What matters the most in curbing early COVID-19 mortality? A cross-country necessary condition analysis.

COVID-19 represents a turbulent problem: a volatile, uncertain, complex, and ambiguous crisis, in which bounded-rational policymakers may not be able to do everything right, but must do critical things right in order to reduce the death toll. This study conceptualizes these critical things as necessary conditions (NCs) that must be absent to prevent high early mortality from occurring. We articulate a policy-institution-demography framework that includes seven factors as NC candidates for high early COVID-19 mortality. Using necessary condition analysis (NCA), this study pinpoints high levels of a delayed first response, political decentralization, elderly populations, and urbanization as four NCs that have inflicted high early COVID-19 mortality across 110 countries. The results highlight the critical role of agility as a key dimension of robust governance solutions-a swift early public-health response as a malleable policy action-in curbing early COVID-19 deaths, particularly for politically decentralized and highly urbanized countries with aging populations.