Sweden’s controversial decision not to lock down during COVID-19 produced more deaths and greater healthcare demand than seen in countries with earlier, more stringent interventions, a new analysis finds. But Sweden fared better than would be expected from its public-health mandates alone, roughly similar to France, Italy and Spain – countries that had more stringent measures but adopted them after the pandemic took hold there.
Sweden’s unusual approach also saw fewer patients admitted to intensive-care units than expected. But the country has seen a higher percentage of COVID-19 deaths in older patients outside of ICUs than other countries when ICU beds were not limited. That suggests health authorities there have considered patients’ chances of recovery in deciding who receives access to intensive care, the researchers say.
The researchers have published their analysis of Sweden’s COVID-19 deaths in the scientific journal Clinical Infectious Diseases.
“Our study shows that individually driven infection-control measures can have a substantial effect on national outcomes, and we see Sweden as a good example of this case,” said Peter Kasson, MD, PhD, Associate Professor of Molecular Physiology and Biological Physics at the University of Virginia’s School of Medicine and Sweden’s Uppsala University. “Higher levels of individual action would further suppress the infection, while a complete lack of individual action would likely have led to runaway infection, which, fortunately, hasn’t happened.”
The researchers set out to analyze the effects of Sweden’s public-health response using population, employment and household data. They say the insights gained from their work can guide future public-health policies. In particular, the findings will help doctors understand the effects of individual compliance with infection-control measures.
Sweden’s per capita death rate was 35 per 100,000 as of May 15. Meanwhile, Denmark’s death rate was 9.3 per 100,000, Finland’s 5.2 and Norway’s 4.7. All three neighboring countries enacted stricter policies. For comparison, the United States had 24 COVID-19 deaths per 100,000 as of May 15. But Sweden has fared better than hard-hit countries such as the United Kingdom and Spain.
While it did not opt for full lockdown, Sweden took several steps to mitigate the spread of COVID-19. The researchers created computer models to measure the effects of these steps, including voluntary self-isolation by symptomatic people and those over 70, closing schools and other interventions.
The researchers’ models anticipated that Sweden’s public-health mandates would result in 40 times more patients needing ICU beds than the number of ICU beds available before the pandemic. Voluntary self-isolation reduced this to five-fold, and the country essentially doubled its number of ICU beds as the pandemic emerged.
