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It did not implement an extensive “blockade” in the economy, nor did it impose strict measures of social distancing. Instead, it relied on voluntary action, advice on the elderly, recommendations for teleworking and avoiding unnecessary travel. Borders and schools for children under the age of 16 remain open, as do many companies, including restaurants and bars.
The reason why Sweden followed its own line at a time when all other European countries have imposed strict restrictions on public life to put a “brake” on its spread derision.
This bold approach drew criticism at home and abroad. Among other things, 22 scientists in an article in the Swedish newspaper Dagens Nyheter last week accused public authorities of failing and urgently called for stricter measures, noting the numerous deaths from coronary heart disease in nursing homes and the highest number of deaths in Sweden. countries that have taken strict measures.
The Sweden, a country with a population of 10.33 million, almost as much as Greece, has the worst statistics as of April 22: it has 15,322 confirmed cases (compared to 2,401 in Greece), 1,765 deaths (compared to 121 in our country ), 175 deaths per million inhabitants (compared to 12 in Greece) and 515 critically ill patients (compared to 59 in Greece).
Epidemiologist Dr. Anders Tegnell of the Swedish Public Health Service, the “brain” behind the country’s controversial and risky strategy (or “devil’s advocate” as some would call it), explained his reasoning to Nature.
The following are the main points of his interview, broadcast by AMPE.
Explain to us Sweden’s approach to managing coronary heart disease
I think the only thing that is this approach has been exaggerated. Like many other countries, our goal is to ‘flatten’ the curve, slowing the spread as much as possible, otherwise the health system and society are at risk of collapse. It is not a disease that can be stopped or eradicated, at least until an effective vaccine is developed. We need to find long-term solutions that keep the distribution of infections to a satisfactory level. Each country tries to keep people away using the measures and traditions at its disposal. That is why we end up doing slightly different things.
The Swedish law on communicable diseases is mainly based on voluntary measures, on individual responsibility. Clearly, the citizen has a responsibility not to spread the disease. This is the nucleus from which we started, as there are not many legal possibilities to close cities in Sweden using existing laws. Quarantine can be applied to people in small areas like a school or hotel. We cannot (legally) exclude a geographic area.
On what basis was this approach based?
It is difficult to talk about the scientific basis of a strategy in such diseases, because we do not know many things and we learn in practice, day by day. The “blocking” and the closing of the borders have no scientific basis, in my opinion. We first looked at some European countries to see if they had published any analysis of the effectiveness of these measures, but found almost nothing. Closing the borders I think is ridiculous, because the Covid-19 it is in all European countries now. We are more concerned with traveling within Sweden. As a society, we prefer incentives: we constantly remind people to follow the measures and improve them. We don’t have to shut everything down completely, because that would backfire.
How does the Swedish Public Health Service make decisions?
Around 15 people meet every morning and review our decisions and recommendations according to the new data. We speak to regional authorities twice a week. The hottest debate now concerns the nursing homes, where there have been very unfortunate coronation outbursts, due to Sweden’s higher death rate compared to its neighbors. The investigations are ongoing because we need to understand which recommendations were followed and which were not.
His approach has been criticized for being too lenient. How do you respond? Do you think it endangers people’s lives more than necessary?
I don’t think there is such a danger. There has been an increase in hospital admissions and deaths, but so far it is not traumatic. Nowhere in Europe has it been possible to significantly curb the spread. For schools, I am convinced that they will remain open nationwide. You have to close schools early enough in the epidemic to get results. Now it doesn’t make sense. Furthermore, it is vital that the younger generation remain mentally and physically healthy.
You have been criticized for not fully recognizing the role of asymptomatic carriers. Do you think that the asymptomatic are a problem?
Asymptomatic can be carriers, as some recent studies show. However, their contribution to spread is relatively small compared to those with symptoms. We really need to stop them.
Do you consider your approach to be successful?
It is very difficult to know, it is very early. Each country must achieve “collective immunity” in one way or another and we will do it differently. We don’t know how long the herd’s immunity will last, but there is definitely an immune reaction (in the coronary artery).
What else could you have done differently?
We underestimated the problem of nursing homes and how the measures would be implemented there. We should have done more extensive checks.
Are you satisfied with your strategy?
Yes! We know that Covid-19 is too dangerous for the very old, which of course is bad. But looking at pandemics, there are much worse scenarios than that. Most of the problems we have today are not due to the disease, but because the measures in some settings were not implemented correctly.
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