Role of government regulations as an early response measure
Using variation in policies and publicly announced cases and mortality data across regions in the United States, Goolsbee and Syverson attributed a large portion of decline in mobility to voluntary stay-at-home decisions based on people’s fear of COVID-19 deaths in their region, with legal restrictions accounting for only ~12% of the mobility decrease. Consistent with this, Andersen et al. found similar reductions in consumer spending in Sweden and Denmark (25% c.f. 29%) despite substantially greater government restraints on economic activity in Denmark. Focusing only on Stockholm county, mobility data indicate a population response to increasing case and mortality counts preceding increasing government restrictions. However, the national analysis we present provides counterevidence as well: Norway, Denmark, and Finland enacted strict and early government regulations prior to observing high case counts or COVID-19 associated deaths and, ultimately, maintained all-cause mortality rates below or equal to the average for the last 5 years. Despite increasing cases and connectivity to global news, mobility data show that the population-based response in Sweden overall was not as strong as its neighbours and did not intensify to their level as the situation worsened. Given that the median time from first symptoms of COVID-19 to death is 14 days, government restrictions can be implemented as a form of early response measure to encourage a stronger shift in population behaviour before a rise in cases and deaths occurs.
Conclusions
Over the first 6 months of the current pandemic, Sweden experienced higher COVID-19 case rates, death rates, and higher all-cause mortality (especially in the Stockholm county epicenter) than its Nordic peer countries. COVID-19 pushed Sweden’s health system to its capacity, exposed systemic vulnerabilities in the seniors’ care system, and revealed challenges with limited testing implementation. Choosing fewer and less intense government restrictions at the beginning of the outbreak likely played a role in the impact of COVID-19 in Sweden, although a connection to international news and rising fear of cases and deaths may have driven Swedish citizens to voluntarily shift to stay-at-home behaviour and reduce their spending. In spite of initial challenges, Sweden was able to adapt with more restrictive mandates, increasing their ICU bed capacity, and shifting their testing strategy. Sweden may provide an example of how an adaptive test-and-learn strategy can be applied to public health decisions made in uncertain times.