Japan and Sweden’s Efforts, Responses to COVID-19 Differ From US

TPG International Health Academy held its first virtual Educational Summit on COVID-19 recently and highlighted were the efforts of Japan and Sweden’s government and public health officials on managing the pandemic, how they’ll approach the vaccine and where things may go in 2021.

Speaking on behalf of Sweden was Dr. Zayed Yasin, an emergency medicine specialist practicing in Sweden and the United States. Yasin is also the founder and the CEO of YaHealth Solutions.

Representing Japan was Dr. Sayaka Hikida, an internal medicine specialist from Japan, who managed Japanese citizens with the virus. Hikida is also a quarantine officer and recently has been deployed to work for the Center for Disease Control in Atlanta.

As of early December, Japan and Sweden remain to respond differently to COVID-19 as the United States has. However, as of more recent, the United Kingdom and the U.S. are now in the first stages of having access to the Pfizer-BioNtech vaccine and are treating patients.

Hikida said she expects Japan to act fast and safely once they are approved to receive the vaccine, mostly because Japan is anticipating hosting the 2021 Olympics in July. She added most of Japan is trusting of a vaccination and they plan to rely on U.S. and U.K. responses to decide how they will take on their deployment approach. Sweden is anticipating a vaccine in the late winter or early spring, but also plan to observe how other countries respond. Yasin said he believes they will “walk and not run toward it.”

As the Pfizer vaccine begins to make its way into the world, the Moderna vaccine is close behind and expecting approval in the U.S. by the end of the week, according to multiple reports.

What a COVID-19 vaccine means for each country

Both Japan and Sweden are facing many challenges because of the pandemic, but their basic indicators and responses are what make them different from each other and what make them different from the U.S.

Japan has an older population than the U.S. and Sweden, yet the U.S. is more significantly obese in adults than Sweden and Japan. With age and obesity being two of the most critical factors of COVID-19, Japan and the U.S. should be heavily affected.

However, information provided in the webinar stated, in COVID-19 cases and deaths per million, Japan is miniscule when compared to both the U.S. and Sweden, as of early December. In addition, Sweden has had about half of the cases that the U.S. has had per million, and about 80% of the deaths per million.

Sweden’s response to COVID-19

According to Yasin, COVID-19 responses in Sweden are different than those in the U.S. and Japan because Sweden has handled the pandemic with a more “hands off approach.”

He said unlike most countries, there's never been a lock down in Sweden. Schools remained open through the entire pandemic and there has been no common use of masks unless you are more at risk and choose to wear one. Sweden also had more general kind of community social distancing measures and focused to try and isolate people in nursing homes and in highly vulnerable populations.

“(Sweden) had a good-sized spike in the early phase of the pandemic. But that spike, especially in deaths, was really limited to where it was really concentrated in: nursing homes and in the homebound elderly,” Yasin said. “And I think there's an acknowledgment in society that they were really too loose and didn't protect those vulnerable in the in the early phases.”

Yasin said the mentality of the Swedish public health ministry has really focused on the approach that “this is a marathon and not a sprint. And if we try to do too much too hard, too early, societies are going to wind up running out of effort when this is going to be going on for quite a while.”

Sweden is currently in the position where they are more prepared for an expected second wave. Yasin said this is because the social and economic exhaustion level is not to the degree that other countries are in. This is mainly in part of Sweden wanting to avoid a collapse in their health system.

The country has also avoided detrimental exhaustion because of their willingness to avoid curfews, lockdowns and give its citizens a choice on how they want to social distance. Yasin explained there's been very consistent communication from the beginning on social distancing and that the coronavirus should be taken seriously. He said there’s also been a lot of economic support for companies to allow employees to work from home, to furlough workers, and to shut down if they felt that they needed to. Additionally, Sweden companies have social health insurance support and coverage if anyone feels sick and has to call off.

This unfortunately isn’t quite the same for everyone in the U.S., where some frontline service workers don’t feel they have the economic support to take the day off right now, even when they’re feeling sick.

“The social protections here in a socialist society, are much higher,” Yasin said. “Schools, and one of the biggest differences that I think families have felt, is that they have had a very consistent approach, which I think now many U.S. communities are following that. And that has been really, I think, one of the reasons why society overall has been able to tolerate these past nine months relatively well is because the kids are in school. “

Sweden’s COVID-19 model of operations were made by Anders Tegnell, state epidemiologist, infectious disease physician and civil servant to Sweden. Yasin said Tegnell has more authority when making these types of decisions, rather than Sweden’s government having control.

Japan’s COVID-19 model

As Japan works through their third wave of COVID, Hikida credits Japan’s success of managing the pandemic through a few strategies, which are:

• Easy access to medical care under the national health insurance system
• Generally providing high quality medical care even in rural areas with hospitals supported by a national network of local public health centers.
• The Japanese public's high standard of hygiene, willingness to comply with government requests and other cultural traits in lifestyle habits.
• Early detection of transmission waves where an infection can be detected and so can its origin.
• Avoid the three C’s: Closed, crowded and in close contact settings.

Japanese health officials make a crucial point not to be a minority and lead by example when wearing masks and washing hands, mainly due to their culture’s life expectancy, Hikida said. As of 2020, the average age of Japanese citizens is 47, while their life expectancy is 81. She added 28% of the country’s citizens are over the age of 65 and 1.7% are living in nursing facilities.

Will the vaccine be enough?

Both Yasin and Hikida remain optimistic for the COVID-19 vaccine and are hopeful its use will help slow the virus down to get back to some sense of normal. Each do believe COVID will stick around but are hoping with the help of the vaccine it will prevent another wave.

“I think even the best-case scenario, we're going to be living in COVID land at least into next summer,” Yasin said. “There's no way that anything is going to make any magical difference over the next six months. The best-case scenario is that next August, September, we're not seeing the fourth wave, and we're starting to feel better and hope that we've kind of started to win.”

Japan is not completely relying on just the vaccine to slow down the rate of cases.

“So we have to keep at the three C's, and wearing a mask and watch (our) distance for a while and wash our hands,” Hikida said. “This is the basic strategy to mitigate COVID-19 and win. But as I said before, we are having the Olympic Games, so we are kind of in a rush to have a vaccination to tackle COVID-19 as soon as possible. We are optimistic to this vaccination strategy and that's the hope for us.”

Future of care is digital

The future of healthcare for Japan and Sweden are more remote and digital, according to Yasin and Hikida.

Sweden has been one of the leaders in the world in terms of telemedicine and digital health, Yasin said. The use of telemedicine and digital care will remain to stay and only become larger, not only in healthcare, but in the economy overall, he added.

Japan, however, will have to adapt the digital healthcare industry eventually as their system currently has only been operating through an in-person visit scenario.

Altough the have been working under normal conditions in health systems, they have remained safe, Hikida said. However, frontline workers are becoming overwhelmed in their work conditions, and because there is a large margin to accept telemedicine in Japan, health professionals are more eager to save as many lives as possible, she added.