Coronavirus: within Sweden’s unique and controversial approach to Covid-19

They are images that seem strange these days: people dining in restaurants, lounging in parks surrounded by others, going to work and leaving their children at school, or chatting in shops.

Since the coronavirus pandemic forced almost every country on the planet to quickly end many elements of everyday life, these once normal activities have been largely impossible.

But a nation remains an outlier, taking a unique and controversial approach to dealing with the public health crisis.

He has not prohibited anything. Instead, Sweden is simply asking citizens to be responsible and safe, and counting on them to do the right thing.

In addition to encouraging people to stay two meters from others and work from home if possible, it is the usual thing in the European nation.

As of Thursday, Sweden has 20,300 confirmed cases of coronavirus and the number of deaths is 2,462, with a high infection death rate of around 12 percent.

Despite that huge loss, significantly larger than its Scandinavian neighbors, some announce the approach as a success, and a possible roadmap for the rest of the world.

As the rest of Europe, and indeed the world, began to crash as the coronavirus spread in February and March, Swedish health authorities decided on a very different approach.

His neighbors watched in horror and surprise.

Across the border with Finland, the government declared a state of emergency in mid-March, closed schools, and ordered the closure of restaurants, bars, and cafes.

A few days later, Denmark made a similar decision, closed its borders, and instituted a series of bans on socialization.

At the same time, Norway closed its schools, childcare centers and universities, and told companies where people were nearby, such as hairdressers and coffee shops, to close.

Defending Sweden’s approach, chief epidemiologist Dr. Anders Tegnell said earlier this month that a blockade like that was considered unsustainable.

“Locking people up at home will not work in the long term,” Tegnell said. “Sooner or later people are going to go out anyway.”

In an interview with The Times, he echoed his belief that a brief, sharp shutdown would only delay the inevitable: a large number of cases and potentially a large number of deaths.

“Even the most optimistic people seem to say that if we have a vaccine available in the next 18 months we will be very lucky,” he told the newspaper.

“To keep the schools closed until we have a vaccine, I would say that will not be possible because then a great harm will be seen in a cohort of children in their country.”

Sweden’s approach has not been without controversy and fierce debate. Far from there.

In late March, some 2,000 investigators across the country signed a petition demanding that the government “take immediate action to comply with the recommendations of the World Health Organization.”

“The measures should aim to severely limit contact between people in society and greatly increase the ability to screen people for Covid-19 infection,” the group wrote.

A group of 22 teachers also wrote an article that raises serious concerns about the strategy and warned that it could lead to preventable deaths and chronic lung disease.

Anders Vahlne, professor of clinical virology, is concerned that Swedes do not appreciate how infectious the coronavirus is and that it may spread through asymptomatic people.

“Even if you don’t sneeze or cough, you still breathe,” he told EuroNews.

“All the data indicates that this virus is spread through inhalation of aerosol particles, which remain infectious in the air for more than 16 hours.”

Unlike those experts, the Swedes themselves seem comfortable, as the ruling Social Democratic Party sees its opinion poll results rise for the second month in a row. Prime Minister Stefan Lofven’s handling of the pandemic is attributed to growing support for the government.

Tegnell believes it is only a matter of time before other nations that reacted quickly and strongly, essentially ending normal life and halting their economies, have to back off.

And it is at this stage that Sweden could shed light on a possible way forward.

THE WORD ‘H’

Sweden’s model for treating the coronavirus can be described simply as planning and hoping for herd immunity.

Herd immunity should theoretically occur when a significant proportion of the population has contracted and recovered from Covid-19, therefore cannot recover, if possible.

The science is not yet resolved, but Tegnell is hopeful.

“I think that is the only thing that is going to delay this when we have a sizeable proportion of the population in most countries that are immune to the disease, because these diseases are not stopped by anything else without a vaccine.”

Paul Franks, a professor of genetic epidemiology at Lund University, is one of those who believes that Sweden could provide guidance to the rest of the world in the next phases of the epidemic.

Until there is a vaccine, there will inevitably be new waves of outbreaks of coronavirus, unless there are enough infected people to achieve collective immunity, Franks said.

But that assumes that those who have already contracted Covid-19 retain enough antibodies to protect them, and that the virus does not mutate into a different new strain.

In any case, herd immunity would require about 60 percent of a population to become infected and recover, according to estimates, Franks said.

“Sweden, which is encouraging social distancing but has not closed completely, could guide the world,” wrote Franks in The Conversation. “Here, authorities say the country is rapidly approaching the immunity (levels) of the herd.”

That impending milestone will not come without significant cost.

Sweden’s death rate is among the 10 highest in the world and is significantly higher than that of its neighbors Norway, Denmark and Finland.

“The high death rate in Sweden that we can see is closely related to our nursing homes in Sweden,” said Tegnell.

“That has happened much less in Norway and Finland.

“We have looked at death rates very closely and are trying to find out why because there was already a ban on visiting nursing homes.”

“But in Swedish homes they are very old and very sick and need constant care.

“They need people to go there and the shutdown cannot stop that.”

It could be that achieving herd immunity and controlling the coronavirus in Sweden is at the expense of the death of the most vulnerable people in the community.

Professor Marylouise McLaws, an epidemiologist with the University of New South Wales Infectious Disease and Infectious Health Control Unit, said the collective immunity approach came at a “high price.”

“Unfortunately, Sweden chose ‘bulk immunity’ at a high price, with 2,500 deaths and a large number of active cases that, without a strict quarantine of cases and contacts, have the potential to continue rather than flatten the curve,” he said. McLaws to the news .com.au.

“Of great concern is the future impact of our ability as a global neighborhood to open our borders with a ‘collective immunity’ approach that fuels the pandemic and can cause a seasonal boomerang worldwide.”

IMMINENT MILESTONE

This week, the Swedish Public Health Agency forecast that a third of people in the Stockholm capital will have been infected with coronavirus early next month.

That equates to 200,000 people and is significantly higher than the official number of confirmed cases across the country.

It is because the agency believes that there are about 75 unconfirmed cases for every confirmed case.

And trust that the peak of infection has passed.

“We believe we passed the peak of the broadcast a week ago,” Tegnell told the BBC.

“It will definitely affect the reproduction rate and slow down the spread.”

There are some early signs that you might be right.

A study by New Zealand researchers this week examined reproduction rates in various countries and compared it to their individual pandemic response plans.

Hassan Vally, an associate professor at La Trobe University, examined the research and said that the Swedish Reff, or effective rate of reproduction infection, has dropped below one.

“A Reff of less than one means that each infected person spreads the virus to less than another person, on average,” Vally explained.

“By keeping Reff below one, the number of new infections will decrease and the virus will eventually disappear from the community.”

Sweden’s “remarkably relaxed” approach has been controversial, he said, and the number of cases and deaths there is much higher than anywhere else in Scandinavia.

“But Reff indicates that the curve is flattening out.”

SHOULD OTHERS FOLLOW THE SUIT?

Franks said the Swedish model provided reasons to be cautiously optimistic about the coming weeks and months.

“If the simulations performed in Sweden are correct, and post-infection immunity is achieved in most people, we should soon expect infections and deaths in Stockholm to decrease substantially in the coming weeks,” said Franks.

But Erik Wengström, professor of economics at Lund University, is not convinced that such an approach works everywhere for a great reason: trust.

In short, the level of trust that people have in the government, politicians, agencies and their fellow citizens is extremely high in Sweden.

“Given that Sweden has one of the highest confidence levels in the world, the strong relationship between confidence and approval of the strategy could suggest that its approach would be less successful elsewhere,” Wengström wrote in an article for The Conversation.

“There is a clear risk that in countries characterized by lower levels of confidence, the perception of a more voluntary approach is less favorable.”

“Also, a crucial part of Sweden’s policy is to get people to voluntarily follow the authorities’ recommendations. And if people don’t trust others to comply, they are less likely to comply with themselves.”

More than confidence, McLaws described Sweden’s approach to controlling the coronavirus as “unsuccessful.”

“To date, Sweden’s approach has resulted in more than 20,000 cases, of which 83 percent are still active cases that have the capacity to contribute to the transmission of other cases. 479 cases are serious or critical and are They have reported almost 2,500 deaths.

“I would describe their control approach as unsuccessful.

“Their curve suggests they have several surges or surges in the cases. For anyone, describing their epidemic curve as early signs of flattening is an optimistic interpretation.”

And Vally said the New Zealand research showed that, aside from Sweden, one approach overwhelmingly seemed to be the most successful.

“Individually, (the country’s results) tell their own story. Together, they have a clear message: the places that moved quickly to implement strict interventions put the coronavirus under control much more effectively, with fewer deaths and illnesses.

“And our final example, Singapore, adds an important coda: the situation can change rapidly and there is no room for complacency.”