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Coronavirus, Sweden and Germany: two case-studies

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Coronavirus: Sweden and Germany represent two European anomalies in how they managed and controlled the epidemic. There are differences with other countries, but the virus shows that Europe exists

People socialize and enjoy the spring, as the coronavirus disease outbreak continues, in Stockholm, Sweden, April 22, 2020. TT News Agency/Anders Wiklund via REUTERS

The Covid-19 pandemic comprise both biological and social factors. The virus now spreading in the world is substantially the same, but the affected human societies, are, theoretically, very different among them. When a pandemic presents the same features in different countries, we can reasonably argue that also the social-health factors determining the virus evolution should be similar. If we observe the European countries facing the pandemic, similarities seem to dominate over differences. The virus has showed that Europe exists, regardless of the cohesion of its ruling classes. However, differences between countries and in the ways these lasts faced the pandemic exist, and they deserve our attention.

The European epicenter

Following the first stage of 2020, when the virus hit especially China and its bordering countries, since the end of February the contagion epicenter moved in Europe. The first Covid-19 outbreaks, rapidly confined, were recorded in the UK, in Germany and in France and they consisted of positive cases “imported” from China. However, the first large-scale outbreak in the heart of Europe was undoubtedly the Italian one, discovered in the Lombardy and Veneto hospitals around the 20th of February. Shortly thereafter, Europe would have been affected by the most extended outbreaks in the world, especially in its most populous countries, such as Spain, France, United Kingdom, Germany, and Italy. The virus did not spare any European country: from Belgium to Portugal, all the governments had to face pandemic outbreaks very difficult to contain.

The strategies adopted by the different countries have been very similar. To stop the chains of transmission, social distancing was adopted, together with the isolation of positive and suspected cases. In many countries, at a certain point, proved to be necessary to adopt lockdown measures, with schools and non-essential services suspended. However, not all governments adopted these measures, and those which did it took this decision with different promptness degrees.

The WHO directives

The pandemic monitoring strategy, instead, was the same everywhere. All the most important European countries applied the WHO and ECDC directives for the testing kits and the contact tracing, according to which only symptomatic Covid-19 cases have to make a swab test. This does not mean that the quantity of tests effectuated has been the same everywhere. Some countries proved to be more efficient than other in effectuating the tests on symptomatic patients – although no one has been able to do so in a complete way.

It is not surprising that, giving the similar strategies of monitoring and containing the virus and the strong European interconnections, the virus spread reached a similar scale across borders. Nevertheless, it remains important to take into account the geographical difference when we compare different countries. A pandemic, because of its nature, develops by localized outbreaks and, if promptly faced, the spread can be limited to a single area. For example, the Italian outbreak remained for the most concentrated in the Northern regions and the lockdown prevented the spread of the emergency in the Southern ones. This dynamic, with some areas more affected than other relatively protected ones, has been observed in all the large European countries – which can therefore be usefully compared.

The mortality rate

At the end of April, in Italy, France, Spain and the UK (quite similar in terms of population) has been recorded a Covid-19 victims’ rate per million inhabitants between the 372 of France and the 525 of Spain. Differences could be even slighter since the pandemic outbreaks, as cited previously, hit some countries more than others. The virus’ lethality, that is the ratio between the Covid-19 victims and the number of the recorded cases, vary between the 11% of Spain, the 13% of Italy, the 14% of France and the 16% of the UK. However, France and the United Kingdom were the countries which effectuated less tests in relationship with their population. Therefore, the pandemic spread – which usually leads to an augmented diagnostical capacity and to a reduction of the emergency that allows to record also less symptomatic cases – will probably lead to an even enhanced uniformity in the lethality ratio among countries.

A very similar dynamic was recorded also in Belgium, very near geographically to the most affected areas of France. Here, the ratio between victims and the whole population has reached the number of 655 deaths per million inhabitants. The number of victims has been very high also in the Netherlands, but it consisted of only 280 deaths per million. Statistics become even more homogenous if we take into account that the real number of Covid-19 related deaths is much higher than the official one. In almost all the European countries the difficulties in promptly effectuating diagnostic tests has led to the exclusion of many victims from being counted. Many press investigative reports confronted the increase of the general level of population mortality, showing that the Covid-19 impact has been higher of what has been officially declared. In Lombardy, it has been calculated that the real victims would even double the official ones. Also, in Spain and in the Netherlands the difference is quite consistent. The most accurate data seem to be the Belgium, United Kingdom and France ones.

The Sweden case

Profoundly different was the pandemic’s dynamic observed in Scandinavia (excluded Sweden), with a very low density of population: 78 deaths per million in Denmark, 39 in Norway, 38 in Finland at the end of April, with lethality ratios between the 3% and the 5%. The same numbers occurred in Baltic countries, in former Habsburg area and in Poland.

As evident from this schematic categorization, Sweden has been excluded from the Scandinavian group and Germany from the most populous countries’ one. In a somehow homogenous framework of geographical areas, these two countries presented two remarkable anomalies. In Sweden, the number of victims per million inhabitants was of 256 at the end of April: less than in great European nations, but way more if compared with the other Scandinavian countries. Sweden, however, was on of the few countries which did not suspend economic activities or closed schools, focusing more on the citizenship individual responsibility to respect the social distancing rules.

The Germany case

The second great European anomaly is represented by Germany. Despite its big metropolitan areas and the fact the Germany presented the very first outbreaks of Europe, Berlin contained these lasts very efficiently, limiting the victims/inhabitants’ ratio to 78 per million, with a 4% lethality ratio.

To explain the German case, two sets of data are useful. The first is related to the number of tests effectuated. Indeed, Germany followed the same rules of the other countries, but the swab tests have been done to the 3% of the population, as in Italy and Spain, with a lower number of cases and victims. Secondly, Germany has more healthcare resources in comparison with the rest of Europe.

Even if the vast majority of people affected by Covid-19 heal with no difficulties, a percentage under the 10% needs intensive care therapies. Despite the seemingly low number, the numerical base has been so wide that put in serious difficulties the European hospitals.

The intensive care departments

The beds’ availability in intensive care departments is limited. Spain, France, Italy, United Kingdom and Sweden have about 9 beds per 100,000 inhabitants (pediatric hospitals excluded). Germany, instead, has about 3 times more beds and this could have had granted a superior quality of the healthcare provided. The beds’ availability and the number of the effectuated tests, however, are not enough to explain the pandemic impact differences in countries so near and with more or less the same population, such as Italy, France and Germany. Also, other countries, such as Belgium, have a higher availability of intensive care units, but the Covid-19 lethality has nevertheless been very high. It is still difficult to understand what really happened in Europe between March and April 2020. The Covid-19 pandemic will provide a lot of material to study for health policies analysts.

This article is also published in the June/July issue of eastwest.

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