I write post after post here about how the U.S. should remain locked down as long as possible, until more testing and contact tracing is in place, but I find myself weirdly glad that Sweden is conducting its highly risky experiment with herd immunity. It’s the only way we’ll know whose approach to the disease was the correct one, the cautious “shut it all down” contingent or the more fatalistic “everyone’s getting infected eventually” group of one, i.e. Sweden. If Sweden’s death toll ends up being lower than expected and the country ends up achieving herd immunity sooner than expected, it’ll look like a brilliant gamble in hindsight. They wagered the lives of thousands of people in refusing to bring their economy to a screeching halt — and it paid off.
Epidemiologists, including many in Sweden itself, are willing to take that wager, though. They see a catastrophe in the making even though the Swedish government has put in place some basic social distancing measures. Gatherings of 50 people or more are banned, and citizens are asked to use good sense in keeping their distance from others. But as far as closing down schools and businesses? Nope. Life goes on.
Today they recorded their 1,000th death from the virus, far more than any of their Scandinavian neighbors.
In all, 1,033 Swedes have died from Covid-19, official figures showed on Tuesday. Though still well below fatality rates in Italy and the U.K., it’s far worse than in any of the Nordic countries with which Sweden usually compares itself. The Swedish mortality rate is almost 10 times higher than in Finland, more than four times higher than in Norway, and twice Denmark’s…
Like elsewhere, most of Sweden’s Covid-19 deaths have hit the elderly–a demographic [Prime Minister Stefan] Lofven has admitted they should have done more to protect.
“We have had an unfortunate development, especially compared to our neighboring countries, with an introduction of the virus at many elderly care homes,” Sweden’s top epidemiologist Anders Tegnell said at a press conference on Tuesday. “We have started working hard on this, in coordination with other government agencies.”
A group of 22 Swedish doctors and virologists published an open letter to the government in a newspaper today pointing to the much better data in Finland and Norway and begging the prime minister to start locking things down. I remember back when the UK was considering this strategy how scientists warned them that the plan to quarantine the old and vulnerable while letting the young and healthy walk free had a (literally) fatal flaw for senior citizens: Many of them need assistance day-to-day, and that assistance is typically provided by younger people. Who’ll provide that assistance if the young are out infecting each other? The fact that Sweden’s seeing an unusual number of deaths in nursing homes made me think of that. Of course the virus is going to get into clusters of the elderly if you’re making little effort to restrain it among younger caregivers.
And yet, and yet, I’m not convinced at this point that the Swedish experiment is a failure relative to the lockdown approach and I’m not sure how anyone else can be when we won’t know the final death toll in each country for a year or more. Sweden’s strategy is to accept a short, severe outbreak in lieu of a much longer but maybe not much less severe one. Picture that famous graph in your mind showing how to “flatten the curve”: Sweden’s making a conscious decision to follow the taller, thinner curve in lieu of the shorter, fatter one. They’re supposed to have a big spike in deaths early; that’ll pay off for them, in theory, with many fewer deaths long-term as other countries are consumed with fighting off large second, third, and fourth waves of the disease. *If* you think “flattening the curve” is a pure matter of protecting hospital capacity, with little effect in reducing the final death toll from the disease over time, then arguably it’s better to go Sweden’s route and get it over with. It’ll be gruesome for them, but it’ll be gruesome for us too. It’ll just take longer for us.
In fact, if you look at the COVID-19 statistics here, you’ll see that Sweden isn’t (yet) a worst-case scenario. They have the ninth-highest number of deaths per one million people of any major country in the world, far more than other Scandinavian countries and ahead of the United States — but also far less than Spain and Italy, the hardest hit European nations. On the other hand, the IHME model predicts that Sweden won’t peak for nearly another month and that it’ll see more than 18,000 deaths before August 4, a *big* number relatively speaking. By population, that would be the equivalent of nearly 600,000 deaths in the United States, around 10 times as many dead as IHME projects for us by August.
Maybe you think that’s okay because of the accelerated timeline Sweden is aiming for. Conceivably they’ll be completely done with coronavirus by August while we’ll be gearing up for thousands more deaths this fall and winter — unless, of course, scientists discover an effective therapy between now and then that makes coronavirus much less lethal for us going forward. That’s the giant hole in Sweden’s “let’s get it over with” strategy. By not playing for time, they’re not giving medicine any chance to partially solve this problem for them. Imagine telling your citizens that they should carry on as usual in the name of herd immunity and accept that that means many thousands of deaths … and then, just as you’re finished burying the bodies and the outbreak is finally calming down, researchers announce great success with an experimental antiviral. It’d be like a “Twilight Zone” episode.
Which is not to say that playing for time doesn’t have its own problems, and I don’t just mean massive economic pain. News is circulating today that Singapore, which had success in tamping down its initial outbreak via testing and contact tracing, is now experiencing a second wave that’s worse than its first. That is, controlling this disease once we reopen for business may be even harder than we expect:
Singapore officials have been screening and quarantining all travelers from outside the country since the beginning of the pandemic. Their contact tracing is second to none. Every time they identify an infection, they commit to determining its origin in two hours. They post online where identified infected people work, live and have spent time so that potential contacts can be identified. They enforce quarantines and isolation of such contacts, with criminal charges for those who violate orders.
And yet, in the last week, they’ve put the entire country into lockdown. All migrant workers are confined to their compounds for at least two weeks. Citizens may leave their homes, but only to buy food or medicine, or to exercise. Anyone who breaks the rules, including spending time with anyone not in their household, can be imprisoned, fined the equivalent of $7,000 U.S., or both.
What Singapore was doing (more on that below) dwarfs what most are discussing in the United States. Its present circumstances bode poorly for our ability to remain open for a long time.
There may be some basic flaws in Singapore’s approach that we can correct for. For instance, apparently mask-wearing isn’t as common there as it is in, say, Hong Kong and importantly Singapore hadn’t closed its schools, providing a huge potential incubator for new cases. We’ve closed ours and we’re moving towards ubiquitous masks; if we can emulate Singapore’s testing and surveillance systems within the next few months, maybe we can keep a lid on the spread until drugs are available to limit severe cases. But for now, we’re not at a point where we can confidently say that in the long run we’ll avoid the large relative death toll that Sweden appears to be staring at. All we can say for sure is that we won’t get there nearly as fast.