Sweden: The Country Without A Lockdown

With most of the world opting to have national lockdowns -- even countries like Rwanda with only 136 cases and no deaths to-date -- Sweden bucked the trend and instead limited gatherings to less than 50, asked people to self quarantine, wash hands and keep social distance, but didn't order people to shelter in place and businesses to close. Yesterday we looked at the question of what happens after lockdowns and I wrote about how many preventative measures would continue even after businesses re-open.  Sweden provides an intriguing look at that scenario. 

Sweden is one of the northernmost countries in Europe. With a population of 10.3 Million -- about the same as North Carolina.  Most of the population is at the southern end of the country and about 1.5 million live in their capital of Stockholm.

They put in place national warnings and social distance advisories about the same time as other European countries. They banned travel with China in Mid-February and put in place policies limiting gatherings of more than 50 on March 11, the day of their first COVID death. The recommended businesses work from home and about half the workforce soon did.  They recommended schools go to distance learning and the schools followed suit.  They advised the elderly to limit contact with others. Their COVID testing is about the same as the US on a population basis -- ranked 10 out of 20 countries on my COVID dashboard.  They pretty much took the same steps as other countries, but never put in place a legal ban to close businesses and make their people shelter at home as we have done in NC and most of the US.  It's been about 40 days since they took a different path. While there are some ways where it seems they've had similar results to other countries, there are also important differences.

When it comes to the reported cases, they seem pretty comparable, if a little lower than other North American and European countries:

When looking at fatalities, they also seem slightly lower than average.

When looked at from this perspective, it appears that lack of a national lock down did not result in a worse situation and that the other measures to avoid COVID growth -- self quarantines, social distance, and voluntary work from home -- were sufficient to contain the pandemic.  As I've noted earlier, nearly all the countries above are several days past their peak day of new COVID cases and many are also past their peak day of new COVID deaths.  Sweden also looks to be on a similar track:

Country	Days post 100 cases	Highest Case per Day	Days Since Peak Case per Day	Highest Death per Day	Days Since Peak Deaths per Day
USA	45	33,752	5	2,482	0
Italy	53	6,203	20	951	11
Spain	45	8,271	20	961	13
Germany	46	6,933	19	333	7
France	47	23,060	12	1,762	1
UK	42	8,681	5	980	5
Canada	34	1,600	10	123	1
Sweden	34	726	7	170	0

While the results look promising,  there are some important differences with Sweden's experience to consider.

First, Sweden is much smaller than the other countries compared here.  Even though the graphs are adjusted for population, density matters.  Sweden's largest city has 1.5 Million people -- much less than the largest cities in these other countries.  It may be fairer to compare Sweden with its neighbors -Denmark and Norway. Each has about half the population of Sweden, but Norway's largest city has only 500K people while Copenhagen in Denmark has 1.1 million.  Here's how they compare:

	Population	Days past 100 cases	Covid Cases	Covid Deaths	Cases per 1M	Deaths per 1M
Sweden	10,230,000	41	11,927	1,203	1,166	118
Denmark	5,806,000	37	6,681	309	1,151	53
Norway	5,368,000	41	6,790	150	1,265	28

On the number of COVID cases, Sweden is very close to its neighbors, but has far many more deaths, including 284 deaths in the past two days -- almost 20% of their total. “We have had an unfortunate development, especially compared to our neighboring countries, with an introduction of the virus at many elderly care homes,” said Sweden’s top epidemiologist Anders Tegnell.  The key oversight seems to be that many of the elderly need day to day assistance and that assistance comes from the younger population.   By asking the elderly to limit contact with others but giving more leeway for their younger caretakers to be out and about,  it seems to have exposed those most vulnerable to COVID to more risk.

As we consider how we should approach ending our lockdowns and allowing more social contact,  it will be important to consider how we can continue to protect our older people and not have them pay a higher price for our decision.