Sweden, famously, decided against instituting a COVID-19 lockdown. How that policy played out is the subject of a new analysis involving a University of Virginia School of Medicine researcher.
One data point has Sweden tracking near the top in terms of deaths per capita. But the country also had less strain on its hospital system than had been anticipated, according to the new analysis, led by Peter Kasson, MD, PhD, of the University of Virginia School of Medicine and Sweden’s Uppsala University, and Uppsala’s Lynn Kamerlin.
Models had 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.
That still would have left many patients without a bed, however, and yet the country’s ICUs weren’t overrun.
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That outcome – and the fact older patients in Sweden were several times more likely to die than to be admitted to an ICU – prompted Kasson and Kamerlin to analyze choices that Swedish health authorities made about who would receive intensive care.
“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 parameters of the study had Kasson and Kamerlin analyzing the effects of the country’s public-health response using population, employment and household data.
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.
They then validated their results by comparing the models with Sweden’s death rate and compared Sweden’s results to other countries’.
Sweden has seen 54 COVID-19 deaths per 100,000 population, as of today’s figures from Worldometers, faring better than the UK (65), Spain (61) and Italy (58), all of which instituted lockdowns.
The U.S., which as we know also instituted lockdowns, has had 40 COVID-19 deaths per 100,000 population as of today’s Worldometers update.
The researchers conclude that Sweden’s “mild” government restrictions, coupled with a population willing to voluntarily self-isolate, produced results quite similar to those seen in countries that enacted more stringent measures later in the pandemic.
“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 a new paper outlining their findings.
“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 have published their analysis in the scientific journal Clinical Infectious Diseases.
Kasson and Kamerlin collaborate at Uppsala University, and Kasson is part of UVA’s Department of Molecular Physiology and Biological Physics. He also holds an appointment in the Department of Biomedical Engineering, a collaboration of UVA’s School of Medicine and School of Engineering.
The research was supported by the Knut and Alice Wallenberg Foundation, grants 2015.0198, 2018.0140 and 2019.0431. Computational resources were provided by the Swedish National Infrastructure for Computing, grant SNIC 2020/5-176.
Story by Chris Graham
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Chris Graham
