key: cord-0882837-ltdav7ic
authors: Coscieme, L.; Fioramonti, L.; Mortensen, L. F.; Pickett, K. E.; Kubiszewski, I.; Lovins, H.; McGlade, J.; Ragnarsdottir, K. V.; Roberts, D.; Costanza, R.; De Vogli, R.; Wilkinson, R.
title: Women in power: Female leadership and public health outcomes during the COVID-19 pandemic
date: 2020-07-15
journal: nan
DOI: 10.1101/2020.07.13.20152397
sha: 793ac115ec70cf284086319b14f22b5f8299f41f
doc_id: 882837
cord_uid: ltdav7ic

Some countries have been more successful than others at dealing with the COVID-19 pandemic. When we explore the different policy approaches adopted as well as the underlying socio-economic factors, we note an interesting set of correlations: countries led by women leaders have fared significantly better than those led by men on a wide range of dimensions concerning the global health crisis. In this paper, we analyze available data for 35 countries, focusing on the following variables: number of deaths per capita due to COVID-19, number of days with reported deaths, peaks in daily deaths, deaths occurred on the first day of lockdown, and excess mortality. Results show that countries governed by female leaders experienced much fewer COVID-19 deaths per capita and were more effective and rapid at flattening the epidemic's curve, with lower peaks in daily deaths. We argue that there are both contingent and structural reasons that may explain these stark differences. First of all, most women-led governments were more prompt at introducing restrictive measures in the initial phase of the epidemic, prioritizing public health over economic concerns, and more successful at eliciting collaboration from the population. Secondly, most countries led by women are also those with a stronger focus on social equality, human needs and generosity. These societies are more receptive to political agendas that place social and environmental wellbeing at the core of national policymaking.

* Corresponding author: 24A Lea Road, Dublin, Ireland -lucaaq@gmail.com 23 24 . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 15, 2020 . . https://doi.org/10.1101 /2020 Abstract 25 Some countries have been more successful than others at dealing with the COVID-19 26 pandemic. When we explore the different policy approaches adopted as well as the underlying 27 socio-economic factors, we note an interesting set of correlations: countries led by women 28 leaders have fared significantly better than those led by men on a wide range of dimensions 29 concerning the global health crisis. In this paper, we analyze available data for 35 countries, 30 focusing on the following variables: number of deaths per capita due to COVID-19, number of 31 days with reported deaths, peaks in daily deaths, deaths occurred on the first day of lockdown, 32 and excess mortality. Results show that countries governed by female leaders experienced 33 much fewer COVID-19 deaths per capita and were more effective and rapid at flattening the 34 epidemic's curve, with lower peaks in daily deaths. We argue that there are both contingent 35 and structural reasons that may explain these stark differences. First of all, most women-led 36 governments were more prompt at introducing restrictive measures in the initial phase of the 37 epidemic, prioritizing public health over economic concerns, and more successful at eliciting 38 collaboration from the population. Secondly, most countries led by women are also those with 39 a stronger focus on social equality, human needs and generosity. These societies are more 40 receptive to political agendas that place social and environmental wellbeing at the core of 41 national policymaking. CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 15, 2020 . . https://doi.org/10.1101 /2020 

The coronavirus pandemic is impacting daily lives, communities, economies, and 51 exacerbating already existing inequalities. Understanding the pandemic in its full complexity 52 is a difficult task that entails separating intertwined environmental, social, and economic 53 dynamics. Since 1980, the global number of human infectious disease outbreaks has risen, as 54 well as the proportion of vector-borne diseases (Smith et al., 2014) . The risk of pandemic 55 outbreaks increases with the loss of natural habitat and biodiversity (IPBES, 2019; Min. 56 Schulze 02/04/2020). Climate change is already affecting vector-borne disease transmission, 57 geographic spread and re-emergence, and its impacts are likely to worsen (Rocklöv and 58 Dubrow, 2020; IPCC, 2018) . The outcomes of pandemics depend on how risk-prepared 59 societies and economies are, including levels of population health (Wood and Jóhannsson 60 2020), health systems, and financial markets. All of this calls for a better understanding of what 61 underpins successful prevention and control, and successful policy choices and 62 implementation. 63

The study of policy responses to COVID-19 can arguably help us understand how to 64 build future-fit societies, particularly thanks to the heterogeneity of outcomes, which may help 65 clarify which actions and which structural factors may be more significant at determining 66 success in dealing with health crises. 67

The short-term impacts of COVID-19 can be limited by "flattening the curve" (i.e. 68 reducing the spread) of number of cases over time. A higher peak in number of cases implies 69 a higher risk of overloading health care systems. This in turn causes ineffective treatment for 70 individuals suffering from COVID-19 (and other conditions), leading to a higher number of 71 deaths, greater restrictive measures for longer periods, and eventually generating higher 72 impacts in terms of job losses and economic recession (and their health consequences). 73 . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted July 15, 2020 . . https://doi.org/10.1101 /2020 4 To flatten the curve, most countries adopted lockdown measures, recommending that 74 people stay home, work from home whenever possible, and respect physical distancing . The  75   containment measures, together with fiscal and monetary measures, as well as employment and  76 social measures, differed across countries in terms of the timeliness of the implementation, 77 level of stringency, and extent of interventions (e.g. amount and type of financial aid or income 78 support). In general, countries that implemented emergency measures early on were more 79 successful at limiting contagion and required stricter lockdowns only for a shorter period of 80 time. 81

Responsiveness to COVID-19 implies early testing, tracing and treating (Sheridan, 82 2020; Normile, 2020) , which also depend on resource capacity. However, in medium to high-83 income countries the decision to take the pandemic 'seriously' was mostly due to political 84

considerations regarding whether economic priorities should trump healthcare concerns. In this 85 regard, some commentators have noted how women leaders were less hesitant than men leaders 86 (Fioramonti et al., 2020; Henley and Roy, 2020; Wittenberg-Cox, 2020) . 87

Against this backdrop, we explore differences in COVID-19 outcomes in terms of 88 number of deaths, number of days with reported deaths, peak in daily deaths, deaths at first day 89 of lockdown, and excess mortality in countries governed by women as opposed to countries 90 led by men. Further, we discuss the possible underlying causes of this relationship. 91 92

Public data on confirmed cases and deaths from COVID-19 is available from the European 95

Centre for Disease Prevention and Control (ECDC) (https://www.ecdc.europa.eu/ last accessed 96 31 July 2020). Cases and deaths are reported on a daily basis from December 31, 2019. The 97 total number of cases and deaths from COVID-19 in the ECDC dataset are in accordance with 98 . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 15, 2020. . https://doi.org/10.1101/2020.07.13.20152397 doi: medRxiv preprint 5 the World Health Organization (WHO) COVID-19 Dashboard (https://covid19.who.int/). 99

From the ECDC dataset, we selected countries with 1) continuous data from December 31, 100 2019 to June 11, 2020, 2) Gross National Income per capita higher than $3,956 (upper-middle 101 income to high income countries), 3) high to very high Human Development Index (HDI) 102 (which includes life expectancy), and 4) a democratic regime (according to the 2019 103 Democracy Index). Finally, we excluded countries (Thailand and Sri Lanka) without a distinct 104 peak in daily deaths over the study period. These selection criteria ensure good quality of data 105 and robust cross-country comparisons with regards to the impacts of COVID-19, thus 106 excluding that poverty, lack of liberties or state capacity may determine the differences in 107 outcomes. Furthermore, concerns have been raised by good governance advocates that 108 authoritarian governments may not have been transparent with COVID-19 data, and there is 109 no mechanism for the WHO to verify these numbers (Winter, 2020; The Economist 18 110 February 2020), hence our decision to only select established democracies. We made one 111 exception to this particular selection criterion for China, for its relevant role as the first country 112 with a COVID-19 outbreak. For each of the 35 countries selected we calculated 1) the count of 113 confirmed deaths from COVID-19 and the mortality rate (deaths/total population), 2) the 114 number of days with at least one reported death, 3) and the highest daily number of deaths over 115 population. Further, we calculated the slope of the curve of deaths, as the ratio of the peak in 116 daily deaths and the number of days from first confirmed death to the day of the peak ( Fig. 1) . 117 118 . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 15, 2020. . https://doi.org/10.1101/2020.07.13.20152397 doi: medRxiv preprint As an indicator of the effectiveness and promptness of the policy responses since the 125 outset of the epidemic, we considered the number of deaths in the population at first day of 126 national lockdown. We excluded countries with no lockdown or with only sub-national 127 lockdowns in place to ensure consistency across countries. In order to control for levels of 128 mortality, we analyzed excess mortality from the Financial Times database on "excess 129 mortality during the COVID-19 pandemic" compiled from multiple official sources (the full 130 dataset is available at https://github.com/Financial-Times/coronavirus-excess-mortality-data). 131

From this database, we extracted weekly data of excess mortality and excess of deaths per 132 capita for 18 countries between December 31, 2019 and June 11, 2020. 133

We grouped countries by the gender of the head of state and government, also 134 considering leaders elected and appointed by a governing committee or parliament where heads 135 of state or government are not directly elected by citizens, excluding women chosen by a 136 hereditary monarch. Of the 35 countries considered, 10 have a woman-led government 137 . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 15, 2020. 

Some of the countries currently led by women are also those with the highest global 144 standards in terms of social progress. This is why we have used the Social Progress Index (SPI) 145 2019 total score, as well as the score of its three main components, namely Basic Human Needs, 146

Foundations of Wellbeing, and Opportunity. Each of these components include four sub-147 dimensions with three to five indicators each (please refer to https://www.socialprogress.org/ 148 for data and the full list of indicators). In order to explore possible relations between female 149 leadership, impacts of COVID-19, and economic inequality, we have used the Gini coefficient, . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 15, 2020. . https://doi.org/10.1101/2020.07.13.20152397 doi: medRxiv preprint 8 163

19 166

Countries with women in position of leadership have suffered six times as few deaths from 167 COVID-19 than countries with governments led by men. When we normalize the data per 168 population, we find that countries led by women had 1.6-times fewer deaths per capita than 169 their male-dominated counterparts ( Fig. 2A) . Female-led countries reported 1,983 (± 2,724; 170 95% CI) deaths, while men-led countries 13,276 (± 9,848; 95% CI), by considering average 171 values. The peak in daily deaths was seven times as low in women-led countries (1.5-times 172 lower per capita), where the average highest number of daily COVID-19 deaths was 91 (± 122; 173 95% CI) across countries, and 643 (± 435; 95% CI) for men-led countries (Fig. 2B) . The 174 number of days with confirmed COVID-19 deaths was, on average, 50 (± 23; 95% CI) days in 175 women-led countries and 79 (± 7; 95% CI) in male-led countries (Fig. 2C) . Female-led 176 governments managed to flatten the curve more effectively and faster than male-led 177 governments: the slope of the curve of daily deaths from COVID-19 is 4-times less steep in 178 female-led countries (Fig 2D) . 179

As further evidence of different timeliness in implementing emergency response, the 180 average deaths over population at first day of national lockdown was 1.6-times higher in male-181 led (7.38E-07 ±6.88E-07; 95% CI) than in female-led countries (1.17E-06 ±1.11E-06; 95% 182 CI). Average excess mortality per capita was 4.8 (±13; 95% CI) in female-led countries, and 183 21 (±24; 95% CI) in men-led countries. This latter result is of particular relevance as excess 184 mortality is acknowledged as the fairest way to compare COVID-19 deaths internationally 185 (Krelle et al., 2020) . Furthermore, we found significant positive correlations between deaths 186 . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 15, 2020. CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 15, 2020. we considered (Fig. 4) Wellbeing was 88 (± 2.01; 95% CI) in female-led countries, and 83.6 (± 2.82; 95% CI) in men-204 led countries. Opportunity was 80.16 (± 3.39; 95% CI) in female-led countries, and 70.89 (± 205 4.44; 95% CI) in men-led countries. The Gini coefficient was 29.2 (± 1.9; 95% CI) in female-206 led countries, and 35.7 (± 2.5; 95% CI) in men-led countries. The GII was 0.07 (± 0.02; 95% 207 CI) in female-led countries, and 0.15 (± 0.04; 95% CI) in men-led countries. The average global 208 rank in happiness score was 21 in female-led countries, and 32 in men-led countries, and the 209 rank in generosity was 44 in female-led countries and 59 in men-led countries. 210

These results point to female leadership as a marker for healthier and more equal societies, 211

where policymaking prioritizes long-term social wellbeing over short-term economic 212

Our results with regards to the GII further confirm the relationship between (gender) 214 equality and social well-being. We found that countries with higher female participation and 215 lower gender inequality, besides having higher SPI scores (R = -0.8; p = 2.61E-10), are also 216 happier (R = -0.5; p = 0.004) and more generous (R = -0.5; p = 4.81E-04) (Fig. S2) . 217 218 . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 15, 2020. CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

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As two out of three dimensions of the SPI include aspects related to gender equality 235 (i.e. Foundations of Wellbeing includes "Gender parity in secondary enrollment", and 236

Opportunity includes "Equality of political power by gender", 237 https://www.socialprogress.org/) we further explored if more gender equal countries perform 238 better on Basic Human Needs (the one SPI dimension not directly including gender equality 239 indicators). We found that higher scores in the Basic Human Needs dimension of the SPI 240 negatively correlate to the GII (R = -0.8; p = 9.93E-13) (Fig. S3) . 241

To explore if female leadership relates with less negative impacts from COVID-19 even 242 among equal countries with good social performance, we repeated the analysis by considering 243 a sub-set of countries with below-average values of Gini coefficient and GII, and above-244 average values of SPI. The results confirmed the pattern observed across all 35 countries. In 245 particular, among the 18 countries with below-average Gini coefficient, female-led countries 246 have 26 less days with deaths, 1.12-times fewer deaths over population, and 33.5-times lower 247 excess mortality per capita. Among the 25 countries with below-average GII, female-led 248 countries have 17 less days with deaths, 1.6-times fewer deaths over population, and 6.5-times 249 lower excess mortality per capita. Finally, among the 24 countries with above-average SPI, 250 . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 15, 2020. From a policy perspective, the COVID-19 crisis has been characterised by three 255 overarching elements: (1) it has threatened the priority goals of the decision-making unit, 256 namely economic growth; (2) it has compressed the time necessary to develop an appropriate 257 decision; and 3) its eruption has taken the members of the decision-making unit by surprise 258 (Hermann, 1979; de Swielande, 2020) . 259

As COVID-19 deaths began to add up, national leaders were faced with an urgent decision: 260 prioritize economic growth and market openness or shift toward people's wellbeing. Leaders 261 who opted for the former demonstrated a short-term vision and lack of understanding of the 262 fact that social wellbeing (and a healthy environment) is the basis for a healthy economy. Our 263 results show that this is the case for most men leaders, while women leaders did not hesitate to 264 adopt precautionary measures, even when they posed immediate economic costs. 265

George Lakoff (2010) has argued that conservative and liberal/progressive political views 266 stem ultimately from conceptions of the family and the metaphor of government as parent. 267

Conservative politics corresponds with a hierarchical "strict father" model of the family. 268

In this model the father's (and by analogy the political leader's) authority is absolute and final. 269

The alternative is the "nurturing mother" model corresponding to liberal/progressive politics. 270

The role of the family (and by analogy the government) is to nurture and enable individual and 271 societal progress. "We are all in this together" is an important way of structuring the family 272 and society. When faced with an illness, the strict father might advise working through it while 273 the nurturing mother would advise staying home until you get better. 274 . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 15, 2020. . https://doi.org/10. 1101 /2020 All modern societies are a mixture of both of these models and they are better adapted 275 to different circumstances. For fighting a war, the hierarchical strict father model works better. 276

But for fighting a pandemic, the nurturing mother model can prove more successful. Countries 277 that lean toward the nurturing mother model of the family and government are more likely to 278 elect progressive female leaders. The fact that countries, such as the United States, supposedly 279 best prepared to fight a pandemic, ended up failing to contain it and suffered more deaths than 280 other nations is evidence of leaders' failure to take appropriate decisions at the right time. . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 15, 2020 . . https://doi.org/10.1101 /2020 15 shaking hands and "high-fiving" COVID-19 patients, in a blunt disrespect of any social 300 distancing precautions. 301

On the opposite side of the spectrum, a number of women leaders heeded scientific 302 active and took immediate action to manage the crisis. Taiwan's Prime Minister Tsai Ing-wen, 303 building on the country's previous experience with SARS, introduced targeted measures and 304 medical checks early on, while the epidemic was still in its initial phase in the Chinese city of 305

Wuhan (Wang et al., 2020) . This massively reduced the risk of an outbreak and therefore made the earliest and toughest self-isolation measures of any country. On the same day, the PM 318 Jacinda Ardern declared "We're going hard and we're going early, … we only have 102 cases, 319 but so did Italy once." One week later New Zealand was in complete lockdown. 320

In Scandinavia, the only country that prioritised economic objectives and, as a 321 consequence, did not impose any serious restrictions was Sweden (led by a male prime 322 minister), while all other countries of the region (led my women) took immediate measures. 323 . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 15, 2020 . . https://doi.org/10.1101 /2020 While Norway implemented strict lockdown for almost two months, and Denmark closed 324 upper primary schools (above age 12) from 13 March to 17 May, Sweden opted for a 'herd 325 immunity' approach, placing economic priorities ahead of health concerns, keeping primary 326 schools (under age 16) open and only isolating, as much as possible, people over 70 (OCED, 327 2020) . This resulted in the highest COVID-19 mortality rate across Nordic countries by the 328 end of May 2020, with 40.5 deaths per 100,000 population, compared to 9.7 for Denmark and 329 4.4 for Norway. 330

The cases above are examples of a more general trend, with female leaders 331 demonstrating more effective management of the pandemic by taking the problem seriously, 332 listening to health experts, and acting quickly. This trend seems to confirm that progressive 333 female leadership is more engaged on issues of health and wellbeing, social equality, 334 sustainability, and innovation, making societies more resilient. Some of these governments 335 have also launched an international alliance to promote, share and further implement wellbeing 336 policies taking the focus off economic growth and putting it on issues that lead to social and 337 ecological wellbeing (https://wellbeingeconomy.org/wego). 338

In business, there is a tendency for preferential selection of female leaders in times of crisis 339 known as the 'glass cliff' effect (Ryan et al., 2011) . However, women still represent only 29% 340 of senior leadership in companies (Catalyst 2019). Recognizing the effectiveness of women 341 political leaders in reacting to this coronavirus crisis is one step towards understanding the 342 underlying conditions for effective leadership to emerge. 343

Implementing policies with short-term economic returns and long-term negative health and 344 social impacts is more common in hierarchical, autocratic societies. These policies often imply 345 pursuing self-interests and attempting to spur dynamics for re-election. There is evidence for 346 women to be more likely to take up positions of political leadership in societies that value 347 equity, solidarity, nurturing, and collaboration, which are usually associated with healthier 348 . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 15, 2020. and being members of parliaments and local governments (Schneir, 1994) . 351

Women's status suffers where there is a stronger dominance hierarchy and the "strict 352 father" approach to politics and governance. In more nurturing, sociable (and egalitarian) 353 societies, where position and authority count for less, women's status tends to be better 354 (Wilkinson and Pickett, 2009 ). Women's status is thus a marker for the more egalitarian and 355 sociable societies in which health is less affected by the costs of competition for dominance. 356

Our results support these points, showing how hierarchical, unequal societies paid higher 357 costs in terms of a broad range of impacts from COVID-19. Our results also show that more 358 equal societies tend to be happier and more generous and tend to better perform better in terms 359 of social progress and environmental quality. Furthermore, even among equal societies, female 360 leaders were more successful than male leaders at dealing with the COVID-19 pandemic. 361 362

We are facing increasing risk of pandemics due to climate change and increasing 364 destruction of ecosystems and biodiversity (IPCC, 2018; IPBES, 2019) . While changing our 365 consumption patterns and acting on further drivers of impact is crucial, so it is to build 366 economies and societies that are equal in terms of gender and wealth, with good public health, 367 and are resilient to shocks. The COVID-19 crisis is showing us how political decisions directly 368 affect health and social wellbeing. Women are elected and lead in societies where social and 369 environmental wellbeing is at the core of national policymaking, and this affects a broad range 370 of impacts from Our results show that female-led countries have consistently less deaths from COVID-19 372 per capita, a shorter number of days with confirmed deaths, a lower peak in daily deaths per 373 . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted July 15, 2020. . https://doi.org/10.1101/2020.07.13.20152397 doi: medRxiv preprint capita, and a lower excess mortality. Female leaders acted quickly, implementing measures of 374 lockdown early on as recommended by national health experts. Our results also show that 375 women are more likely to take up positions of leadership in societies that value equity, 376 nurturing, solidarity, and collaboration, which are usually associated with healthier 377 communities, more resilient to external shocks. 378 Current data about economic growth forecasts also point out that countries that have taken 379 more determined containment measures will also be rewarded in economic terms: they will 380 suffer much less severe recessions than countries that have hesitated, thus spreading the 381 contagion further afield. CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

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Quick Take: Women in Management

Can atmospheric pollution be considered a co-factor 434 in extremely high level of SARS-CoV-2 lethality in Northern Italy

CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)The copyright holder for this preprint this version posted July 15, 2020 . . https://doi.org/10.1101 /2020 Leonhardt D and Leatherby L 2 June 2020. Where the virus is growing most: countries with 463 . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 15, 2020. . CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 15, 2020. CC-BY-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)The copyright holder for this preprint this version posted July 15, 2020. . https://doi.org/10. 1101 /2020