Europe can slow coronavirus without total lockdowns — but not the Swedish way


Politicians are determined to discover a stability of restrictions that flatten the curve without flattening the economic system or upsetting residents who’re wanting to reunite for the holidays.

“The key question now is to determine what is the optimal package of policies to maximize the health benefit at least cost,” stated Thomas Hale, an affiliate professor of public coverage at the University of Oxford. “However, this ‘magic formula’ will likely differ across different countries and populations, and of course over time as the virus surges or recedes.”

It’s an advanced and ever-changing calculus, and each nation is totally different.

But the approaches of three nations — Finland, Norway and Denmark — in latest months stand out, a CNN evaluation reveals. The evaluation, which checked out knowledge from the University of Oxford and Johns Hopkins University, discovered that whereas all three nations carried out a few of the continent’s most relaxed mixtures of restrictions, they nonetheless managed to maintain common each day deaths low — beneath one per million — for the three-month interval between September 1 and November 30.

Denmark success could also be ending. In late November, Danish dying charges exceeded one per million for the first time since May, Johns Hopkins knowledge reveals. On Friday, the variety of newly reported circumstances topped 4,000. Earlier in the week, officers expanded restrictions and introduced a nationwide lockdown aimed toward tamping down rising infections.

But what led to the three nations’ success in the fall?

Denmark, Finland and Norway responded shortly to the slightest improve in infections, which allowed them to virtually eradicate the virus throughout the summer season and face the autumn from a stronger place, in keeping with interviews with six students. Clear steerage and residents’ willingness to comply with it was additionally key, the consultants stated. And ramping up testing and contact-tracing capacities and offering paid sick depart helped to maintain any outbreaks localized.

How to be the greatest (or the way to be Finland)

Finland had Europe’s lowest common of infections and deaths per capita in latest months, Johns Hopkins knowledge reveals. It managed to include native outbreaks whereas sticking to a few of the most relaxed restrictions on the continent. Internal motion was not restricted, those that wanted to may attend college and workplaces in individual, and mask-wearing was not necessary.

“There is nothing magical about doing this — we just have a pragmatic approach,” stated Pekka Nuorti, an epidemiology professor at Tampere University who has labored for public well being companies for greater than 25 years.

Cultural, political and geographic elements — akin to low inhabitants density, much less journey and excessive belief in authorities — have been useful, Nuorti stated, but it was the work of the nation’s well being companies that made a distinction.

During the summer season, Finland constructed up “tried-and-true field epidemiology practices,” Nuorti stated: Testing, isolating, contact tracing, quarantining and stopping superspreading occasions on a neighborhood stage.

The common each day testing quantity almost quadrupled from 2,900 samples in May to 11,300 in August, well being ministry knowledge reveals. In late November, Finnish laboratories carried out as much as 23,000 exams a day, or 90% of the present capability.

Medical workers take samples from patients at a coronavirus drive-in test center in Espoo, Finland, on April 1, 2020. (Jussi Nukari/Lehtikuva/AFP)

Finland used the summer season to arrange for the new wave by responding with preventative measures as an alternative of a lockdown, stated Mika Salminen, director of well being safety at the Finnish Institute for Health and Welfare. Restricting worldwide journey for many of the summer season added to Finland’s success in the fall, he stated.

To assist folks isolate and keep house, the authorities offered financial help. Thousands of people that have been uncovered may quarantine as a result of the authorities supplied compensation for his or her misplaced revenue, Salminen stated.

“It’s not that we haven’t had outbreaks,” Nuorti stated. Finland had native flare-ups and tremendous spreader occasions, but native well being authorities, coordinated by the central authorities, have been in a position to include them utilizing real-time knowledge, he stated. But as case numbers rise, it turns into more and more tough to determine all transmission sources, Nuorti stated.

If the scenario deteriorates, Salminen stated, a full lockdown has not been dominated out.

The Norway way

Across the border, Norwegian officers elevated their give attention to addressing the most susceptible.

Norway’s spring lockdown was the strictest in Scandinavia. The nation’s oil and gasoline trade was in a position to present a big financial buffer to melt the impact on folks’s purses, but the authorities quickly confronted a rising psychological well being disaster and officers shifted their restrictions.

Also, in late summer season, health authorities found that roughly 40% of Covid-19 cases reported in July were among Norway’s foreign-born population. To regulate its communication technique, the government committed about $770,000 to fund a Covid-19 consciousness marketing campaign for the nation’s immigrant inhabitants. These focused interventions appeared to contribute to a notable drop in an infection charges amongst these communities, stated Jonathan Tritter, a professor of sociology and coverage at Aston University.

Knowing what to do, doing what you are informed

Three consultants interviewed by CNN stated a important consider Denmark’s early success was clear and coherent messaging about dangers and the want for behavioral modifications. They attributed the nation’s achievement to its historical past of mutual belief between residents and the authorities.

“The government was able to activate that background of trust, the good default position, with effective communication,” stated Michael Bang Petersen, a political psychology professor at Aarhus University who runs the HOPE project, a analysis examine inspecting how folks and governments are dealing with the pandemic.

Petersen stated two elements decide whether or not folks behave to keep away from an infection. One is motivation: Whether they’re fearful about turning into contaminated. The different is whether or not they know precisely what to do to stop spreading the illness, which hinges on communication from well being authorities and politicians, Petersen stated.

One of the officers main the Danish pandemic response echoed that time.

“Handling a pandemic is all about human behavior,” stated Søren Brostrøm, basic director of the Danish Health Authority.

Human conduct helps illnesses unfold, and controlling it’s the place options lie, Brostrøm stated. Physical distancing, not a drug or vaccine, is the “medical magic bullet” everyone seems to be hoping for, he stated.

Brostøm spoke to CNN previous to Denmark’s latest surge in circumstances. But at a press convention on Wednesday, Prime Minister Mette Frederiksen addressed the nation’s worsening scenario.

“In the end, only one thing works against corona,” Frederiksen stated. “That is if you and I and we all take responsibility for ourselves and for each other.”

Calibrating the restrictions

Multiple research have concluded that lockdowns work. At Oxford’s Blavatnik School of Government, scientists developed what they known as a Stringency Index. The index charges about 180 nations and territories based mostly on their restrictions, akin to college closures and stay-at-home orders, on a scale of 1 to 100. Higher scores characterize extra stringent restrictions.
In a preprint study posted in July, the Oxford researchers discovered that in the spring, increased scores on their scale have been related to slower progress of each day deaths. On common, they discovered, every week’s delay in reaching medium stringency led to virtually twice as many new deaths over the months that adopted.

But as pandemic fatigue seeps in, folks turn into extra reluctant to comply with strict new measures, consultants informed CNN.

Constant social distancing is not sustainable in the future, Brostrøm stated. A rustic wants simply sufficient restrictions to have the ability to management the pandemic.

“I think we found we actually struck quite a good balance in this country in this regard,” he stated.

Even in Denmark, one misstep can have a detrimental impact on belief after which compliance, consultants stated.

A authorities choice to cull the nation’s farmed mink over fears the animals may unfold the coronavirus to people is one instance. After ordering the cull, officials realized they did not have the legal authority to do so and rolled back the mandate.

But the authorities’s overreach shook Danish unity, Petersen stated.

“Right now, we are seeing an increased polarization. We’re seeing decreased support of the government strategy. And the question that is facing us here in Denmark is, ‘What will be the consequences of that for the pandemic over the next months?'” Petersen stated.

Rules vs. suggestions

Danish officers’ willingness to impose stricter measures when obligatory stands in distinction to Sweden, the place officers first took a lighter hand to try to stem the pandemic.

“There was a greater emphasis on voluntary measures, and without the extreme ‘shutdown’ measures put in place in Denmark (in the spring),” stated Rowland Kao, a veterinary epidemiology professor at the University of Edinburgh.

“Other Nordic countries are much more in line with the rest of Europe,” Kao stated. “They had a stricter lockdown in spring and did it sooner.”

Kao stated this method made Sweden’s uptick of circumstances in June, when most different European nations have been recovering, inevitable. And in November, regardless of having the next common stringency rating than different Scandinavian nations, Sweden was struck by a nationwide outbreak.

“When Covid-19 arrived in our country, we all agreed to take responsibility,” Löfven stated. “This autumn, too many of us have neglected to follow the advice and recommendations.”

When it involves a illness that spreads so quick, Kao, the Edinburgh professor, stated very small variations in how issues are achieved can make all the distinction in the world.

How CNN reported this story

For this story, we sought to look at the relationship between authorities restrictions and Covid-19 deaths throughout the interval between September 1 and November 30, when many nations have been in the throes of a resurgence.

To achieve this, we analyzed knowledge from Johns Hopkins University to calculate the each day new deaths per million residents in 31 European nations. We used a transferring common to account for variations in the knowledge induced, for instance, by delays in reporting on weekends, or modifications in knowledge assortment strategies that will in any other case lead to a sudden spike in each day figures. We used new deaths as an alternative of recent circumstances as a result of the reporting standards for deaths is extra constant throughout nations than for circumstances, which is partly a perform of testing quantity.

We then plotted the new dying charges in opposition to every nation’s stringency rating, which we discovered utilizing Oxford University’s Stringency Index. The index scores nations’ Covid-19 response measures on a scale of 1 to 100.

We analyzed the 27 European Union members, the United Kingdom and free commerce nations (Iceland, Liechtenstein, Norway and Switzerland). We then excluded Liechtenstein as a result of stringency scores for that nation have been not obtainable.

Following interviews with consultants, we outlined nations with low an infection charges as these with one or fewer dying per million residents. We outlined much less restrictive nations as these with stringency scores beneath 60 as a result of it was roughly the minimal rating for nations with full lockdowns in October and November in keeping with knowledge we compiled on European nations’ lockdown standing at the moment.

We targeted on Finland, Norway and Denmark as a result of these have been the solely nations to persistently keep low dying charges (one per million or much less) and stringency scores beneath 60 throughout the September 1 to November 30 interval. Other nations additionally maintained low dying charges, but we did not give attention to them as a result of they both carried out a strict lockdown (Ireland) or had a excessive stringency rating (Cyprus).

Antonia Mortensen, Samantha Tapfumaneyi, Nina Avramova, Sharon Braithwaite and Amy Cassidy contributed to this story.



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