Science for Life Laboratory, Department of Chemistry-BMC, Uppsala University, Uppsala, Sweden.
Science for Life Laboratory, Department of Cell and Molecular Biology, Uppsala University, Uppsala, Sweden.
Clin Infect Dis. 2020 Dec 15;71(12):3174-3181. doi: 10.1093/cid/ciaa864.
The coronavirus disease 19 (COVID-19) pandemic has spread globally, causing extensive illness and mortality. In advance of effective antiviral therapies, countries have applied different public health strategies to control spread and manage healthcare need. Sweden has taken a unique approach of not implementing strict closures, instead urging personal responsibility. We analyze the results of this and other potential strategies for pandemic control in Sweden.
We implemented individual-based modeling of COVID-19 spread in Sweden using population, employment, and household data. Epidemiological parameters for COVID-19 were validated on a limited date range; where substantial uncertainties remained, multiple parameters were tested. The effects of different public health strategies were tested over a 160-day period, analyzed for their effects on intensive care unit (ICU) demand and death rate, and compared with Swedish data for April 2020.
Swedish mortality rates are intermediate between rates for European countries that quickly imposed stringent public health controls and those for countries that acted later. Models most closely reproducing reported mortality data suggest that large portions of the population voluntarily self-isolate. Swedish ICU use rates remained lower than predicted, but a large fraction of deaths occurred in non-ICU patients. This suggests that patient prognosis was considered in ICU admission, reducing healthcare load at a cost of decreased survival in patients not admitted.
The Swedish COVID-19 strategy has thus far yielded a striking result: mild mandates overlaid with voluntary measures can achieve results highly similar to late-onset stringent mandates. However, this policy causes more healthcare demand and more deaths than early stringent control and depends on continued public will.
新型冠状病毒病（COVID-19）大流行已在全球范围内蔓延，造成广泛的疾病和死亡。在有效的抗病毒疗法问世之前，各国已采取不同的公共卫生策略来控制传播并管理医疗保健需求。瑞典采取了独特的方法，没有实施严格的封锁，而是敦促个人承担责任。我们分析了这种方法和瑞典在大流行控制方面的其他潜在策略的结果。
我们使用人口、就业和家庭数据对瑞典的 COVID-19 传播进行了基于个体的建模。针对 COVID-19 的流行病学参数在有限的日期范围内进行了验证；对于仍然存在大量不确定性的参数，我们进行了多次测试。在 160 天的时间内测试了不同的公共卫生策略的效果，分析了它们对重症监护病房（ICU）需求和死亡率的影响，并与瑞典 2020 年 4 月的数据进行了比较。
瑞典的死亡率处于迅速实施严格公共卫生控制的欧洲国家和行动较晚的国家之间的死亡率之间。最能准确反映报告死亡率数据的模型表明，大部分人口都自愿自我隔离。瑞典的 ICU 使用率仍低于预测，但很大一部分死亡发生在非 ICU 患者中。这表明 ICU 入院考虑了患者的预后，降低了医疗保健负担，但未入院患者的生存率降低。
迄今为止，瑞典的 COVID-19 策略取得了惊人的结果：轻度的强制措施与自愿措施相结合，可以取得与后期严格强制措施非常相似的结果。但是，这种政策会导致更多的医疗保健需求和更多的死亡，超过了早期严格控制的情况，并且取决于公众的持续意愿。
