Digitalization impacts the COVID-19 pandemic and the stringency of government measures

COVID-19 poses a significant burden to populations worldwide. Although the pandemic has accelerated digital transformation, little is known about the influence of digitalization on pandemic developments. Therefore, this country-level study aims to explore the impact of pre-pandemic digital adoption on COVID-19 outcomes and government measures. Using the Digital Adoption Index (DAI), we examined the association between countries' digital preparedness levels and COVID-19 cases, deaths, and stringency indices (SI) of government measures until March 2021. Gradient Tree Boosting based algorithm pinpointed essential features related to COVID-19 trends, such as digital adoption, populations' smoker fraction, age, and poverty. Subsequently, regression analyses indicated that higher DAI was associated with significant declines in new cases (β = − 362.25/pm; p < 0.001) and attributed deaths (β = − 5.53/pm; p < 0.001) months after the peak. When plotting DAI against the SI normalized for the starting day, countries with higher DAI adopted slightly more stringent government measures (β = 4.86; p < 0.01). Finally, a scoping review identified 70 publications providing valuable arguments for our findings. Countries with higher DAI before the pandemic show a positive trend in handling the pandemic and facilitate the implementation of more decisive governmental measures. Further distribution of digital adoption may have the potential to attenuate the impact of COVID-19 cases and deaths.

The post-peak period describes the time and duration at which the spread of deaths has dropped below the peak. Linear regression was fit on the monthly data between the peak maximum and the maximum of the minimum that followed the peak. The period after the peak was determined separately for each country, and the slope values were finally included in the linear regression models. Countries were excluded if they a) were unable to reduce their death rates, b) experienced an increase in death rates that exceeded half of the peak height, or c) reached the peak at the end of the observation time (March 2021). Post-peak periods were analyzed for each country separately and, therefore, differed in length. Supplementary Table 1 presents the results of the treatment contrasts of the interaction of DAI and its three subgroups (low, medium, and high). This step is undertaken as an additional step after noticing three trends in data when plotting the SImean against DAI. The DAI:subgroup interaction shows a significant effect (β=-109.44, p<0.05). Therefore, DAI slope is dependent on the subgroups. This also indicates that the effect of a country's digitalization depends on its relative position within the DAI scale. Identify the report as a scoping review.

Supplementary
We did not include this information in the title, as the scoping review was one of three methodologies applied. ABSTRACT

Rationale 3
Describe the rationale for the review in the context of what is already known. Explain why the review questions/objectives lend themselves to a scoping review approach. 2

Objectives 4
Provide an explicit statement of the questions and objectives being addressed with reference to their key elements (e.g., population or participants, concepts, and context) or other relevant key elements used to conceptualize the review questions and/or objectives.

Protocol and registration 5
Indicate whether a review protocol exists; state if and where it can be accessed (e.g., a Web address); and if available, provide registration information, including the registration number. n.a.

Eligibility criteria 6
Specify characteristics of the sources of evidence used as eligibility criteria (e.g., years considered, language, and publication status), and provide a rationale.
Supplementary Table 2 Information sources* 7 Describe all information sources in the search (e.g., databases with dates of coverage and contact with authors to identify additional sources), as well as the date the most recent search was executed.

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Search 8 Present the full electronic search strategy for at least 1 database, including any limits used, such that it could be repeated.

Supplementary Note
Selection of sources of evidence † 9 State the process for selecting sources of evidence (i.e., screening and eligibility) included in the scoping review. Supplementary Table 2 Data charting process ‡ 10 Describe the methods of charting data from the included sources of evidence (e.g., calibrated forms or forms that have been tested by the team before their use, and whether data charting was done independently or in duplicate) and any processes for obtaining and confirming data from investigators.

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Data items 11 List and define all variables for which data were sought and any assumptions and simplifications made. Supplementary Table 4 Critical appraisal of individual sources of evidence §

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If done, provide a rationale for conducting a critical appraisal of included sources of evidence; describe the methods used and how this information was used in any data synthesis (if appropriate). n.a.

Synthesis of results 13
Describe the methods of handling and summarizing the data that were charted. 12-13

Selection of sources of evidence 14
Give numbers of sources of evidence screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally using a flow diagram.

SECTION ITEM PRISMA-ScR CHECKLIST ITEM REPORTED ON PAGE # Characteristics of sources of evidence 15
For each source of evidence, present characteristics for which data were charted and provide the citations.
Supplementary  16 If done, present data on critical appraisal of included sources of evidence (see item 12). n.a.

Results of individual sources of evidence 17
For each included source of evidence, present the relevant data that were charted that relate to the review questions and objectives. n.a.

Synthesis of results 18
Summarize and/or present the charting results related to the review questions and objectives. Supplementary Table 3 DISCUSSION Summary of evidence 19 Summarize the main results (including an overview of concepts, themes, and types of evidence available), link to the review questions and objectives, and consider the relevance to key groups.

3-8 & Supplementary Results
Limitations 20 Discuss the limitations of the scoping review process. 10

Conclusions 21
Provide a general interpretation of the results with respect to the review questions and objectives, as well as potential implications and/or next steps.

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FUNDING Funding 22 Describe sources of funding for the included sources of evidence, as well as sources of funding for the scoping review. Describe the role of the funders of the scoping review.
19 JBI = Joanna Briggs Institute; PRISMA-ScR = Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. * Where sources of evidence (see second footnote) are compiled from, such as bibliographic databases, social media platforms, and Web sites. † A more inclusive/heterogeneous term used to account for the different types of evidence or data sources (e.g., quantitative and/or qualitative research, expert opinion, and policy documents) that may be eligible in a scoping review as opposed to only studies. This is not to be confused with information sources (see first footnote). ‡ The frameworks by Arksey and O'Malley (6) and Levac and colleagues (7) and the JBI guidance (4,5) refer to the process of data extraction in a scoping review as data charting. § The process of systematically examining research evidence to assess its validity, results, and relevance before using it to inform a decision. This term is used for items 12 and 19 instead of "risk of bias" (which is more applicable to systematic reviews of interventions) to include and acknowledge the various sources of evidence that may be used in a scoping review (e.g., quantitative and/or qualitative research, expert opinion, and policy document).  News articles and scientific reports on technology adoption in combatting COVID-19 are analyzed.

Distribution of authors' residence
Supplementary Figure 4. The distribution of first authors' residence. This also includes multiple countries in the case of cofirst authorship.

Data synthesis
Supplementary  Supplementary Fig. 3 shows the occurrence and overlap of all nine keywords included in the scoping review. Large disparities in affordability and access to mobile communications widen the digital divide 14 . Low-income settings, ethnic minorities, less educated groups, and the digitally illiterate are disproportionally affected by digital inequalities 50 . Reddick et al. illustrate this with a case study of broadband access in San Antonio, USA, where more than half the population is Hispanic. Residents of poorer neighborhoods had significantly lower rates of broadband use, defined here as an essential factor in a person's quality of life. This study highlights the significant digital divide within geographic structures 50 . Anthony et al. identified barriers to adopting digital health solutions at the infrastructural and institutional level, similar to the DAI pillars. They ultimately created determinants meaningful in adopting telehealth 8 . In addition, great exposure to information, inappropriate risk communication, or even misinformation have confused and influenced individual health behaviors. Misinformation and changing guidance have led people to reject public health measures such as wearing masks and physical distancing 14,60 . Finally, digital technologies raise legal, ethical, and privacy concerns 8,57 .
Supplementary Figure 6. Occurrence of keywords and themes within the scoping review. The radar chart illustrates the frequency and overlap of studies assigned to the following three themes of the scoping review: i) health care system, ii) government responses, and iii) determinants facilitating or hindering public health outcomes. The results of the first two themes are extensively described in the main manuscript. The third theme (green) includes keywords from all three themes. The axis of the radar chart represents the total number of included keywords within the themes (see Supplementary Table  5). The scale for the radial aces of this chart is the total number of reports per keyword.

Global level of digital adoption by income
Supplementary Figure 7. Distribution of digital adoption by income group. Box and Whisker plot of the digital adoption index (DAI) by income level: low, lower-middle, upper-middle, and high income. One-way ANOVA of income groups followed by a Games-Howell post-hoc test for pairwise comparisons. DAI showed statistically significant differences between all groups (p<0·001). (Note: LIE = low-income economy; LMIE = lower-middle-income economy; UMIE = upper-middle-income economy; HIE = high-income economy).