Epidemiological outcomes and policy implementation in the Nordic countries during the COVID-19 pandemic.

backgroundDuring the initial phase of the COVID-19 pandemic, there was an intensive debate on which strategies would be most effective to minimize the negative societal impact of the pandemic. This study aimed to provide an overview of key epidemiological outcome measures of the disease in the Nordic countries and the subsequent policy implementation that were undertaken to curb the outbreak.

methodsTime trends in test-positive infections, hospitalizations, and intensive care unit (ICU) admissions due to COVID-19 as well as COVID-19 mortality and excess mortality were compared between Denmark, Finland, Iceland, Norway, and Sweden. The epidemiological patterns were presented in relation to 13 different policies implemented to a different degree in the countries, eight of which were related to containment and five to health systems policy. A stringency index summarized the intensity of the policies. Data were collected from Our World in Data, the Oxford COVID-19 Government Response Tracker and Eurostat. The investigated time period was 1 January 2020 to 30 April 2022.

resultsOverall, Sweden had more infections, deaths, hospitalizations, and ICU admissions than the other Nordic countries during the first three waves of the pandemic. However, in the fourth wave, Denmark exceeded Sweden in all outcomes. The overall stringency among the Nordic countries varied broadly. The lowest average stringency index was observed in Iceland and the highest in Sweden. Excess mortality over the whole study period was lowest in Iceland while Norway had very few ICU admissions.

conclusionsThe Nordic countries took vastly different approaches to contain the spread of the pandemic, but the long-term impact on excess mortality was similar. The variety in policy responses and epidemiological measures bring many opportunities for learning across the countries.