COVID-19: SO WHY NOT SWAP TO SWEDEN'S STRATEGY?

After this coming winter, Sweden's strategy may be seen as having been the best overall, all things considered.  Certainly after a second winter by March 2022.  I've been willing to place a fiver bet 'each way' on it (first or a place).

Sweden has kept schools for under 16s open, with most businesses staying open.  Just banning large gatherings (over 50 people) and schools for over 16s.

They took a long-term view on COVID-19, as it was clearly too infectious to be eradicated quickly.  Taking that into account plus the 'side-effects' of lockdowns, I felt back in February that the lightest possible lockdown would be best.  That is what Sweden has done.  They have effectively had a voluntary lockdown.  Not a 'herd immunity' strategy, as that would take years at any reasonable infection rate.

Sweden's strategy looked foolish if just looking at deaths short term, arising from a much higher infection rate.  Now teh strategy is looking inspired if considering everything over the longer term, which is what it was designed to be.

It is reported that Sweden now has a lower rate of new cases than neighbours Denmark and Norway:

People are increasingly wondering why we didn't all follow Sweden's lead?  Indeed shouldn't we all change to their strategy?


THE 'BUTS' ABOUT THE SWEDISH STRATEGY

Health System Being Overrun

The frst thing to realise is that no country wants to deliberately experience what we saw in northern Italy back in February, when the hospitals there were overrun.

Not only did that mean people suffering from COVID-19 couldn't be treated properly, but other healthcare at the hospitals had to stop.  Staff over-stretched too, both physically and emotionally, especially when colleagues around them were dying.

Sweden deliberately set their restrictions to ban the most dangerous activities, in the hope their hospitals would not be overrun.  So far they have been successful.  They regret not protecting the elderly more, especially in care homes, which is one reason their death toll has been higher than their Scandinavian neighbours.

We also need to be aware that if a country 'runs hot' near the limit of its health service, many more people will die and suffer from LongCOVID than at lower infection rates.  The health service capacity should be seen as 'just in case of need', not a target in its own right.


LongCOVID

What wasn't understood back in February was the extent of complications generically called LongCOVID.  This is where symptoms last for months or more, of two main types:

• Long-term lethargy, where the ability to function is substantially reduced, often to the point of not being able to work
• Damaged organs.  Liver, kidneys, digestive tract, lungs, heart, brain.  Nasty and painful.

The Long COVID Support Group says that King's College ZOE study estimates that "...up to 10% of people with the virus take at least 3 weeks to recover, with 250,000 people in the UK alone thought to experience symptoms for 30 days or more."  That figure is five times the excess deaths in the equivalent months, and from what else I have seen, is probably significantly understated.

LongCOVID affects all age groups, including children.  A major concern is that younger adults have seen that deaths have mainly affected older people, and so have felt they need not take precautions.  LongCOVID can readily affect them too.  They can also easily pass the virus to someone else who could die or suffer.

Devi Sridhar, an advisor to the Scottish government and a member of the Independent SAGE group warns at 30min30 that this virus is “too dangerous to spread through the population, not only because of the mortality [dying] but because of the morbidity [LongCOVID] it causes in young adults…that’s going to be the story about COVID, not about the deaths”.  Chilling stuff.

The risks of COVID-19 are in three groups, affecting the person, their family and friends amongst others:

• Inconvenience of illness, not to mention actually feeling ill
• LongCOVID
• Death or stroke

The more I understand about this disease, the more I am concerned about the inconvenience of being ill and the consequences of LongCOVID.   Financial consequences as well as personal.  Certainly I am actively trying to avoid catching COVID-19, as I think I would have done in my 20s, 30s or 40s too.

I wonder if Sweden would have followed their strategy if they had known about LongCOVID?  I'd be interested to see estimates of the problem there.


Sweden's Culture

The Swedish implementing a voluntary lockdown means relying on the people of Sweden to follow guidance rather than needing legal restrictions, as happened elsewhere in Europe.  That is something almost uniquely Swedish.

It does not translate into UK, USA or much of other parts of the European continent.


Swedish Resistance

There has been an increasingly vocal resistance within Sweden to their strategy.  That includes this open letter to the USA saying "Don't do what we did".  Though this seems to focus exclusively on short-term deaths, and so ignores the whole point of Sweden's longer-term strategy.


THE SWEDISH POSITIVES

Current Infection Rates

The infection rate in Sweden is now very similar to the UK, at around 26 per hundred thousand "confirmed new cases" over the last fortnight.  That is substantially lower than Spain, France and many other parts of Europe that had a stricter lockdown policy.

Per European Centre for Disease Prevention and Control

This vindicates Sweden's approach in not having a tough lockdown.  Spain's was ridiculously tough, and now people have been released, infections are running at over two hundred a day per hundred thousand.  France's rate is high too.

This also vindicates UK's lighter lockdown, letting us take daily exercise.

Benefiting from Cross-Immunity?

Sweden's infection rates are lower than might be expected for the amount of infections that people there have had to date.  One possibility is that they have benefited from 'cross-immunity'

COVID-19 is caused by a coronavirus named SARS-COV-2.  There are four other coronaviruses that cause common colds.  It looks like they can get the human immune system to create T-cells that can fight COVID-19.  Indeed it looks like immunity against COVID-19 will come from T-cells rather more than antibodies (which are produced by B-cells).  That's whether the immunity is natural or via a vaccine.


THE DIFFERENCE BETWEEN A STRATEGY IN MARCH AND WHERE WE ARE NOW

Time has moved on.  Now we understand:

• LongCOVID on the downside of the Swedish strategy
• Possibly cross-immunity on the upside
• The limit of health service capacity
• The higher the infection rate the more deaths and LongCOVID
• The 'side-effects' of lockdowns, that were forecast in theory and experienced in practice
• How people behave long-term, especially after strict lockdowns

It's looking like a strategy based on the Swedish strategy could be best, at least for a new pandemic.  But there are swings and roundabouts about it, and the conclusion won't be much clearer until after the northern hemisphere's winter, at least.  Then deaths, LongCOVID, the economy and a host of other factors will be better understood and comparable across the world.  Too early to decide now.

That's if a new pandemic threat were to appear.   But we've already had a first wave, and each country is where it is in its anti-COVID-19 response and infection rates.  Should a Swedish approach be adopted if we see a second wave?  That has arguably already started in some countries, like Spain and France.

Again it's probably too early to tell.  But should the UK in particular embrace such an approach and substantially relax restrictions?

Alternatively there are strong reasons to follow a #NearZero strategy, which is to get infections down to below 2 per hundred thousand a day (28 a fortnight in reality, not just confirmed by testing) and pounce on any outbreaks.  That would allow much of life to return to 'normal'.

Relaxing restrictions too much would throw away the progress to date.  Current real infection rates in the UK are only about four or five times that #NearZero level, better in Scotland.  Within touching distance with the right policies. Silly to throw that opportunity away.


IN CONCLUSION

So no, the UK should not follow a Swedish-style strategy.  From where we are today, a #NearZero strategy would get us back to near 'normal' more quickly and reliably.

For other countries, it will depend on their position.  But in general, it is too early to say that the Swedish approach is the right thing to do.