Updated North Cyprus response status for COVID-19 in comparison with similar country sizes. Highlights on the importance of population per square meter

The COVID-19 pandemic is straining health systems worldwide. The World Health Organization has provided guidelines on a set of targeted and immediate actions that countries can use on a national, regional, and local level. Recommendations go from public hand hygiene stations, making face masks use obligatory, testing, and index finding which together with national closure of borders have been used to limit the disease so the countries' health care system can cope with the challenges. This is especially important as there seems to be an increased mortality rate even in countries normally regarded as well-functioning and having strong health system. In more susceptible countries this maybe even more important. The effect of these measures should be easier seen in small communities or countries. Societies have acted differently on when to apply the lockdown but most European countries have initiated lockdown after the first SARS-CoV-2 was diagnosed in their countries. With the COVID-19 pandemic and its economic consequences, it became especially important to re-evaluate the effect of response in light of a possible second wave. Yet, little is known about the effect of lockdown with respect to disease development and its handling. Hereby, we compare responses from relatively small 17 European countries including islands in three groups based on their population and report the response from North Cyprus in comparison to other small European countries. Our results indicate the importance of population per meter square, degree of isolation from others as well as social distancing, hygiene rules, timing of lockdowns in response to COVID-19 pandemic in small countries/ societies that are more susceptible for overwhelming their health system.