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Infectious Diseases

15 July 2020

Sweden's lack of lockdown: What researchers found

Sweden's mortality rates were higher than European countries that went into lockdown faster, but lower than countries that implemented lockdown at a much later stage.

  • Sweden's Covid-19 mortality rate was fuelled by its lax lockdown regulations
  • The country depended on residents' own decision to self-isolate
  • The pandemic's economic impact was the same as on its neighbours who had stricter measures

Governments around the world imposed various methods to try and curb the spread of the coronavirus. South Africa opted for a hard lockdown from the get-go, while the UK went into lockdown a lot later, only after the numbers of positive cases surged. 

Sweden is one of the few countries that imposed no government-mandated lockdowns, rather placing the onus on its residents to be responsible for their own safety. It's been used by both sides of the lockdown debate as an example for stricter or laxer regulations.

But the question is how effective was this compared to countries that instituted various degrees of lockdown?

READ | What we learned from Italy's outbreak: About 40% of coronavirus cases in one town were asymptomatic

Suppression vs. mitigation

Researchers from the University of Virginia used Sweden's population, employment, and household data to analyse the effects of two different coronavirus lockdown strategies over a 160-day period.

In these models, they looked at ICU demand and death rate and compared it to the real-life Swedish data of April, publishing their findings in the Clinical Infectious Diseases journal.

The two strategies are:

  • Suppressive approach – to try to stop the spread of infection in its tracks
  • Mitigation approach – focusing instead on slowing the spread of the virus and shielding vulnerable groups without cutting off transmission

South Africa took the suppressive approach with full lockdown, while Sweden is an example of mitigation.

Mortality rate high

They found that although Swedish residents were quick to self-isolate themselves, their mortality rates were higher than in European countries that went into lockdown more quickly, but lower than countries that implemented lockdown at a much later stage.

The ICU demand in Sweden was also quite low. However, it's important to note that a lot of their deaths happened outside the ICU, despite not having limited resources like other countries where the lack of ICU beds contributes to mortality. 

The case-fatality rate – focused only on diagnosed cases – in Sweden was 15%, while the country's infection-fatality rate – which includes asymptomatic and undiagnosed estimates – was much lower than the worldwide rate, which is between 0.36% and 1.2%.

READ MORE | Why vaccines need to be tried and tested in different populations across the world

ICU beds not used for high-risk patients

"Analysed by categorical age group, older Swedish patients with confirmed Covid-19 were more likely to die than to be admitted to the ICU, suggesting that predicted prognosis may have been a factor in ICU admission," writes the researcher.

"This likely reduced ICU load at the cost of more high-risk patients dying outside the ICU."

Their demographic data also held some interesting insights. The average household has only around two to three people, with almost 40% of the population living on their own. Also, only 5% of adults over 70 lived in facilities like retirement homes.

While Sweden fared better than countries that imposed late-stage lockdowns, there were still increased demands on healthcare, and mortality rates remained higher than countries with early adoption of lockdown measures.

Strategy depends heavily on compliance

Swedish citizens' willingness to continue to self-isolate was 30% of the population, which is expected to go down exponentially the longer the pandemic goes on. 

While Sweden had fewer deaths per capita than Italy, Spain and the UK, it far surpassed the numbers of its Scandinavian neighbours who implemented strict lockdown measures.

"Predicted deaths and ICU demand are also greater with voluntary adherence than with stringent mandates until adherence rates exceed 75%."

But in terms of the economic impact of the pandemic, Sweden's experience was similar to its neighbours. This means that not having a lockdown in a pandemic doesn't necessarily prevent job losses. 

READ | What if there were no lockdowns for Covid-19? Analysis of a study is showing a shocking alternative

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