Sweden’s declining coronavirus death is not a sign of herd immunity

• Sweden had the highest per capita coronavirus death rate in the world in May.
• Many experts attributed this to the country’s decision to avoid a complete lockdown and to deliberately or unintentionally advance mob immunity.
• Sweden has seen a significant drop in deaths and ICU admissions since June, possibly due to the protection of nursing nursing-home residents and the greater social gap in the summer months.
• But with schools reopening, nursing homes will allow visitors and people will be able to reopen when they return home to the cities after a summer vacation.
• Visit Business Insider’s homepage for more stories.

Looks like Sweden has taken a significant turn.

This spring, after imposing some lockdown rules on the rest of the world, the number of per capita deaths in the country has risen to the highest in the world in May. But last week there were an average of three daily deaths in Sweden compared to a peak of 115 in April. Its per capita death toll – now 58 deaths per 100,000 people – has surpassed 13 other countries, including the US and the UK.

The country’s daily ICU admissions have also been in single digits since early July.

Experts consider four major factors to reduce mortality. There is a five-month ban on large gatherings by Sweden, which helped slow transmission over time. The second is the country’s official guidance that tells people to work from a social distance and from home. The third country is the summer vacation period, which caused people to leave the cities. And fourth, the country’s new focus is on improving safety in nursing homes.

But Sweden’s recent success does not mean that its strategy is working as a whole.

“They basically got to these plates now, while some people got there a few months ago,” Christian Althous, an epidemiologist at the University of Bern in Switzerland, told Business Insider. “Because they are taking action now, the number of cases is likely to increase.”

Sweden last week lifted the ban on nursing-home visits. Children aged 17 and over went back to school in August. From 1 October, Sweden is also expected to allow gatherings of up to 500 people at public events until the physical distance is observed.

Combined, experts say, those factors could increase the risk of a new transmission, which could lead to another wave.

Did work in Sweden

Residents of elderly care homes account for about half of Sweden’s coronavirus deaths, so stopping transmission to those facilities seems to have significantly reduced deaths in particular.

Sweden banned visitors to nursing homes in March. Since then, features have become tougher about social distance and the need for facial masks. In recent months, the Swedish government has also begun working with care homes to make it easier for employees to report instances in which an elderly patient does not have adequate care or access to a doctor.

In May, Sweden’s prime minister pledged 2.2 billion kroner (20 220 million) to fund more staff in elderly care homes. By July, nursing-home staff in Stockholm said they were no longer short on personal protective devices.

At the top of this initiative, time seems to be on Sweden’s side.

The country’s vacation period lasts longer than other countries: from May to September. During that time, many residents leave the cities in favor of longer holidays in the countryside, where people are more scattered. People probably spend more time outdoors, where transmission is less likely, and naturally the frequency of interactions between people as a whole decreases.

Solid action for a long time

When most countries asked residents to stay at home in March, Sweden’s state epidemic, Anders Tagnell, controversially chose to keep Sweden’s primary schools, restaurants, bars and gyms open.

Earlier this month, Tagnell told the Financial Times that the national downdown was “like using coriander to kill a fly.”

But he added that contrary to popular belief, Sweden’s goal is not to allow the virus to run rampant until the majority of the population is exposed. Instead, Tagnell said, leaders rely on residents to fulfill personal responsibilities.

By Claudio Bresciani / TT News Agency / AFP Getty Images

All but 2% of Swedish residents who responded to a government vote in April said they would change their behavior to protect themselves from COVID-19. In May, 87% of respondents reported that they were keeping more distance than others on shops, restaurants and public transport.

Sweden imposed some restrictions, however: it closed high schools and universities for three months, urged people to work from home, required social distance in bar and rest restaurant rent, and told the sick and elderly to stay at home. Gatherings of more than 50 people were banned in March.

“There is always a lot of misunderstanding about what has been done and what is being done in Sweden,” Althous said. “While other European countries may have tougher measures and lockdowns, but came out of it in April or May, Sweden has taken concrete measures, but kept them in place for a very long time.”

However, the consequences of this weak approach are now clear: from January to June, more than 1,000,000 people died in Sweden – the highest death toll in the six months since the famine hit the country 1,150 years ago.

“They were a little misunderstood, obviously, because for a long time they were ‘talking,’ this is like the flu or a little bit stronger. ‘” But you could also argue that other European countries put it a little too much. . The right balance is probably in between. “

Swedish advantage: in small houses

Given Sweden’s current low rate of coronavirus deaths, it is surprising whether other countries should take a queue. But experts say recent lessons learned there in Sweden’s small households have made it difficult to apply elsewhere.

“Before claiming ‘X’ will be what the country does [the] Here too the same effect, ‘We need to consider whether there is a major difference in the composition of the population between the countries,’ said epidemiologist Adam Kucharsky of the London School of Hygiene and Tropical Medicine recently. Wrote on Twitter.

Importantly, Sweden has a low proportion of high-rise homes compared to most European countries. About one-third of Sweden’s elderly population lives alone, compared to only one-fifth of Greece’s or Spain’s elderly population. Sweden also has one of the smallest average sizes in Europe: about 2.2 people per household. In contrast, the average rate per household in the US and Russia is 2.6, while in Brazil it is 3.3.

Studies show that coronavirus has the highest secondary attack rate in home contacts. A June study found that the attack rate in households was 20%, compared to 6% in the general population. Other studies have found that the rate of home invasion can be as high as 0%. Althus estimates that half of the coronavirus transmission may occur in homes.

“As a series of indoor epidemics, epidemiological thinking can be useful, which is connected between home transmissions,” Kucharsky wrote.

The proportion of Swedish residents living alone or in small groups is therefore high so it has probably made it easier to slow down – especially after their outbursts have been brought under control by aging-care facilities.

‘Death toll really shocks’

David Lidstrom / Getty Images

Although Tagnell has changed his tone slightly since the spring, emails received by Swedish journalists show that he initially thought Sweden could reach herd immunity – a threshold in which a sufficient population becomes immune to the virus to prevent infection.

In April, Tagnell told the Financial Times that he expects 40% of people in Stockholm to be immune to the coronavirus by the end of May. That didn’t happen: A study by University College London estimated that the level of infection in Stockholm was about 17% in April – the same as in London.

Then in June, Tagnell estimated that as many as 30% of Sweden’s population may be immune, but a national study showed that by the end of May only 6.1% of people had developed coronavirus antibodies.

Althous said the idea that Sweden would reach the mob’s immunity was “always ridiculous.” Scientists widely agree that the safest way to boost the immune system of a herd is through vaccination, not a natural infection.

“The idea is that, basically, 50%, 60%, 70% of people get infected and then the problem is solved, which wasn’t really based on science,” Alth. Said. “It’s highly unlikely that something like this can be achieved, and if it can be achieved, it will come at a huge cost – at least in European countries or demographic countries like the US.”

Tagnell also acknowledged that strict sanctions should be imposed on Sweden.

“If we were to face the same disease of knowledge that we have today, I think our response would fall somewhere between what Sweden has done and what the rest of the world has done.”

Tagnell also told “The Daily Show” host Trevor Noah that he underestimated how the virus affects the elderly.

“We counted more people getting sick, but the death toll really came as a surprise to us,” Tagnell said at the event in May. “We really thought it would be better for our elderly homes to keep the disease out.”