A new analysis has found that Sweden's decision to not lock down amid the coronavirus pandemic caused more deaths and placed greater pressure of the country's healthcare system, according to research from the University of Virginia School of Medicine and Sweden’s Uppsala University released on Friday.
On the other hand, the study found that Sweden's healthcare system fared better due to its public-health mandates alone, similar to other Western European countries, including France, Italy and Spain, which had more stringent restrictions following the coronavirus outbreak.
Nevertheless, Sweden's approach, despite seeing fewer people patients admitted to intensive-care units, also revealed a higher percentage of deaths in older patients outside ICUs than other countries when ICU beds were not limited. This suggests, according to the study, that Swedish health authorities considered patients’ potential of recovery in deciding who receives access to intensive care.
“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, of the University of Virginia School of Medicine and Sweden’s Uppsala University.
He added that “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.”
An important aspect to research, notes Lynn Kamerlin of Uppsala University, was that Sweden’s relatively looser policies on coronavirus was influenced by a population more willing to voluntarily self-isolate and social distance, producing somewhat similar results to other advanced, industrialized European countries.
Despite this, Sweden’s per capita death rate was 35 per 100,000 as of May 15, while its southern neighbor Denmark was 9.3 per 100,000, and the bordering Scandinavian countries of Finland and Norway maintaining a 5.2 and 4.7 death rate per 100,000, respectfully. In comparison, the US had a death rate of 24 per 100,000 during the same period.
“Sweden is perhaps the most prominent example of mitigation — limiting the extent of socially and economically disruptive interventions while still aiming to slow spread and allow for an effective medical response,” the researchers wrote in the new study.
“Studying the effects of this strategy, which elements are key to reducing mortality and healthcare need, and how it might compare to other approaches, is thus of critical importance to the global understanding of pandemic responses,” the researchers concluded.
While Sweden did not enforce a full lockdown, the country took some steps to stop the spread of coronavirus, including voluntary self-isolation by symptomatic people and those over 70, and school closures. The predictive model suggested that Sweden would have 40 times more patients needing ICU beds than the number of ICU beds available, but the push to self-isolate reduced this to to five-fold.
The availability of ICU beds, the researchers note, was in part due to the strong likelihood that older patients were more likely to die quicker.
“Analyzed 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,” the researchers wrote. “This likely reduced ICU load at the cost of more high-risk patients dying outside the ICU.”
“The key finding is that individual actions matter, If enough individuals stay home and take precautions when in the community, it can really change the infection curve. And we can’t let up now,” Kasson summarized
The study can be found in the scientific journal Clinical Infectious Diseases.