Three Coronavirus response choices: Sweden, Germany and the United States.

As we survey COVID-19 responses of countries around the world, stark differences emerge.

Sweden, the United States and Germany provide an interesting basis for comparison. I think it is too early to tell definitively, which is best. Also, effectiveness of any given strategy may vary by a country’s circumstances and culture.

Sweden: Mitigation?

Some characteristics of Sweden’s strategy:

1 — Social distancing and hygiene recommendations.

2 — Recommendation to remain prudently physically active.

3 — Limited and non-mandatory business and school closures. Limited work from home where possible.

4 — Limited testing available.

5 — Guidance to at-risk groups (note, it is generally accepted, as of this writing, that groups that are most at-risk, for ventilator need and death, include age sixty-plus and anyone with a number of underlying health conditions, which can be easily reviewed on the U.S. Centers for Disease Control web site). This guidance is essentially that you should self quarantine and/or be prudent when you must leave your home. If you decide to leave the home, you do so at your own risk of death.

6 — Limited police and/or military enforcement of points 1 through 5.

Some goals of Sweden’s strategy:

1 — Flatten and lengthen the curve to avoid overwhelming hospital ventilator availability and an exponential increase in death rate. Reduce ventilator need and death rate among at-risk groups because they follow the guidelines.

2 — Mitigate the economic impact to make it easier to combat a phase 2 of the epidemic, beyond three months.

3 — Increase the chance that a significant percentage of the population is immune to COVID 19 by a Phase 2, after three months but before a vaccine is readily available, presumably in twelve to eighteen months.

Germany: Suppression?

Some characteristics of Germany’s strategy:

1 — Social distancing and hygiene mandatory order.

2 — Mandatory business and school closures. Work from home where possible.

3 — Widespread testing available.

4 — Guidance to at-risk groups to

take more precautions.

5 — Police and/or military deployed to enforce points 1 through 5.

6. Aggressive pursuit of treatments and vaccines.

Some goals of Germany’s strategy:

1 — Flatten the curve to avoid overwhelming hospital ventilator availability and an exponential increase in death rate within two to three months.

2 — Shorten the economic impact by flattening the curve within three months so they may then reduce restrictions.

3 — Gradually loosen restrictions and economic impact beyond three months as the epidemic curve flattens. Continue to test and evaluate whether restrictions need to be reinstated.

United States: Something in between Mitigation and Suppression?

Some characteristics of the United States’ strategy:

1 — Social distancing and hygiene non-mandatory guidelines (or fragmented by state and county). However, few travel restrictions between states and counties.

2 — Mandatory business and school closures. Work from home where possible.

3 — Limited testing available.

4 — Guidance to at-risk groups to

take more precautions.

5 — Police and/or military generally not deployed to enforce points 1 through 4.

6 — Aggressive pursuit of treatments and vaccines; however, with tighter FDA restrictions.

Some goals of the United States’ strategy:

1 — Flatten the curve to avoid overwhelming hospital ventilator availability and an exponential increase in death rate within two months.

2 — Mitigate the economic impact to make it easier to combat a phase 2 of the epidemic, beyond two months.

3 — Gradually loosen restrictions and economic impact beyond two months as epidemic is under control. Continue to evaluate whether restrictions need to be reinstated.

What are some of the key differences between each country’s response?

1 — Testing availability.

2 — Mandatory vs non-mandatory closures and guidelines.

3 — Police/military enforcement of guidelines.

4 — Culture of personal responsibility and accountability to follow guidelines or recommendations.

Commentary on above differences:

1 — Testing availability. There is no question that testing is a positive. There is a question as to how quickly and easily countries can ramp up testing.

2 — Mandatory closures and guidelines vs non-mandatory. It seems that if you have a historical culture of greater personal responsibility and following government recommendations, then a mitigation strategy, with non-mandatory guidelines, can be effective or, at least, more feasible than in a country where that is not the culture. Sweden, Germany and the U.S. seem to have a “personal accountability” culture in decreasing order.

3 — Military enforcement may seem draconian but it could be a key factor in a country like Germany’s success. Even having a police officer or soldier making a firm but gentle recommendation may be impactful on adhering to guidelines. The effectiveness of this strategy would seem to increase, the less a country has a culture of personal responsibility to follow guidelines voluntarily.

4 — A culture of personal responsibility. As discussed above, it seems Sweden would have the greatest chance of having a government recommendation-based mitigation strategy working.

Conclusion?

Sweden and Germany seem to have strategies that are better aligned with their culture and demographics. The U.S. should be making a suppression strategy more stringent, as it is in Germany, and it should be employing the military and police to enforce that suppression strategy, as is Germany. These changes in the U.S. would result in flattening the curve faster, reducing ventilator need and case death rate among at-risk groups, and mitigating the time to reducing restrictions (mitigating economic impact).