**4. General information about the impact of the disease in Azerbaijan and around the world**

The coronavirus pandemic is a unique phenomenon. Right after the emergence of the virus and information from China, people around the world were locked-up in their homes. Cities and streets became empty. The world community divided into groups of those who feared the new virus and those who did not believe in it. Fear changed the world. Politicians had to enforce restrictive measures to create a sense of security among citizens. Moreover, the population blamed politicians who did

#### *A Qualitative Study of Pre-Vaccine Decrease of Mortality from COVID-19 DOI: http://dx.doi.org/10.5772/intechopen.97017*

not act. However, there was also another part of the population that was left without income because of restrictive measures, whose business went bankrupt. On the contrary, they wanted the restrictions to be lifted as soon as possible. Many people came out to mass demonstrations against the mask regime and other restrictions in such big cities such as London, Berlin, Madrid, Amsterdam [49–52].

Comparative statistics analysis for 9 months (March 2020 – February 2021) shows more than two fold growth in morbidity and mortality in the world. Coronavirus cases at the end of February 2021 almost doubled compared to May 2020 (about 112 million compared to more than 5 million) [53]. The coronavirus death toll also increased significantly. Thus, for the mentioned period it has increased from 351,886 in May 2020 to more than 2 million 400 thousand deaths to date. However, recovery rate also has increased indicating that more than 87 million or about 80 percent of patients have already recovered [54]. The above data give us reason to believe that most of the people currently undergoing treatment will fully recover. 99,6% of those who are active cases now have a high chance to be recovered. So, our observations of global mortality rate being 6–7% in early months of March – April, went down to 5–5,5% in May – June, then to 4% in August and to 2,2% from the fall of the year till start of the vaccination. This says a lot. So present mortality rate at 2,2% is not a result of vaccination but this is result of natural processes, which can be scientifically explained or not, but this is a fact which all of us should accept.

The disease, which was classified as the pandemic by the WHO, which affected more than 100 million people in one year has been also registered in Azerbaijan. At the beginning of January 2020, when there were no cases of infection among the population, epidemiological and overall situation in Azerbaijan was not so tense. Even before the first officially documented coronavirus case, the authorities have started the development of the antiviral measures. These measures included the adoption of the Action Plan to prevent the spread of the new coronavirus disease in the Azerbaijan Republic, and then the creation of the Task Force under the Cabinet of Ministers (Task Force or Operative Headquarter under Prime-Minister) to combat coronavirus [55]. However, the escalation of the situation in the media made the situation worse. Global and local media resources covered information of a purely medical or biological nature. This information was not familiar for the average reader, but aggravated fear in society.

The first case of the coronavirus infection was registered at the end of February 2020 in Azerbaijan [56]. The shocking news from other countries by that time have already scared people. Subsequently, after the first death case that followed in March [57] social situation deteriorated. The massive information flow, which was accompanied by frightening statistics about the rapid spread of the virus and lack of treatment of the unknown disease filled local media. The further introduction of quarantine measures led not only to the deterioration in the emotional state of people, but also disrupted the work of almost all areas.

Throughout the year, easing and tightening of the quarantine regime have changed alternately several times, that had a negative impact on the psyche of the people and the economy of Azerbaijan. Thus, according to the latest data, the state spent 2 billion manats (local currency, 1 USD = 1,7 AZN manat) to fight the coronavirus in the country in 2020 [58]. The imminent recession in the economy, business activity, tourism and other spheres negatively affected the economic condition of people. As a result, the income of the population has significantly decreased or stopped altogether. Although the state has provided financial support [59] to the citizens and entrepreneurs [60], people accustomed to the certain level of incomes, who took out a flat or a bank loan on a mortgage, found themselves in very difficult circumstances. The most difficult situation was observed in the tourism, restaurant, and entertainment sectors. Under the conditions of quarantine measures, their work was either prohibited or significantly restricted. Consequently, the economic factor has become an additional reason for the deterioration of the psychological health of the population. Moreover, under the conditions of the strict quarantine, restrictions and even ban to leave home were applied in the country [61].

Implemented during the quarantine time limit for leaving home [62] negatively affected people's everyday life. In fact, people were limited to outdoor walks. The time restrictions on leaving the house forced people to make a choice between visiting, for example, a bank and taking a walk in the park or even doctor visit.

The ban on the work of gyms and admission to parks has become an additional fact of the aggravation of not only the physical but also the psychological health of the people. Accustomed to a sports lifestyle were limited even to visiting parks and the sea. Morning jogging along the embankment was allowed only in compliance with epidemiological measures, such as wearing a medical mask, which questioned the benefits of such a run. In our opinion, in Azerbaijan, where the summer season is very hot wearing a medical mask during that times was more harmful than beneficial especially while morning jogging. Wearing a mask limited calm breathing, caused shortness of breath and additional sweating. In general, from a medical point of view, the value of wearing a mask in the hot summer season, weighed down by the high levels of humidity that is observed in the most parts of the country, from our point of view, are not just controversial, but rather negative. Thus, sweaty masks, in conditions of poor air exchange during summer season, often absent or very weak wind attracts bacteria more than protects health. Such measures had an extremely negative impact on both the physical and emotional state of people. Moreover, unfortunately, masks were not distributed free of charge on a massive scale to the country's whole population. Therefore, some people ignored the need to change the mask every 2 hours, and there was no point in it due to the high air temperature, which some days was above 40 degrees Celsius, and high humidity.

Even during the hot summer months, within the framework of quarantine measures people were deprived of the opportunity to visit the beaches. Access to the beaches was opened only at the beginning of August when the beach season in Baku was already ending [63]. Moreover, the opening also took place subject to the necessary epidemiological measures [64] such as social distance between beach loungers and limiting the number of people on the beach. To this end, a website was created where people could book their place in advance on the beach and estimate how many people are there.

Places of religious worship were also closed in Azerbaijan during the tough quarantine as well as in many countries. However, people who were already in the stressful state and used to find peace only in such places through prayer were deprived of this opportunity. The pilgrims were deprived of the opportunity to perform the Hajj [65], the devout deprived of carrying out religious rites in relation to those who died from the coronavirus. The closure of churches [66], temples, mosques and other places of worship at certain times has been implemented around the world. Unfortunately, it is difficult to maintain social distance in places of worship. There were also recorded cases of mass infection in such places [67, 68] that ensured the restrictive measures. Nevertheless, such restrictive measures have created an additional burden on the psychological health of people and have disrupted the usual way of life. The mosques remain closed even at present. Moreover, the closure of the religious sites while restaurants are open is also causing debates in the society.

We believe that one of the unjustified measures taken in the fight against coronavirus in Azerbaijan as well as in many other countries was the disinfection of the streets. The chemicals used for the disinfection were further absorbed into the soil, disrupting the ecology and harming biodiversity. Moreover, these substances posed

#### *A Qualitative Study of Pre-Vaccine Decrease of Mortality from COVID-19 DOI: http://dx.doi.org/10.5772/intechopen.97017*

a particular threat on people's health, especially of those suffering from allergies and lung diseases. Therefore, both from an environmental and a medical point of view, this measure caused more damage than benefit. Large financial resources were allocated for its implementation, which in the conditions of the economic downturn was spending that could be directed to health care needs. An additional, albeit not so important, negative factor of disinfection is the inconvenience of the population. Often people were advised not to leave the house during disinfection.

From the epidemiological point of view, mentioned restrictive measures might be justified if they made sense in terms of reducing the rate of increase in the incidence. However, the statistics, unfortunately, show the opposite. Moreover, the negative influence of the lack of sports activity and walking in the fresh air, the importance of vitamin D produced by the body under the influence of sunlight is widely known. That is, the restriction on walking in the fresh air led to stress and an even greater weakening of natural immunity, which is so important in the fight against the virus.

Restrictive measures in connection with the coronavirus in Azerbaijan have been further tightened as a result of the introduction of martial law at the end of 2020. Coronavirus disease during the war has become an additional burden on the healthcare system. The outbreak of the Patriotic War or the Second Karabakh 44-day war [69] at the end of September created tension in society. News reports from the front line were combined with statistics on the spread of coronavirus infection. Moreover, the restrictive measures have been further tightened in connection with the introduction of martial law in the country. The country's health care had to solve a difficult task of allocation of resources between the needs of the front and coronavirus hospitals. In this respect, this period was especially difficult for doctors. Consequently, the health care system was overloaded during this period.

The Task Force significantly weakened the quarantine regime, however, has not completely lifted it as of February 2021. Thus, a number of restrictions such as the necessity to wear medical masks, large shopping centres and metro remain closed, public transport does not work on the weekends, will remain valid until April 2021 [70].

The coronavirus emergence also gave impetus to the development of domestic healthcare in Azerbaijan. Thus, foreign experts from China, Russia, Italy and Cuba were repeatedly invited to the country to exchange experience and help to fight coronavirus [71–74]. For the first time in the country, modular hospitals were opened [75]. Factories for the production of medical masks and even disinfection tunnels [76] for domestic use and export have been launched.

As of February 2021, statistics on coronavirus in Azerbaijan show about 80 percent recovery [77]. At present, some patients are still in hospitals, some are being treated at home, so it is difficult to give a final figure yet. However, based on one-year observation we can assume that the final death rate from the disease in the country will be low and not more than 2 percent.

Not only Azerbaijan experienced coronavirus-related restrictions. Worldwide unprecedented control measures have been taken. Thus, all international sporting, cultural and scientific events have been cancelled. Many events such as international chess tournaments and even political meetings with the participation of state officials were held in the online format.

Restrictive measures of unprecedented scale and often-conflicting media coverage may have resulted from the lack of timely action by the WHO [78], which declared pandemic and gave appropriate medical advice to the member-states quite late. Were these measures justified? Experts have yet to figure it out. At the initial stage, when the world was gripped by panic due to the unknown type of virus, such measures may have been necessary. However, by the middle of 2020, their

destructive side in relation to the economy and the psychological health of people became clear. A similar situation and restrictive measures were observed in many countries of the world and for now, people still do not have the opportunity to return to their usual way of life. For now, continuation of quarantines around the world, restrictive measures when the coronavirus infection has already been studied and vaccines have been developed and made available, is questionable and causes controversial ideas among the world community.
