and machine learning.© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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