How did Sweden manage to flatten the epidemic curve without lockdown?


In mid-July, while i worrying death figures made the chorus of criticisms against his response to the pandemic increasingly loud, the Swedish Prime Minister, Stefan Lovfen, hadn’t given in an inch. Stockholm’s choice was against the tide: no lockdown to not destroy the economy, perhaps with the hope of achieving flock immunity. “The strategy is the right one, I am absolutely convinced of it,” he told Aftonbladet newspaper. It was July 16th and the Scandinavian nation was registering more deaths per capita than the United States.

Two weeks later, the data says that Sweden managed to flatten the epidemic curve without any lockdown. The weekly average of new cases dropped to 200 at the end of last month, compared to around 1,140 in mid-June. And the daily number of coronavirus-related deaths is from two weeks to two digits, after hitting a high of 115 in mid-April. The epidemic therefore seems to be under control but critics believe that the price, in terms of human lives, was too high and that, if the government secretly harbored the goal of immunizing the population by letting Covid circulate, the result is not seems to have been achieved.

The confrontation with Italy

It is natural for local observers to compare with the Nordic neighbors: 567 deaths per million people (data Worldometers) many may appear when compared with 106 in Denmark, 59 in Finland or 47 in Norway. The picture changes if the comparison is with the 581 deaths per million inhabitants of Italy or the 680 of Great Britain, whose epidemic curve is struggling to flatten out.

Anders Tegnell, chief epidemiologist of the Stockholm Public Health Agency, has no doubts: the Swedish way works. The twenty-five Swedish academics who, in an editorial published by Usa Today, write that the government’s approach had “death, torment and suffering” effects, are of a different opinion. “We have given the world an example of how not to deal with a deadly contagious disease,” they write.

No lockdown, no masks, and closing, at first, only for high schools and universities. The Swedes were only asked to refrain from non-essential travel and to work from home whenever possible. Shops and restaurants had to reduce the number of people who could enter but never closed. Assemblies have been banned, yes, but only over 50 people. Those over the age of 70 were advised not to go out but everything was left to their common sense, without the threat of sanctions. So what happened in Sweden? A shared explanation does not yet exist and experts have developed some theories.

What the experts say

“Swedes in general changed their behavior during the pandemic and the practice of social distancing was widespread,” he told MedPageToday Maria Furberg, an infectious disease specialist at the University of Umea, “from March to the beginning of June all the shops were almost empty, people had stopped having dinner with friends and families had interrupted contacts with even the closest relatives. A lockdown could not have been more effective. Washing your hands, using disinfectants as much as possible and staying at home at the first sign of cold became very normal. “

Second Mozhu Ding, epidemiologist of the Karolinka Institute, the flattening of the curve is due “probably to a combination of measures taken by individuals, companies and the effects of the vast information campaign launched by the government”. “Even without a rigid and mandatory lockdown, many companies have allowed employees to work from home and universities have offered distance courses to students,” he told the scientific paper.

Another factor may have been the arrival of the warm season, with the closure of schools and the possibility of making excursions in nature. Second Anne Spurkland, immunologist at the University of Oslo, “perhaps Sweden has finally reached greater control of the disastrous spread of the virus in nursing homes, which may explain to some extent the relatively high mortality rate“. Half of the 5,730 deaths recorded by Sweden have indeed occurred in the hospitalization for the elderly. According to Spurkland it is however” too early to establish that the Swedish approach has been the wisest “. We will have to wait for autumn and see if it will occur a second wave in Norway and other neighboring countries that imposed the lockdown.

The question of herd immunity

The cautions required of the population seem to exclude – as the most heated critics argue – that the aim of the government was herd immunity, that is what British Prime Minister Boris Johnson wanted at the beginning of the epidemic. Yet statements like that, recent of Karin Tegmark Wisell, head microbiologist of the Public Health Agency (“a large part of the population is not protected because it is not infected”) seemed to suggest otherwise. The target would appear to have failed, if any, since antibody positivity in the Swedish population appears to be nailed down to 10%. However, the issue could be more complex.

In fact, a study by the Karolinska Institute has shown that 30% of asymptomatic or coronavirus-infected patients with weak symptoms are negative for antibodies but have immunity linked to T lymphocytes. “This is splendid news from the point of view of public health”, Ding points out, “people who tested negative for antibodies could still be immune to the virus at the cellular level.”


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