Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
Uppsala Monitoring Centre, Uppsala, Sweden.
Ann Epidemiol. 2021 Feb;54:21-26. doi: 10.1016/j.annepidem.2020.11.005. Epub 2020 Nov 23.
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.
在应对 COVID-19 方面，各国实施了一系列针对人群和场所特定性的应对策略，从抑制策略到缓解策略不等。抑制策略通常包括在整个人群中实施避难所命令或封锁、关闭非必要的物理场所、旅行禁令、检测和接触者追踪，以及隔离。瑞典采取了缓解策略，侧重于针对老年人的特定风险的方法，以减轻特定的感染风险，最大限度地减少对教育和其他医疗保健服务的干扰，并建议保持社交距离以最大限度地减少疾病负担。迄今为止，瑞典报告的病例数和归因死亡率高于其他斯堪的纳维亚国家，低于其他北欧国家。然而，由于检测策略、疑似和确诊病例定义以及归因死亡率评估的异质性，进行比较存在一些限制。瑞典的决策也反映了社会优先事项，例如公平是瑞典社会制度的基本原则。一致的是，对于 16 岁以下的人，面对面教育一直在继续。值得注意的是，缓解策略并没有消除 COVID-19 病例和死亡率在瑞典的不平等影响，高暴露风险和普遍低收入职业与这些社区的较高风险相关，而这些社区通常居住在人口密度更高的多代家庭中。自 2020 年 1 月 1 日至 11 月 15 日，与 2015-2019 年的平均水平相比，所有原因的死亡率增加了 1.8%，这意味着每 10 万人中增加了 14.3 例死亡。然而，只有在未来几年才能计算出瑞典 2020 年超额死亡的最终评估，包括按年龄分层和整合长期趋势。随着 2020 年秋季病例的增加，瑞典继续利用面向企业的法规和面向公众的社交距离指南，而不是警察强制命令。最终，大流行没有赢家。各国根据自身优先事项和法律制度，实施了一系列不同的 COVID-19 预防和缓解策略，包括公平和平衡竞争的健康优先事项。鉴于这些不同的方法，追求消除、抑制或缓解策略的国家可以相互学习不同策略的成功和挑战，为 COVID-19 和未来的大流行应对提供信息。
