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“CORONAVIRUS | SWEDEN
Coronavirus: elderly in lockdown and children in school help Sweden pursue herd immunity
Swedes enjoy the spring sunshine in a Stockholm park as life carries on almost as normal
Louise Callaghan, Halmstad
Sunday March 29 2020, 12.01am GMT, The Sunday Times
In the bright spring sun, flaxen-haired families held barbecues on the beach. Crowds in this provincial Swedish town shopped in designer boutiques and in supermarkets laden with lavatory paper and pasta.
As much of the world hunkered down at home to hide from the coronavirus, life in Sweden was — for many — carrying on almost as normal last week.
Swedish public health experts argue that the virus can be stopped solely by vaccination or by herd immunity.
Since a vaccine for widespread use is still at least a year away, they say, the only possible way to stop the epidemic is by isolating vulnerable people while allowing the virus to spread as slowly as possible through the healthy population as they build resistance.
Scientists at Sweden’s public health agency say this will also prevent a harsh resurgence in infections.
“It’s important to think how long can you keep these measures going” said the state epidemiologist, Anders Tegnell. What we’re doing now we think we can do for a long time. Of course it slows down many things in society but we can make it work. We all know that this is going to go on for months. You can’t keep schools closed for months.”
Infections in Sweden passed 3,000 last week, with 92 deaths by Friday, and some restrictions have been imposed to slow the spread of the virus and protect the vuGatherings of more than 50 people are banned and colleges and universities are closed. Those over 70, or with pre-existing health problems, have been asked to stay at home except for a daily walk. But restaurants and bars are open and children are going to school.
The authorities say that Swedes can be trusted to follow recommendations to socially distance and do not need draconian laws to slow the spread of the virus.
“If the public health agency goes out and says stay home, people do stay home,” said Tegnell. “My feeling is that the actual impact of having a law in another country and a recommendation in Sweden isn’t that different.”
Last week Holland, which has been aiming for herd immunity, announced a ban on almost all gatherings amid public fears over a large projected number of deaths.
In Sweden, scientists at the public health agency are shaping the national response to the virus together with the government, but — by law — politicians cannot intervene in the details of its implementation.
“The agencies have the technical and scientific expertise. The government has the expertise in policies and politics,” Tegnell said. “Most experts in the world agree that there’s no way of stopping this any more. It hits almost every country in the world. We can’t get rid of it, that never happened in history — only with smallpox after decades of vaccination.”
Anders Bjorkman, a leading epidemiologist who — along with the British chief medical officer, Chris Whitty — spent years at the forefront of malaria research, challenges the model used by researchers at Imperial College London, which estimated that about 1% of those who contracted the virus would die.
He argues that the estimate is misleading as it does not include those with the virus who exhibit no symptoms.
“They say there’s 1% mortality. That’s not true. They completely discard the asymptomatics,” he said. “In all these groups there are some who don’t have symptoms and aren’t reported. In Sweden the average age of all reported corona cases is 56 years roughly. The average age of the population is 40 . . . and I believe that all age groups have been more or less equally exposed. Among the younger population, those under 40, there are so many non-symptomatics.”
The death rate in Sweden, he said, was likely to be closer to 0.1% than 1%. Hundreds, rather than tens of thousands, would die before herd immunity was achieved.
The public health agency said that in tests of around 5,000 people who had returned to Sweden from visits to Italy, the few hundred that were positive all exhibited very mild symptoms — implying that there could be a large number of people in Sweden who are asymptomatic — with mild or no symptoms — who have not sought medical treatment.
Some Swedish scientists say the laissez-faire approach will cost lives and the country would be better off following the UK in stopping people leaving their homes.
Joacim Rocklow, an epidemiologist at Umea University, challenged the asymptomatic theory. “It’s a huge risk,” he said.
“Herd immunity builds on the fact that there is a lot of silent transmission that would make you immune. But most of the scientific evidence doesn’t show much silent transmission.”
Some have called for large-scale testing — as Iceland did after skiers returned with the virus from a trip to Austria. They were isolated and their contacts traced and tested. So far there have been 890 confirmed cases, two deaths and 18 people hospitalised. Iceland has not closed its borders.
Svandis Svavarsdottir, the health minister, said Iceland’s low population density, well-developed health system and geographical isolation worked in its favour. By lowering transmission through social distancing, the proportion of the population that needs to become immune would be much lower than the 60%-70% rate of infection typically needed for herd immunity, she said. But the main goal of the strategy in Iceland now is to contain the spread of the virus, she added.
Haraldur Briem, Iceland’s former chief epidemiologist and an adviser to the government, said: “ It is too early to tell if we have beaten back the virus. Yes, the spread is slowing down, but we will have to wait and see.
“What we have done could be used by other countries. Closing borders may not be a good idea when the epidemic is spreading in your back yard.”