Trade, uneven development and people in motion: Used territories and the initial spread of COVID-19 in Mesoamerica and the Caribbean.

Mesoamerica and the Caribbean form a region comprised by middle- and low-income countries affected by the COVID-19 pandemic differently. Here, we ask whether the spread of COVID-19, measured using early epidemic growth rates (), reproduction numbers ( ), accumulated cases, and deaths, is influenced by how the 'used territories' across the regions have been differently shaped by uneven development, human movement and trade differences. Using an econometric approach, we found that trade openness increased cases and deaths, while the number of international cities connected at main airports increased , cases and deaths. Similarly, increases in concentration of imports, a sign of uneven development, coincided with increases in early epidemic growth and deaths. These results suggest that countries whose used territory was defined by a less uneven development were less likely to show exacerbated COVID-19 patterns of transmission. Health outcomes were worst in more trade-dependent countries, even after controlling for the impact of transmission prevention and mitigation policies, highlighting how structural effects of economic integration in used territories were associated with the initial COVID-19 spread in Mesoamerica and the Caribbean.