Sweden: Dramatic drop in deaths doesn't mean Covid-19 plan worked
- Sweden's daily coronavirus death rate is approaching zero.
- Newly diagnosed Covid-19 cases have fallen to one-sixth of their number at the peak, just two weeks ago.
- Suddenly, Sweden's "no-lockdown" approach to the crisis looks like a late-running success.
- But experts are warning that the path Sweden took came at a high price: Sweden's death toll was 11 times that of neighboring Norway, and the current drop in fatalities is on a par with Haiti or Pakistan, countries that are struggling to control outbreaks .
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By all accounts, Sweden's high rate of coronavirus deaths was evidence that the country had made a horrendous error. Sweden - which did not impose a strict lockdown - suffered 543 deaths per million of its population, compared to just 105 in neighboring Denmark. The Swedish death toll has been roughly 11 times worse than Norway's, on a per capita basis.
Yet coronavirus deaths in Sweden have fallen dramatically in recent days, and are now approaching zero. Between June 30 and July 6, Sweden recorded fewer than five deaths per day on all days but one.
The decline in newly diagnosed cases has been even more dramatic. In late June, Sweden diagnosed more than 1,800 people per day as Covid-19 positive. Today, just two weeks later, only one-sixth of that number are testing positive on a daily basis.
On paper, Sweden suddenly looks like a stunning - albeit late-running - success. But experts are warning that their recent spell of good news does not mean the country's no-lockdown plan was successful, or that other countries should follow its path.
- Jon Tallinger, a doctor who left his job in Sweden to campaign for better treatment of the elderly during the pandemic, said people shouldn't be amazed by charts showing Sweden's progress because they look remarkably similar to those of countries that have been hard-hit by the with coronavirus, including Peru, Pakistan, and Haiti.
He said any decline in deaths now is not a win for Sweden's strategy: "They said that Sweden's response was effective when its deaths were rising, now they are saying it is effective as deaths are going down."
"The deaths rates have fallen but it doesn't change the fact that our strategy has failed. And we don't know when the rates will rise again."
In fact, Sweden's death count is similar to that of countries that failed to take swift measures against the novel coronavirus.
The toll has declined slowly over the months. It follows the familiar pattern seen in Italy, Spain, and the UK, where the coronavirus was only brought under control after a catastrophic wave of fatalities that took more than 100,000 lives.
Cases have started dropping in Sweden
Sweden did not implement a full-scale lockdown. Instead, it allowed people to live relatively normal lives. It banned gatherings with more than 50 people, imposed limits on customers in restaurants, urged people to social distance, and banned elderly care home visitors. The hope, state epidemiologist Anders Tegnell said, was that people might develop a widespread "herd immunity" as this happened.
Experts pointed to a host of reasons for the shifting numbers. They credited myriad factors, including the arrival of summer, with fewer people in offices creating more distance, and Sweden quietly taking steps to protect people in care homes. Johan Carlson, the director-general of Sweden's public health agency, credited the "effect of us keeping up the social distancing" for the decline.
- Swedish authorities said the reason the case rate shot up in June is due to increased testing.
Professor Juan-Jesus Carrero, an epidemiologist at Sweden's Karolinska Institutet, backed this idea up. "The number of cases is increasing because the Swedish government has recently relaxed the requirements for testing, and more citizens are being tested mainly in primary care," Carrero told Business Insider.
As for why there's been a recent drop: "The short answer is, that there is no short answer," Pekka Nuorti, an epidemiologist in Finland's Tampere University, told Business Insider, pointing to changes in testing, changes in behaviours, and more time spent outside.
But Nuorti warned against taking much comfort from this chart alone.
"In general, looking only at total reported case counts can be misleading and they have a tendency to fluctuate," he said.
Sweden is now preparing for a second wave, like other countries - a situation it had hoped to avoid. Health Minister Lena Hallengren warned this week "the danger is not over," and announced Sweden is planning in case the virus starts to peak again.
Sweden did not achieve immunity, far from it
Many in Sweden argued that its plan would allow its population to achieve "herd immunity".
But that's not even close to being achieved: Tegnell said in June that "the trends in immunity have been surprisingly slow." One study then showed 6.1% of Sweden's population had developed antibodies by late May.
Experts say the small build-up of immunity may be a minor factor in the fall in deaths, but not enough to dramatically drive numbers down.
Summer may have slowed the spread because people are spending less time indoors
Since the pandemic began, research has suggested warmer weather could slow the virus' spread. Heat degrades particles faster, and other coronaviruses have seasonal cycles, hitting hardest in the winter.
It was a small silver lining experts hoped would offset the summer rush of activity which Tegnell warned against in June: "It is very important in summer and midsummer that you keep a distance to each other. If you travel, you must travel responsibly."
But it's unlikely heat alone has been a powerful antidote, as we don't see similar trends in hotter parts of the world, like Brazil, or the southern US - two regions with the highest rates of Covid-19 in the world.
Jan Albert, a professor of infectious diseases at the Karolinska Institutet, pointed to the summer season potentially creating social distancing, with people out of work and school, and spreading to the country's remote areas with their family units.
"It is difficult to tell what the reasons are, but probably a combination of season, partial herd immunity, and social distancing," Albert said.
New rules for care homes, and better hygiene everywhere
Carrero said that now, in Sweden, "there are genuinely more hygiene measures everywhere."
That applies to care homes, too, which have been hit hard: 90% of the country's deaths have been among those over 70. Care home workers previously said they were initially told to not bring residents to hospitals, or to give patients oxygen without a doctor's approval.
The government made some effort to work with care homes after Tegnell admitted in early June that the elderly death rate was too high.
Sweden has started providing funding for more staff in care homes, and giving more money to the local authorities that oversee healthcare provision. After some pressure, the government also made it easier for staff to tip-off the authorities to problems at care homes, including infrequent visits from doctors, The Local reported.
According to one report on the handful of Swedish care homes with no cases of Covid-19 at all, it was internal measures - better equipment, less hourly staff, better access to doctors - that made the difference.
Ultimately, 'the more aggressive approach turned out to be the more appropriate one'
- But Carrero said it is too soon to know how to judge Sweden's strategy: "Whether these have been the best measures to implement, that is another issue that we can discuss, but an issue that probably we will not be able to judge fully until everything is over. "
Professor Luke O'Neill, an immunologist at Ireland's Trinity College Dublin, said the general consensus among European scientists is that, because of the high toll of deaths, "Sweden's strategy failed."
"In some ways, the decisions they made were based on how they assessed the evidence at the time. And other countries decided to be more aggressive and sadly the more aggressive approach turned out to be the more appropriate one."
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