Sweden COVID-19 Deaths Linked to Failure to Lockdown as Country Prepares for Second Wave

Sweden's decision not to lockdown amid the COVID-19 pandemic may have led to more deaths, according to a study. However, researchers also found the Scandinavian country fared similarly to some others with stricter measures.

Unlike other countries, such as Spain and Italy, Sweden didn't enforce a lockdown to prevent the spread of the coronavirus, but instead advised citizens on how to act responsibly. Shops, restaurants, and gyms stayed open, but schools and universities closed to over-16s, and large-scale gatherings of more than 50 people were banned. Over-70s and those with COVID-19 symptoms were told to self-isolate.

To explore the outcomes of Sweden's "unique" approach, the authors of the paper published in the journal Clinical Infectious Diseases created a model using national population, employment and household data, as well as death rates and ICU demand. The data spanned from between March 21 to April 30. They used this to look at how individual behavior affected the spread of disease in different model scenarios.

Deaths in Sweden fell somewhere in between countries that quickly implemented public health measures and those that acted later, the team found. The data suggests that "large portions" of the population self-isolated voluntarily.

They also noted that fewer patients needed to be treated at ICUs than expected, but a "large fraction" of those who died didn't need ICU care. This suggests that health care workers considered a patient's prognosis before admitting them to ICU. If this approach was taken it would have lessened the load on the healthcare service, but at the cost of a patient not surviving when they perhaps otherwise would have.

The approach also appeared to put greater pressure on the health care system and seemed to cause more people to die when compared with that taken by countries which locked down early.

Sweden had fewer deaths per capita than Italy, Spain and the United Kingdom, but more than their Scandinavian counterparts that locked down quickly and "most other European countries," as of May 15, the authors said.

According to the study, Sweden's per capita death rate was 35 per 100,000, compared with 9.3 in Denmark; 5.2 in Finland; and 4.7 in Norway, where there were tougher lockdowns.

Having a large portion of the population self-isolating was found to "profoundly" reduce the burden on ICUs and deaths. "It therefore also follows that greater self-isolation in Sweden would have commensurately reduced deaths," the researchers wrote.

Co-author Dr. Peter Kasson of the University of Virginia School of Medicine and Uppsala University, Sweden, said in a statement: "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 told Newsweek: "We can explain Sweden's COVID-19 spread using the current public health agency recommendations overlaid with about a third of the population working from home and socially distancing in the community. But it would take about twice that many to achieve pandemic control as effective as a strong coordinated public health strategy."

The study was limited, he said, because although the model was based on the best current data on the coronavirus, "there's a lot being learned every day, and we don't have enough data." In addition, the model wasn't refined enough to distinguish between indoor and outdoor transmission, and therefore can't be used to guide specific recommendations for limiting spread, he said.

"Swedes have a high degree of trust in governmental authorities," said Kasson. "It's disappointing that the Swedish public health ministry didn't issue stronger, evidence-based recommendations for pandemic control, as even recommendations, as opposed to mandates, more in line with international consensus could have saved many lives."

According to Johns Hopkins University, Sweden makes up over 73,000 of the world's confirmed COVID-19 cases. That compares with 2.9 million in the U.S., 1.6 million in Brazil, and over 719,000 in India.

On Monday, three Swedish government ministers wrote on what the pandemic may hold for their country in the newspaper Aftonbladet.

Lena Hallengren, Minister for Health and Social Affairs, Mikael Damber, Minister for Home Affairs, and Lena Micko, Minister for Home Affairs, said it was of "utmost importance that everyone continues to follow the recommendations and guidelines available to prevent the spread of infection."

They said: "We do not know when this global pandemic will be over. We do not know how we will be affected this fall. We do not know if Sweden will be flooded by a wide second wave of infections or if we will see several smaller local outbreaks in different parts of Sweden.

"As with most things in this pandemic, we are constantly learning more about both the evolution of the virus and how it is being fought."

But they said: "Sweden should be well prepared for all conceivable scenarios regarding the development of the spread of COVID-19."

Newsweek has contacted Sweden's Ministry of Health and Social Affairs for comment.
This article has been updated with comment from Peter Kasson.

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A sticker on a sidewalk in Stockholm instructs people to follow social distancing advice amid the COVID-19 pandemic on May 4, 2020. Jonathan NACKSTRAND / AFP