Coronavirus: Why the Nordics Are Our Best Bet for Comparing Strategies

As of March 28, the reproduction numbers for Sweden and Norway are estimated to be 2.47 and 0.97 respectively, with Denmark’s around one. Unsurprisingly, the spread of the virus is also estimated to be among the highest in Sweden (3.1% of the population infected) and lowest in Norway (0.41% of the population), likely reflecting the radically different containment strategies. This compares with 9.8% and 2.5% for Italy and the UK, respectively.

Indeed, one Swedish academic has predicted that up to half the Swedish population will be infected by the end of April. Although it is probably too soon to see a clear effect of interventions on mortality rates, by April 1, COVID-19 deaths in Sweden accounted for 24 per million citizens, whereas in Norway it was only eight deaths per million. Finland was lower still with just three per million.

The virus transmission rate is important, as the faster it spreads, the more condensed the burden of mortality will be and the higher the peak burden hospitals will be forced to endure. The core objective of epidemic suppression is to minimize the number of daily hospital admissions in order to maintain a functioning health care system, even if the total deaths is eventually the same.

When the burden substantially exceeds capacity, hospitals collapse, casting staff and patients into the medical dark ages. So staying within capacity is paramount. In preparation, each of the Nordic countries have conducted detailed simulations to estimate the extent to which the hospitals will need to “surge”.

Those simulations show that the overall burden is expected to be similar across countries, resulting in about 528 to 544 deaths per million. Importantly though, unlike its peers, Sweden is likely to take the hit sooner and over a shorter period, with the majority of deaths occurring within weeks, rather than months.

That’s despite the fact that Sweden has the lowest number of ICU beds per 100,000 people (5.8), with Denmark (6.7), Finland (6.1) and Norway (8.0) all being better prepared. They all, however, lag far behind Germany at more than 29 beds per 100,000 people, being more similar to the U.K.’s 6.6. And concerns are being expressed in Sweden about inadequate protective equipment for frontline medical staff.

In the event that Sweden has pitched it right, the other Nordic countries will find the strain on hospitals is well within capacity. But, if the opposite is true, health care professionals in Sweden will face the fight of their lives.

The Long Run
This may make it sound like an intensive strategy is crucial. But there are strong counter arguments. As those living through a lockdown will attest, the psychological burden can be considerable – there’s a reason the incarcerated are sent to “solitary” for harsher punishment.

Consider too that the effects of intensive restrictions on freedom of movement wanes over time as social disobedience increases. Deploying milder containment strategies, as Sweden has done, which are followed by nearly all, may be more effective than strict interventions that are frequently flouted. Here, it will be interesting to see how Sweden compares to the other Nordic countries, which may have been able to achieve high levels of compliance with voluntary social distancing.

There’s also the perpetual danger of epidemic resurgence where herd immunity – whereby enough people have been infected to prevent the virus from spreading further – has not been achieved. Sweden is likely to reach herd immunity faster, so it’s not impossible that it will see fewer additional outbreaks of the virus than its neighbors. And there are numerous economic arguments too.

There is no knowing at this stage how the interventions adopted by Sweden and the other Nordic nations will play out. But within weeks, this will start to become clear. From this, we will learn much about the delicate balance between strategic under- and overreaction in the face of an infectious disease pandemic.

And what we learn may serve other nations where COVID-19 is still emerging or where second and third waves hit, as well as future societies facing other global pandemics, which are certain to come.

Paul W Franks is Professor of Genetic Epidemiology, Lund University. This article is published courtesy of The Conversation.