Sweden’s strategy to combat coronavirus

The Swedes decided to oppose this time. While throughout the world, from China to Colombia, quarantines altered the routines of cities and towns, restaurants and cinemas, schools and universities were closed, millions of bus, car and motorcycle engines did not restart, Swedes bet on coping with the pandemic in a less dramatic, freer way. (See here all the information about coronavirus)

Johan Giesecke, Swedish epidemiologist, professor emeritus at the Karolinska Institute, the same institution that every year has the task of assigning the Nobel Prize for Medicine, explained the Swedish bet in the magazine The Lancet. The logic is as follows: 1. Everyone will sooner or later be exposed to SARS-CoV-2. 2. Most will become infected. 3. There is very little that can be done to stop the spread, and what is accomplished with quarantines is simply to delay serious cases, but they reappear when the restrictions are lifted.

“I hope that when we count the number of COVID-19 deaths in each country in a year from now, the numbers will be similar, regardless of the steps taken,” Giesecke noted. If this is the result according to the Swedes, why disturb the lives of so many millions of citizens, put the economy at risk and add more stress to the threat that the coronavirus already represents?

And the vaccine? For Giesecke, the virus moves much faster than our chance of having an effective vaccine available to the population. And the success of the countries that imposed quarantines on time? According to Giesecke, they simply put off the problem for the not-too-distant future. “Our most important task is not to stop the spread, which is futile, but to focus on giving the unfortunate victims optimal care,” he wrote.

As soon as someone raises the Swedish case in a table conversation, on social networks, in the media, the usual happens: two sides willing to gouge out their eyes to defend their position without much interest in nuances. Anders Tegnell is the brain behind Swedish strategy. The doctor and epidemiologist at the service of the Swedish government has become famous at the age of 64. His face is already stamped on T-shirts and some more fans have even tattooed it. Tegnell never seems to lose his composure in the debates, even when he is accused of having imposed an immoral strategy to sacrifice part of the population. (You can read: See why Norway, Finland, Denmark and Sweden are a success against the coronavirus)

Tegnell and his advisers bet on a “trust-based” strategy. On the one hand, aware that the virus hits older people harder, they recommended that they avoid social contact and work from home. Restaurants, one of the places with the highest risk of contagion, were asked to take measures to maintain the distance between their customers. The university students were sent to study from home, but they kept the schools open for children under 16 years old. The companies, of course, remained open and many commercial premises.

In an interview with the magazine NatureTegnell tried to clarify the role of irreverent assigned to them in the midst of the pandemic: “I think the singularity of the approach has been exaggerated. As in many other countries, our goal is to flatten the curve, slow down the spread as much as possible; otherwise, the health system and society are at risk of collapse. ”

That is an important first clarification. It is not that the Swedes are not taking action. It is that their population has taken them on their own following government recommendations. According to Google’s free mobility reports, Swedish visits to shopping malls, restaurants, cafes and cinemas decreased by 20%, public transport fell by almost 30% and commuting to workplaces fell by approximately 12 %. What increased considerably among Swedes were visits to parks: 81%.

When asked if he considered the strategy successful at this point, Tegnell was honest: “It is very difficult to know; it’s very early, really. Each country has to achieve ‘herd immunity’ [cuando una alta proporción de la población es inmune a una infección, lo que limita en gran medida la propagación de personas que no son inmunes] in one way or another, and we are going to achieve it in a different way. “

The common currency to measure the “success” of strategies in these pandemic days is the number of infections and deaths. And if that’s the case, in the case of Sweden it all depends on who you compare it to. The death toll in Sweden exceeded 3,000, approximately 22 per 100,000 inhabitants. Next to his neighbors (Norway, Finland and Denmark) he looks bad. Norway and Finland have fewer than four deaths per 100,000, while in Denmark the figure is 7.3. When compared to other European countries like Italy, Spain or England their numbers shine. In the United Kingdom the rate is close to 182 per 100,000 inhabitants.

But making comparisons at this time, following Giesecke’s argument, would be like wanting to define the winners of a marathon in the first quarter of the race. On the other hand, the Swedes have so far met one of the objectives common to all countries: to keep the number of those infected who require hospital care below the maximum capacity of the health system. About 20% of intensive care units in Sweden remain available. (Also read: After the quarantine comes the “new normal”: nothing will be as before)

In this sense, the Colombian epidemiologist Zulma Cucunubá has been insistent and has explained it many times: “Quarantines are not a permanent solution. They are only a temporary measure that should serve to avoid the collapse of the health system, last as little as possible and be used intelligently to propose a sustained exit strategy. ”

A problem not foreseen in all its dimension by the Swedes was that of the elderly. “We underestimated the problems in nursing homes and how the measures would be applied. We should have controlled this more thoroughly, ”said Tegnell.

The Swedish Public Health Authority reported that the coronavirus spread to 75% of the 101 nursing homes in Stockholm. The employees who work in them suffered shortages of personal protective equipment, as well as training. About 50% of the deaths reported in Sweden correspond to these elderly people. Due to this, in recent weeks protection measures have been tightened in these places.

As beans are cooked in all the houses, criticism has also been leveled at Tegnell and the Swedish government. About three weeks ago a group of 22 Swedish doctors, virologists and researchers published a letter against the strategy: “The approach must be changed radically and quickly. As the virus spreads, it is necessary to increase the social distance ”. Tegnell rejected the criticisms, considered that they were based on wrong figures, and insisted that the biggest problem was concentrated in the elderly.

Swedes estimate that by the first days of May more than half a million people in Stockholm had already been infected, equivalent to 25% of the city’s population. A figure, which at least to the Swedish capital, is bringing it closer to what epidemiologists call “herd protection.”

After almost two months of quarantine, it seems that the example of Sweden tried to be raised in Colombia as the new model to copy. This forgetting the old saying that we do not live in “Denmark, but in Cundinamarca”. Sweden, as the newspaper suggested The GuardianTo be sure, to control the spread of the virus, its demographic profile (more than 50% of households are single) and a relatively low population density of approximately 25 people per square kilometer, compared to, for example, 205 in Italy and 259 in the United Kingdom. To which should be added a different citizen culture and different types of education, among many other variables.

For his part, Jonathan García Ruiz, a researcher at Dejusticia and a professor of the Universidad de los Andes in public health, recalled this week, regarding a debate on measures taken against the pandemic on a global scale, that low-income countries and medium, “from the Colony we depend (or have been made dependent) on the global north to respond to public health challenges. It is natural for us to look for evidence in the north to make the best decisions, but perhaps it is time to start believing that we can solve this in our own way. Nor is it that we have another alternative. ”

Perhaps we are at a point where even a national recipe is not enough and the wisest thing to do is to encourage much more localized strategies. In Colombia, for example, the difference between towns such as Leticia and Medellín is as marked as that of Sweden and Colombia. Even begin to see different trends in the behavior of the pandemic in Bogotá and Medellín. (Could read: Crowdfunding platform to support social ventures in the middle of COVID-19)

Despite the fact that today about 700 scientific articles on coronaviruses are published every day, and before 2020, an average of 3,000 articles on coronaviruses were published per year, the questions about the pandemic are still many and we will need time to understand who acted better, who He was right, or simply who was lucky and who was not. “Each new disease is different and its epidemiology only clears up gradually and in retrospect,” British science writer Matt Ridley reflected this week in an essay: “Is COVID-19 transmitted primarily by breathing or by touching? Do children transmit it without getting sick? Why is it so much worse in Britain than in Japan? Why are obese people especially at risk? How many people have had it? Are fans useless after all? Why isn’t it exploding in India and Africa? Will there be a second wave? We still don’t have answers to these questions. As a result, we don’t really know what works. “

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