TY - JOUR
T1 - Leveraging epidemiological principles to evaluate Sweden's COVID-19 response
AU - Baral, Stefan
AU - Chandler, Rebecca
AU - Prieto, Ruth Gil
AU - Gupta, Sunetra
AU - Mishra, Sharmistha
AU - Kulldorff, Martin
N1 - Funding Information:
Equity is a fundamental determinant in social systems in Sweden, exemplified specifically by its provision of both universal education and healthcare. Consequently, in its response to COVID-19, Sweden has attempted to minimize the inequities that result from universal lockdown mandates, as such mandates potentially concentrate COVID-19 among lower socioeconomic communities given those in higher socioeconomic classes are more likely to be able to work remotely. Specific interventions included the provision of paid leave from the first day of illness to essential workers to avoid undue pressures to continue working while under quarantine or isolation. Similarly, financial support was provided to people in multigenerational households facilitating temporary relocations to mitigate risks of onward transmission to household contacts [ 4 ].
PY - 2021/2
Y1 - 2021/2
N2 - In the response to COVID-19, countries have implemented response strategies along a continuum of population- and venue-level specificity ranging from suppression to mitigation strategies. Suppression strategies generally include population-wide shelter-in-place mandates or lockdowns, closure of nonessential physical venues, travel bans, testing and contact tracing, and quarantines. Sweden followed a mitigation strategy focused on risk-tailored approaches to mitigate specific acquisition risks among the elderly, minimizing the disruption to education and the delivery of other health care services, and recommendations for social distancing to minimize the disease burden. To date, Sweden has reported higher case counts and attributable mortality than other Scandinavian countries and lower than other Northern European countries. However, there are several limitations with comparison given heterogeneity in testing strategies, suspected and confirmed case definitions, and assessment of attributable mortality. The decisions in Sweden also reflect social priorities such as equity being a foundational principle of Swedish social systems. Consistently, in-person education for those aged less than 16 years continued throughout. Notably, the mitigation strategy did not eliminate the inequitable impacts of COVID-19 cases and mortality in Sweden with higher-exposure and generally lower-income occupations being associated with higher risks intersecting with these communities often residing in more dense multigenerational households. From January 1 to November 15, there has been a 1.8% increase in all-cause mortality in 2020 compared with the average of 2015-2019, representing an excess of 14.3 deaths per 100,000 population. However, the final assessment of excess deaths in Sweden in 2020 including stratification by age and integration of secular trends can only be calculated in the coming years. In response to increasing cases in the fall of 2020, Sweden has continued to leverage business-oriented regulations and public-oriented guidelines for social distancing rather than police-enforced mandates. Ultimately, pandemics present no winners. Countries have implemented a range of different COVID-19 prevention and mitigation strategies responsive to their own priorities and legal systems including equity and the balancing of competing health priorities. Given these varied approaches, countries that pursued elimination, suppression, or mitigation strategies can collaboratively learn from both successes and challenges of the different strategies to inform COVID-19 and future pandemic responses.
AB - In the response to COVID-19, countries have implemented response strategies along a continuum of population- and venue-level specificity ranging from suppression to mitigation strategies. Suppression strategies generally include population-wide shelter-in-place mandates or lockdowns, closure of nonessential physical venues, travel bans, testing and contact tracing, and quarantines. Sweden followed a mitigation strategy focused on risk-tailored approaches to mitigate specific acquisition risks among the elderly, minimizing the disruption to education and the delivery of other health care services, and recommendations for social distancing to minimize the disease burden. To date, Sweden has reported higher case counts and attributable mortality than other Scandinavian countries and lower than other Northern European countries. However, there are several limitations with comparison given heterogeneity in testing strategies, suspected and confirmed case definitions, and assessment of attributable mortality. The decisions in Sweden also reflect social priorities such as equity being a foundational principle of Swedish social systems. Consistently, in-person education for those aged less than 16 years continued throughout. Notably, the mitigation strategy did not eliminate the inequitable impacts of COVID-19 cases and mortality in Sweden with higher-exposure and generally lower-income occupations being associated with higher risks intersecting with these communities often residing in more dense multigenerational households. From January 1 to November 15, there has been a 1.8% increase in all-cause mortality in 2020 compared with the average of 2015-2019, representing an excess of 14.3 deaths per 100,000 population. However, the final assessment of excess deaths in Sweden in 2020 including stratification by age and integration of secular trends can only be calculated in the coming years. In response to increasing cases in the fall of 2020, Sweden has continued to leverage business-oriented regulations and public-oriented guidelines for social distancing rather than police-enforced mandates. Ultimately, pandemics present no winners. Countries have implemented a range of different COVID-19 prevention and mitigation strategies responsive to their own priorities and legal systems including equity and the balancing of competing health priorities. Given these varied approaches, countries that pursued elimination, suppression, or mitigation strategies can collaboratively learn from both successes and challenges of the different strategies to inform COVID-19 and future pandemic responses.
KW - COVID-19
KW - Education
KW - Epidemiology
KW - Equity
KW - Europe
KW - Public Health
KW - SARS-CoV-2
KW - Sweden
UR - http://www.scopus.com/inward/record.url?scp=85097872485&partnerID=8YFLogxK
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U2 - 10.1016/j.annepidem.2020.11.005
DO - 10.1016/j.annepidem.2020.11.005
M3 - Comment/debate
C2 - 33242596
AN - SCOPUS:85097872485
VL - 54
SP - 21
EP - 26
JO - Annals of Epidemiology
JF - Annals of Epidemiology
SN - 1047-2797
ER -