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Comparing the responses of the UK, Sweden and Denmark to COVID-19 using counterfactual modelling.

ABSTRACT: The UK and Sweden have among the worst per-capita COVID-19 mortality in Europe. Sweden stands out for its greater reliance on voluntary, rather than mandatory, control measures. We explore how the timing and effectiveness of control measures in the UK, Sweden and Denmark shaped COVID-19 mortality in each country, using a counterfactual assessment: what would the impact have been, had each country adopted the others' policies? Using a Bayesian semi-mechanistic model without prior assumptions on the mechanism or effectiveness of interventions, we estimate the time-varying reproduction number for the UK, Sweden and Denmark from daily mortality data. We use two approaches to evaluate counterfactuals which transpose the transmission profile from one country onto another, in each country's first wave from 13th March (when stringent interventions began) until 1st July 2020. UK mortality would have approximately doubled had Swedish policy been adopted, while Swedish mortality would have more than halved had Sweden adopted UK or Danish strategies. Danish policies were most effective, although differences between the UK and Denmark were significant for one counterfactual approach only. Our analysis shows that small changes in the timing or effectiveness of interventions have disproportionately large effects on total mortality within a rapidly growing epidemic.

SUBMITTER: Mishra S

PROVIDER: S-EPMC8358009 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:IntroductionDenmark and Sweden initially adopted different responses to the COVID-19 pandemic although the two countries share many characteristics. Denmark responded swiftly with many mandatory restrictions. In contrast, Sweden relied on voluntary restrictions and a more "relaxed" response during the first wave of the pandemic. However, increased rates of COVID-19 cases led to a new approach that involved many more mandatory restrictions, thus making Sweden's response similar to Denmark's in the second wave of the pandemic.AimThe aim was to investigate and compare the extent to which the populations in Denmark and Sweden considered the COVID-19 restrictions to be acceptable during the first two waves of the pandemic. The study also aimed to identify the characteristics of those who were least accepting of the restrictions in the two countries.Materials and methodsCross-sectional surveys were conducted in Denmark and Sweden in 2021. The study population was sampled from nationally representative web panels in the two countries, consisting of 2,619 individuals from Denmark and 2,633 from Sweden. The questionnaire captured key socio-demographic characteristics. Acceptability was operationalized based on a theoretical framework consisting of seven constructs and one overarching construct.ResultsThe respondents' age and gender patterns were similar in the two countries. The proportion of respondents in Denmark who agreed with the statements ("agree" alternative) that captured various acceptability constructs was generally higher for the first wave than the second wave of the pandemic. The opposite pattern was seen for Sweden. In Denmark, 66% in the first wave and 50% in the second wave were accepting of the restrictions. The corresponding figures for Sweden was 42% (first wave) and 47% (second wave). Low acceptance of the restrictions, defined as the 25% with the lowest total score on the seven acceptability statements, was associated with younger age, male gender and lower education levels.ConclusionRespondents in Sweden were more accepting of the restrictions in the second wave, when the country used many mandatory restrictions. In contrast, respondents in Denmark were more accepting of the restrictions in the first wave than in the second wave, implying an increased weariness to comply with the restrictions over time. There were considerable socio-demographic differences between those who expressed low acceptance of the restrictions and the others in both countries, suggesting the importance of tailoring communication about the pandemic to different segments of the population.

Project description:BackgroundThe development and widespread use of an effective SARS-CoV-2 vaccine could prevent substantial morbidity and mortality associated with COVID-19 and mitigate the secondary effects associated with non-pharmaceutical interventions.MethodsWe used an age-structured, expanded SEIR model with social contact matrices to assess age-specific vaccine allocation strategies in India. We used state-specific age structures and disease transmission coefficients estimated from confirmed incident cases of COVID-19 between 1 July and 31 August 2020. Simulations were used to investigate the relative reduction in mortality and morbidity of vaccine allocation strategies based on prioritizing different age groups, and the interactions of these strategies with concurrent non-pharmaceutical interventions. Given the uncertainty associated with COVID-19 vaccine development, we varied vaccine characteristics in the modelling simulations.ResultsPrioritizing COVID-19 vaccine allocation for older populations (i.e., >60 years) led to the greatest relative reduction in deaths, regardless of vaccine efficacy, control measures, rollout speed, or immunity dynamics. Preferential vaccination of this group often produced relatively higher total symptomatic infections and more pronounced estimates of peak incidence than other assessed strategies. Vaccine efficacy, immunity type, target coverage, and rollout speed significantly influenced overall strategy effectiveness, with the time taken to reach target coverage significantly affecting the relative mortality benefit comparative to no vaccination.ConclusionsOur findings support global recommendations to prioritize COVID-19 vaccine allocation for older age groups. Relative differences between allocation strategies were reduced as the speed of vaccine rollout was increased. Optimal vaccine allocation strategies will depend on vaccine characteristics, strength of concurrent non-pharmaceutical interventions, and region-specific goals.

Project description:BackgroundNational responses to the COVID-19 pandemic depend on national preparedness systems that must be understood as components of global public health emergency preparedness systems, governed and coordinated through the World Health Organization's 2005 International Health Regulations. The pandemic has raised the question of why countries belonging to similar public health regimes, coordinated through the same global system, responded differently to the same threat. Comparing the responses of Denmark, Sweden and Norway, countries with similar public health regimes, the paper investigates to what degree national differences in COVID-19 policy response reflect significant differences in the policy preferences of national expert groups.ResultsWe employ a structured case comparison of Denmark, Norway, and Sweden to analyze their' politico-administrative pandemic preparedness systems and policy responses during the first wave of the COVID-19 pandemic. We use the results of an interdisciplinary expert survey completed in 2020 to analyze expert perceptions in two ways. First, we analyze expert perceptions of COVID-19 responses while controlling for national COVID-19 trajectories and experts' characteristics. Second, we analyze the distribution and effect of dominant global expert-held ideas across countries, showing the importance of dominant ideas for experts' perceptions and preferences for COVID-19 response.ConclusionThe study finds no evidence indicating that COVID-19 policy variation between the most similar cases of Denmark, Norway, and Sweden are the result of differences in the policy preferences of national expert groups. Instead, our study highlights the importance of other factors than cross-national expert dissensus for explaining variation in pandemic response such as the politico-administrative organization of pandemic preparedness systems. Further, we find that expert support for dominant ideas such as a 'focused protection strategy' is associated with consistent policy preferences across locational, disciplinary, and geographic affiliations. Recognition of the latter should be a part of future discussions about how global ideas of pandemic preparedness are diffused transnationally and embedded in national politico-administrative systems.

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Comparing the responses of the UK, Sweden and Denmark to COVID-19 using counterfactual modelling.

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