Pandemic Planning Research Articles

Urban community-level stay-at-home orders and small businesses: Evidence from chain restaurants in Beijing during the COVID-19 pandemic

Non-pharmaceutical interventions (NPIs) can effectively contain the spread of the coronavirus disease 2019 (COVID-19) when implemented promptly and decisively. However, legislative concerns on the economic repercussions of NPIs often delay their rollout. Utilizing proprietary transaction-level data from two major restaurant chains, we quantitatively assess the effects of stay-at-home (SAH) orders implemented during the COVID-19 pandemic. Our findings indicate a significant 17.5 % decrease in revenue for restaurants affected by these orders, with a more pronounced impact observed in densely populated areas. The study also reveals a notable decline in home delivery revenues, suggesting a comprehensive disruption in both dine-in and delivery services. However, post-lifting of the SAH orders, we document a rapid diminishment in the revenue disparity between affected and unaffected restaurants, followed by a robust rebound in overall performance within several weeks. Our study contributes to the broader discourse on the resilience and adaptability of small businesses in the face of public health crises, providing a foundation for future research and policy formulation in pandemic resilience planning.

Socioeconomic Inequalities in SARS-CoV-2 Infection and COVID-19 Health Outcomes in Urban Italy During the COVID-19 Vaccine Rollout, January–November 2021

This study analysed the evolution of the association of socioeconomic deprivation (SED) with SARS-CoV-2 infection and COVID-19 outcomes in urban Italy during the vaccine rollout in 2021. We conducted a retrospective cohort analysis between January and November 2021, comprising of 16,044,530 individuals aged ≥ 20 years, by linking national COVID-19 surveillance system data to the Italian SED index calculated at census block level. We estimated incidence rate ratios (IRRs) of infection and severe COVID-19 outcomes by SED tercile relative to the least deprived tercile, over three periods defined as low (0–10%); intermediate (> 10–60%) and high (> 60–74%) vaccination coverage. We found patterns of increasing relative socioeconomic inequalities in infection, hospitalisation and death as COVID-19 vaccination coverage increased. Between the low and high coverage periods, IRRs for the most deprived areas increased from 1.09 (95%CI 1.03–1.15) to 1.28 (95%CI 1.21–1.37) for infection; 1.48 (95%CI 1.36–1.61) to 2.02 (95%CI 1.82–2.25) for hospitalisation and 1.57 (95%CI 1.36–1.80) to 1.89 (95%CI 1.53–2.34) for death. Deprived populations in urban Italy should be considered as vulnerable groups in future pandemic preparedness plans to respond to COVID-19 in particular during mass vaccination roll out phases with gradual lifting of social distancing measures.

From test to rest: evaluating socioeconomic differences along the COVID-19 care pathway in the Netherlands

IntroductionThe COVID-19 pandemic exacerbated healthcare needs and caused excess mortality, especially among lower socioeconomic groups. This study describes the emergence of socioeconomic differences along the COVID-19 pathway of testing, healthcare use and mortality in the Netherlands.MethodologyThis retrospective observational Dutch population-based study combined individual-level registry data from June 2020 to December 2020 on personal socioeconomic characteristics, COVID-19 administered tests, test results, general practitioner (GP) consultations, hospital admissions, Intensive Care Unit (ICU) admissions and mortality. For each outcome measure, relative differences between income groups were estimated using log-link binomial regression models. Furthermore, regression models explained socioeconomic differences in COVID-19 mortality by differences in ICU/hospital admissions, test administration and test results.ResultsAmong the Dutch population, the lowest income group had a lower test probability (RR = 0.61) and lower risk of testing positive (RR = 0.77) compared to the highest income group. However, among individuals with at least one administered COVID-19 test, the lowest income group had a higher risk of testing positive (RR = 1.40). The likelihood of hospital admissions and ICU admissions were higher for low income groups (RR = 2.11 and RR = 2.46, respectively). The lowest income group had an almost four times higher risk of dying from COVID-19 (RR = 3.85), which could partly be explained by a higher risk of hospitalization and ICU admission, rather than differences in test administration or result.DiscussionOur findings indicated that socioeconomic differences became more pronounced at each step of the care pathway, culminating to a large gap in mortality. This underlines the need for enhancing social security and well-being policies and incorporation of health equity in pandemic preparedness plans.

Strategic planning and organizational performance in food business: The role of organizational trust and pandemic planning

BACKGROUND: Strategic planning is very important in achieving sustainable organizational performance. Therefore, leaders need to pay attention to their planning by considering the conditions they face. OBJECTIVE: This study aims to investigate the relationship between strategic planning and performance with organizational trust as a mediator and pandemic planning as a moderator. METHODS: A survey technique was used to obtain cross-sectional data on 227 food business leaders (restaurants and cafes). Furthermore, the data were analyzed using Hayes Process Macro models 4 and 8 to answer the research hypothesis. RESULTS: The results showed that strategic planning had a positive effect on organizational trust and performance. Moreover, the relationship between strategic planning and performance was mediated by organizational trust and moderated by pandemic planning. However, pandemic planning was not proven as the moderator on the relationship between strategic planning and organizational trust. CONCLUSIONS: This study contributes to the performance of the food business by relating strategic planning, pandemic planning, and trust as the drivers of organizational sustainability. Moreover, the findings have implications for leaders that the interaction of pandemic planning needs to be considered in efforts to improve organizational performance during the COVID-19 period.

Equity in the recovery of elective and oncological surgery volumes after the COVID-19 lockdown: a multicentre cohort study in Italy

BackgroundThe COVID-19 pandemic has had, and still has, a profound impact on national health systems, altering trajectories of care and exacerbating existing inequalities in health. Postponement of surgeries and cancellation of elective surgical procedures have been reported worldwide. In Italy, the lock-down measures following the COVID-19 pandemic caused cancellations of surgical procedures and important backlogs; little is known about potential social inequalities in the recovery process that occurred during the post-lockdown period. This study aims at evaluating whether all population social strata benefited equally from the surgical volumes’ recovery in four large Italian regions.MethodsThis multicentre cohort study covers a population of approximately 11 million people. To assess if social inequalities exist in the recovery of eight indicators of elective and oncological surgery, we estimated Risk Ratios (RR) through Poisson models, comparing the incidence proportions of events recorded during COVID-19 (2020-21) with those in pre-pandemic years (2018-19) for each pandemic period and educational level.ResultsCompared to 2018-19, volumes of elective surgery showed a U-shape with the most significant drops during the second wave or the vaccination phase. The recovery was socially unequal. At the end of 2021, incidence proportions among highly educated people generally exceeded the expected ones; RRs were 1.31 (95%CI 1.21–1.42), 1.24 (95%CI 1.17–1.23), 1.17 (95%CI 1.08–1.26) for knee and hip replacement and prostatic surgery, respectively. Among low educated patients, RR remained always < 1. Oncological surgery indicators showed a similar social gradient. Whereas volumes were preserved among the highly educated, the low educated were still lagging behind at the end of 2021.ConclusionsSurgical procedures generally returned to pre-pandemic levels but the low educated experienced the slowest recovery. An equity-oriented appraisal of trends in healthcare provision should be included in pandemic preparedness plans, to ensure that social inequalities are promptly recognised and tackled.

COVID-19 Information Platform for Primary Care: Emergence and Development of a Web-based Knowledge Platform in the COVID-19 Pandemic

The SARS-Cov-2 outbreak in the spring of 2020 challenged the health care system, and thus primary care, on an unprecedented scale. Knowledge about the new disease was low, whereas the dynamics of knowledge generation were high and inhomogeneous. A number of new primary care tasks related to the pandemic situation emerged. Guidance in the management of COVID-19 was therefore needed, although robust evidence was not yet available. The information required concerned not only the virus and the new disease COVID-19, but also regulatory requirements and organizational issues. In this situation, a flexible, web-based information tool, easy to update and usable at the point of care, was developed at Karl Landsteiner Private University Krems and put online under the name of "COVID-19: prevention and management in primary care practices" on March 25, 2020. In a retrospective process description, we describe the needs-triggered process of developing and disseminating a practice-based tool to support practicing primary care physicians in a period of high uncertainty with an urgent need for information. Afterwards, we reflect on the learning process from a purely pragmatic to an increasingly structured approach and try to draw conclusions regarding optimization possibilities in terms of creation and dissemination. In situations of high uncertainty combined with an acute need for action and decision-making, there is a significant need for information that is as reliable as possible. Science transfer must be done in such a way that information can be implemented quickly. Dissemination, as always, plays an essential role. Gaps must be accepted. A structured process of quality assurance must be established in parallel. Funds and resources for knowledge transfer should be included in future pandemic plans.

“Family doctors are also people”: a qualitative analysis of how family physicians managed competing personal and professional responsibilities during the COVID-19 pandemic

BackgroundFamily physicians (FPs) fill an essential role in public health emergencies yet have frequently been neglected in pandemic response plans. This exclusion harms FPs in their clinical roles and has unintended consequences in the management of concurrent personal responsibilities, many of which were amplified by the pandemic. The objective of our study was to explore the experiences of FPs during the first year of the COVID-19 pandemic to better understand how they managed their competing professional and personal priorities.MethodsWe conducted semi-structured interviews with FPs from four Canadian regions between October 2020 and June 2021. Employing a maximum variation sampling approach, we recruited participants until we achieved saturation. Interviews explored FPs’ personal and professional roles and responsibilities during the pandemic, the facilitators and barriers that they encountered, and any gender-related experiences. Transcribed interviews were thematically analysed.ResultsWe interviewed 68 FPs during the pandemic and identified four overarching themes in participants’ discussion of their personal experiences: personal caregiving responsibilities, COVID-19 risk navigation to protect family members, personal health concerns, and available and desired personal supports for FPs to manage their competing responsibilities. While FPs expressed a variety of ways in which their personal experiences made their professional responsibilities more complicated, rarely did that affect the extent to which they participated in the pandemic response.ConclusionsFor FPs to contribute fully to a pandemic response, they must be factored into pandemic plans. Failure to appreciate their unique role and circumstances often leaves FPs feeling unsupported in both their professional and personal lives. Comprehensive planning in anticipation of future pandemics must consider FPs’ varied responsibilities, health concerns, and necessary precautions. Having adequate personal and practice supports in place will facilitate the essential role of FPs in responding to a pandemic crisis while continuing to support their patients’ primary care needs.

Lessons Learned from Cross-Systems Approach to COVID-19 Pandemic Response in Juvenile Justice System, Colorado, USA.

The global COVID-19 pandemic illustrates the importance of a close partnership between public health and juvenile justice systems when responding to communicable diseases. Many setting-specific obstacles must be navigated to respond effectively to limit disease transmission and negative health outcomes while maintaining necessary services for youth in confinement facilities. The response requires multidisciplinary expertise and collaboration to address unique considerations. Public health mitigation strategies must balance the risk for disease against the negative effects of restrictions. Key aspects of the COVID-19 response in the juvenile justice system of Colorado, USA, involved establishing robust communication and data reporting infrastructures, building a multidisciplinary response team, adapting existing infection prevention guidelines, and focusing on a whole-person health approach to infection prevention. We examine lessons learned and offer recommendations on pandemic emergency response planning and managing a statewide public health emergency in youth confinement settings that ensure ongoing readiness.

Evolution of the data and methods in real-world COVID-19 vaccine effectiveness studies on mortality: a scoping review protocol

BackgroundEarly evidence on COVID-19 vaccine efficacy came from randomised trials. Many important questions subsequently about vaccine effectiveness (VE) have been addressed using real-world studies (RWS) and have informed most vaccination...

Lessons Learned from Contact Tracing COVID-19 cases in Dental Settings in East Scotland.

Dental settings were considered high risk settings for COVID-19. A Dental Public Health Team in East Scotland worked to risk assess each situation timeously to break chains of transmission. To present learning from routine data collected from contact tracing COVID-19 cases in the dental setting. Retrospective analysis of a routine data set of COVID-19 cases associated with a dental setting reported via the national contact tracing system for two health board areas in the East of Scotland. Descriptive statistics summarise the data collected over a 13-month period (Oct 2020-Dec 2021) during which all included COVID-19 cases were confirmed by PCR. A narrative presents output from contact tracing of all cases and includes themes identified during contact tracing that led to transmission within a dental setting. A case study illustrates impact of transmission. 752 cases are included. No evidence of staff to patient transmission or vice versa was found in this study. Staff to staff transmission occurred in non-clinical areas contributing to 33% of total staff cases with the remainder assessed to result from community transmission. Transmission of COVID-19 in a dental setting, in the context of this study, appears to be confined to non-clinical areas with the majority of staff cases resulting from community transmission. Future pandemic plans should include tools to aid with implementation of guidance in non-clinical areas.

Pandemic Marine Risks Assessment for Marine Spatial Planning (MSP): A Case Study of Northport, Malaysia

The pandemic outbreak has emphasized the necessity of incorporating pandemic marine risk assessment as a critical component of marine spatial planning (MSP). The purpose of this study was to utilize the Risk Assessment Matrix (RAM) methodology to determine the most severely impacted zone at Northport, Port Klang. 31 senior management personnel at Northport, Port Klang were involved in a survey to assess the pandemic's severity in various zones. According to the findings, the Vehicle's Terminal zone had the highest score of 17.72, indicating it to be the most severely impacted zone, followed by the Passenger's Terminal zone (15.88), Distribution Centre zone (14.62), Bulk zone (14.52), Dangerous Good zone (14.13), Free Zone (14.10), Ancillary Service zone (13.65), and Container zone (13.39). These results can be integrated into Geographical Information System (GIS) and Multi Criteria Decision Analysis (MCDA) to convert themfrom numerical values to spatial data, and visualize them hierarchically. Additionally, this study's findings can contribute to enhancing MSP practices, not only at Northport, Port Klang, but also at other ports facing similar challenges. By including pandemic risk assessment as a crucial part of MSP, ports can develop effective pandemic response plans that prioritize the health and safety of port workers and visitors, as well as ensure the continuity of trade and economic activities.

Preparing For Pandemic

Scholars from a wide range of disciplines, including communication and rhetoric, have argued that infectious disease has been increasingly securitized in the post-9/11 environment. This essay tracks the rhetoric of seven U.S. pandemic plans from 1978 to 2017 to investigate how the evolving language of these plans supports or undermines the infectious disease securitization thesis. Our analysis reveals stark differences in the arrangement, delivery, and style of U.S. pandemic plans, despite a consistent focus on antigenic shifts of influenza A, vaccines, and medical research and development. Although U.S. pandemic plans reflect connections to security since their earliest inception, they have adopted more explicit linkages to national and global health security since 2005. This move reflects the emergence of the global health security paradigm and raises questions about pandemic planning implementation.

Hospitalization forecast to inform COVID-19 pandemic planning and resource allocation using discrete event simulation

Purpose: This study aims to address the pressing need for accurate forecasting of healthcare resource demands during the COVID-19 pandemic. It presents a novel approach that combines a stochastic Markov model and a discrete event simulation model to dynamically predict hospital admissions and daily occupancy of hospital and ICU beds.Design/methodology/approach: The research builds upon existing work related to predicting COVID-19 spread and patient influx to hospital emergency departments. The proposed model was developed and validated at San Juan de Alicante University Hospital from July 10, 2020, to January 10, 2022, and externally validated at Hospital Vega Baja. The model involves an admissions generator based on a stochastic Markov model, feeding data into a discrete event simulation model in the R programming language. The probabilities of hospital admission were calculated based on age-stratified positive SARS-COV-2 results from the health department's catchment population. The discrete event simulation model simulates distinct patient pathways within the hospital to estimate bed occupancy for the upcoming week. The performance of the model was measured using the median absolute difference (MAD) between predicted and actual demand.Findings: When applied to data from San Juan hospital, the admissions generator demonstrated a MAD of 6 admissions/week (interquartile range [IQR] 2-11). The MAD between the model's predictions and actual bed occupancy was 20 beds/day (IQR 5-43), equivalent to 5% of total hospital beds. For ICU occupancy, the MAD was 4 beds/day (IQR 2-7), constituting 25% of ICU beds. Evaluation with data from Hospital Vega Baja showcased an admissions generator MAD of 2.42 admissions/week (IQR 1.02-7.41). The MAD between the model's predictions and actual bed occupancy was 18 beds/day (IQR 19.57-38.89), approximately 5.1% of hospital beds. The ICU occupancy MAD was 3 beds/day (IQR 1-5), making up 21.4% of ICU beds.Practical implications: The dynamic predictions of hospital admissions, ward beds, and ICU occupancy for COVID-19 patients proved highly valuable to hospital managers, facilitating early and informed planning of resource allocation. Additionally, this study underscores the importance of utilizing simulation techniques to predict and manage hospital occupancy levels, thereby enhancing decision-making in hospital bed management, not only during pandemics but also during regular periods.Originality/value: This study introduces a novel hybrid approach that combines stochastic modeling and discrete event simulation to forecast healthcare resource demands during the COVID-19 pandemic. The methodology's effectiveness in predicting admissions and bed occupancy contributes to improved resource planning and situational awareness.

Rapid antigen testing for SARS-CoV-2 by lateral flow assay: A field evaluation of self- and professional testing at UK community testing sites

BackgroundThe advent of lateral flow devices (LFDs) for SARS-CoV-2 detection enabled widespread use of rapid self-tests during the pandemic. While self-testing using LFDs is now common, whether self-testing provides comparable performance to professional testing was a key question that remained important for pandemic planning. MethodsThree prospective multi-centre studies were conducted to compare the performance of self- and professional testing using LFDs. Participants tested themselves or were tested by trained (professional) testers at community testing sites in the UK. Corresponding qRT-PCR test results served as reference standard. The performance of Innova, Orient Gene and SureScreen LFDs by users (self) and professional testers was assessed in terms of sensitivity, specificity, and kit failure (void) rates. Impact of age, sex and symptom status was analysed using logistic regression modelling. Results16,617 participants provided paired tests, of which 15,418 were included in the analysis. Self-testing with Innova, Orient Gene or SureScreen LFDs achieved sensitivities of 50 %, 53 % or 72 %, respectively, compared to qRT-PCR. Self and professional LFD testing showed no statistically different sensitivity with respect to corresponding qRT-PCR testing. Specificity was consistently equal to or higher than 99 %. Sex and age had no or only marginal impact on LFD performance while sensitivity was significantly higher for symptomatic individuals. Sensitivity of LFDs increased strongly to up to 90 % with higher levels of viral RNA measured by qRT-PCR. ConclusionsOur results support SARS-CoV-2 self-testing with LFDs, especially for the detection of individuals whose qRT-PCR tests showed high viral concentrations.

Stakeholder participation in the COVID-19 pandemic preparedness and response plans: A synthesis of findings from 70 countries

Stakeholder participation is a key component of a fair and equitable priority-setting in health. The COVID-19 pandemic highlighted the need for fair and equitable priority setting, and hence, stakeholder participation. To date, there is limited literature on stakeholder participation in the development of the pandemic plans (including the priority setting plans) that were rapidly developed during the pandemic.Drawing on a global study of national COVID-19 preparedness and response plans, we present a secondary analysis of COVID-19 national plans from 70 countries from the six WHO regions, focusing on stakeholder participation.We found that most plans were prepared by the Ministry of Health and acknowledged WHO guidance, however less than half mentioned that additional stakeholders were involved. Few plans described a strategy for stakeholder participation and/or accounted for public participation in the plan preparation. However, diverse stakeholders (including multiple governmental, non-governmental, and international organizations) were proposed to participate in the implementation of the plans. Overall, there was a lack of transparency about who participated in decision-making and limited evidence of meaningful participation of the community, including marginalized groups.The critical relevance of stakeholder participation in priority setting requires that governments develop strategies for meaningful participation of diverse stakeholders during pandemics such as COVID-19, and in routine healthcare priority setting.

Characterizing collective physical distancing in the U.S. during the first nine months of the COVID-19 pandemic.

The COVID-19 pandemic offers an unprecedented natural experiment providing insights into the emergence of collective behavioral changes of both exogenous (government mandated) and endogenous (spontaneous reaction to infection risks) origin. Here, we characterize collective physical distancing-mobility reductions, minimization of contacts, shortening of contact duration-in response to the COVID-19 pandemic in the pre-vaccine era by analyzing de-identified, privacy-preserving location data for a panel of over 5.5 million anonymized, opted-in U.S. devices. We define five indicators of users' mobility and proximity to investigate how the emerging collective behavior deviates from typical pre-pandemic patterns during the first nine months of the COVID-19 pandemic. We analyze both the dramatic changes due to the government mandated mitigation policies and the more spontaneous societal adaptation into a new (physically distanced) normal in the fall 2020. Using the indicators here defined we show that: a) during the COVID-19 pandemic, collective physical distancing displayed different phases and was heterogeneous across geographies, b) metropolitan areas displayed stronger reductions in mobility and contacts than rural areas; c) stronger reductions in commuting patterns are observed in geographical areas with a higher share of teleworkable jobs; d) commuting volumes during and after the lockdown period negatively correlate with unemployment rates; and e) increases in contact indicators correlate with future values of new deaths at a lag consistent with epidemiological parameters and surveillance reporting delays. In conclusion, this study demonstrates that the framework and indicators here presented can be used to analyze large-scale social distancing phenomena, paving the way for their use in future pandemics to analyze and monitor the effects of pandemic mitigation plans at the national and international levels.

A global comparative analysis of the the inclusion of priority setting in national COVID-19 pandemic plans: A reflection on the methods and the accessibility of the plans

BackgroundDespite the swift governments’ response to the COVID-19 pandemic, there remains a paucity of literature assessing the degree to which; priority setting (PS) was included in the pandemic plans and the pandemic plans were publicly accessible.This paper reflects on the methods employed in a global comparative analysis of the degree to which countries integrated PS into their COVID-19 pandemic plans based on Kapiriri & Martin's framework. We also assessed if the accessibility of the plans was related to the country's transparency index. MethodsThrough a three stage search strategy, we accessed and reviewed 86 national COVID-19 pandemic plans (and 11 Canadian provinces and territories). Secondary analysis assessed any alignment between the readily accessible plans and the country's transparency index. Results and conclusion71 national plans were readily accessible while 43 were not. There were no systematic differences between the countries whose plans were readily available and those whose plans were ‘missing’. However, most of the countries with ‘missing’ plans tended to have a low transparency index. The framework was adapted to the pandemic context by adding a parameter on the need to plan for continuity of priority routine services. While document review may be the most feasible and appropriate approach to conducting policy analysis during health emergencies, interviews and follow up document review would assess policy implementation.

Lessons from a hygienic-medical point of view

The basic premise of preventive health protection through hygiene and infection medicine is to always design corresponding concepts taking into account proportionality and the societal and social consequences (no infection-preventive tunnel vision). It remains inexplicable why, at the beginning of the pandemic, political crisis management decided not to draw on the quality of the preliminary work of the pandemic plan, which was last updated in 2017, and the expertise of preventive health protection experts from the fields of hygiene and infection medicine.

Systems Are Overstretched from the COVID-19 Pandemic: An Interpretive Description of Disabled People’s Access to Healthcare and Disability Support in New Zealand

The COVID-19 pandemic disrupted healthcare and support services, creating challenges for disabled people. New Zealand implemented a range of policies to prevent and limit viral transmission of COVID-19. This study investigates disabled people’s experiences accessing healthcare and disability support services during the COVID-19 pandemic, and based on this analysis, the implications of public health policy decisions on disabled people’s experiences during the pandemic in New Zealand are explicated. A qualitative design underpinned by interpretive description methodology guided this study. A total of 64 disabled people or parents of disabled children participated in semi-structured interviews. The team of health services and disability researchers then engaged in an iterative thematic approach to analysis, which led to three key themes: (1) protective personal factors, which assisted disabled people to access healthcare and support services, (2) immediate pandemic policy impacts, including policy and legislative changes, which created additional access barriers for disabled people, and (3) exacerbating factors, including compounding vulnerabilities, overstretched systems, and the impact of the vaccine mandate, which worsened the already limited access to healthcare and disability services for disabled people. The pandemic overwhelmed an already stretched healthcare and disability support system, resulting in service disruptions with negative consequences for disabled people’s health and wellbeing. Future policy development needs to be disability-centred in its inclusion of people with lived experience and consideration of the support needs of disabled populations. A first step in this process could include pandemic planning and policy co-design to ensure a continuum of healthcare services and support availability for individuals when services are disrupted. In addition, access to formal and informal support for disabled people should be recognised as a fundamental human right when accessing healthcare and disability support services.

Promoting healthy populations as a pandemic preparedness strategy: a simulation study from Mexico

The underlying health status of populations was a major determinant of the impact of the COVID-19 pandemic, particularly obesity prevalence. Mexico was one of the most severely affected countries during the COVID-19 pandemic and its obesity prevalence is among the highest in the world. It is unknown by how much the COVID-19 burden could have been reduced if systemic actions had been implemented to reduce excess weight in Mexico before the onset of the pandemic. Using a dynamic epidemic model based on nationwide data, we compare actual deaths with those under hypothetical scenarios assuming a lower body mass index in the Mexican population, as observed historically. We also model the number of deaths that would have been averted due to earlier implementation of front-of-pack warning labels or due to increases in taxes on sugar-sweetened beverages and non-essential high-energy foods in Mexico. We estimate that 52.5% (95% prediction interval (PI) 43.2, 61.6%) of COVID-19 deaths were attributable to obesity for adults aged 20-64 and 23.8% (95% PI 18.7, 29.1%) for those aged 65 and over. Had the population BMI distribution remained as it was in 2000, 2006, or 2012, COVID-19 deaths would have been reduced by an expected 20.6% (95% PI 16.9, 24.6%), 9.9% (95% PI 7.3, 12.9%), or 6.9% (95% PI 4.5, 9.5%), respectively. If the food-labelling intervention introduced in 2020 had been introduced in 2018, an expected 6.2% (95% PI 5.2, 7.3%) of COVID-19 deaths would have been averted. If taxes on sugar-sweetened beverages and high-energy foods had been doubled, trebled, or quadrupled in 2018, COVID-19 deaths would have been reduced by an expected 4.1% (95% PI 2.5, 5.7%), 7.9% (95% PI 4.9, 11.0%), or 11.6% (95% PI 7.3, 15.8%), respectively. Public health interventions targeting underlying population health, including non-communicable chronic diseases, is a promising line of action for pandemic preparedness that should be included in all pandemic plans. This study received funding from Bloomberg Philanthropies, awarded to Juan A. Rivera from the National Institute of Public Health; Community Jameel, the UK Medical Research Council (MRC), Kenneth C Griffin, and the World Health Organization.