• Sweden never issued a mandatory lockdown to curb the spread of the novel coronavirus, instead asking its citizens to voluntarily maintain social distance.
  • Sweden has a relatively high per capita death toll and case count compared with other countries – signs the strategy may not be working.
  • These graphs compare Sweden’s per capita deaths and cases, along with its death rate, to those of other countries with major outbreaks.
  • Visit Business Insider’s homepage for more stories.

At least 45 countries issued lockdowns to slow the spread of the novel coronavirus in March and April. Sweden was not one of them.

Instead, the “Swedish model” encourages residents to voluntarily maintain social distance and allows businesses, restaurants, bars, and schools to remain open.

Data suggests the country may be paying a worrisome price, though: Sweden has a higher number of deaths per capita than many other countries with large outbreaks.

The following chart, based on data from Johns Hopkins, compares Sweden’s per capita COVID-19 deaths with those of 16 other countries.

covid 19 deaths per country

Foto: Source: Shayanne Gal/Business Insider

The country, which has a population of 10.23 million, has reported nearly 4,000 COVID-19 deaths. That count is small in absolute terms, compared to the number of people the virus has killed in some large countries – the US death toll has topped 95,000, for example. But relative to the size of Sweden’s population, the number of people who have died is in line with countries that have had far bigger outbreaks.

Earlier this month, epidemiologist Anders Tegnell, who is leading Sweden’s coronavirus response, said in an interview on “The Daily Show” that the country’s high death toll was unexpected.

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“We never really calculated with a high death toll initially, I must say,” he said. “We calculated on more people being sick, but the death toll really came as a surprise to us.”

Similarly, Sweden’s death rate – a calculation that divides the number of confirmed coronavirus deaths by the number of reported cases – is among the highest in the world. Approximately 12% of people officially given a COVID-19 diagnosis in the country have died.

covid 19 death rates per country

Foto: Source: Shayanne Gal/Business Insider

There are several potential explanations for these numbers. Death rates, for example, can be shaped largely by testing: Lower testing rates lead more minor cases to be missed and therefore inflate the rate. Sweden’s per capita testing rate is 20.78 per 1,000 people, according to tracking by Statista. That’s relatively low compared to Norway’s, which is 41.14, and Iceland’s, at an impressive 168.75.

The US has tested 36.96 people out of every 1,000, according to Our World in Data, although the site notes that the country has been reporting its testing numbers inconsistently.

The number of tests coming back positive in Sweden also suggests this explanation could have merit. Sweden has confirmed about 32,800 cases of 209,900 tests done – a positive rate of about 15.6%. The World Health Organization has said that countries will know they’re testing at a sufficient threshold when fewer than 10% of tests are coming back positive.

Sweden has only just expanded its testing to include those with mild symptoms.

Another explanation for the country’s relatively high number of deaths could be that half of Sweden’s deaths have been in nursing homes. Older people are far more likely to die from the coronavirus than younger people, so outbreaks in long-term care facilities are likely to be deadlier than those among other subsets of the population.

Still, Sweden’s total case numbers are also high relative to its population.

covid 19 cases per country

Foto: Source: Shayanne Gal/Business Insider

Lockdowns worked in other countries

Sweden’s strategy relies on personal responsibility: The government asks residents to monitor themselves for symptoms, stay home when sick, practice good handwashing, and avoid crowds.

“It’s definitely part of the culture to follow the rules, or guidelines, and to not be too pushy about it,” an archaeologist and art history professor, Nancy Wicker, who has traveled frequently between Sweden and the US for nearly four decades, previously told Business Insider.

Evidence from other countries suggests mandatory lockdowns have prevented the spread of the virus: China, Germany, and Spain all saw their number of daily infections drop off after restrictions were implemented.

A team of Italian researchers recently simulated what could have happened if the country had relaxed its restrictions in March – or never imposed them. The results suggested the country’s lockdown prevented about 200,000 hospitalizations between February 21, when Italy confirmed its first case, and March 25. The policy reduced transmission in the country by about 45%.

Another study found that Chinese cities that issued restrictions before they confirmed any COVID-19 cases saw one-third fewer cases during their first week of infections than cities with delayed responses.

Aria Bendix and Hilary Brueck contributed reporting.