Canadians should wish Sweden well in its no-lockdown approach
Last week, Maclean’s reported on a group of University of Ottawa researchers who had found, to their consternation, that each province offers different advice to people who think they might be showing coronavirus symptoms. “Even in a cross-Canada pandemic as devastating as this, there is not a single, evidence-based Canadian standard of care simply for self-assessment,” the researchers wrote.
It’s strange how many Canadians seem uncomfortable with the most basic design of their country, which is that of a federation. What the U of O researchers find alarming is not just a matter of Canada operating as it was intended to operate, but also a good example of the benefits. Provinces and territories can shape their responses to the needs of their populations. They can learn from each other what works. It’s a living laboratory.
In the same vein, assuming things don’t go catastrophically wrong, we should be thankful that Sweden is sticking to its guns in avoiding a total lockdown. That, too, will provide very useful data in preparation for COVID-the-next.
It is important to realize that lockdowns take a human toll, sometimes fatal, just like coronaviruses (though probably not on the same scale). Emergency room doctors are worried about their lack of business nowadays, the National Post’s Richard Warnica reported Friday. “Doctors believe … patients who are afraid of contracting COVID-19 are just waiting (to seek treatment) and getting sicker,” Warnica reported. The head of a Vancouver ER department noted that opioid overdose deaths are up, even as his hospital treats far fewer. Are they overdosing alone, whereas before they might have been saved? When we postmortem this pandemic, we will hear about sexual and domestic assaults, suicides and other isolation-related harms. They will need to be weighed against the risks inherent in a less draconian approach.
Sweden’s strategy has been somewhat caricatured. High schools and universities closed; people aged 70 or older were advised to self-isolate; large gatherings ceased. Easter travel was down a reported 90 per cent. More Swedes have reportedly filed for unemployment benefits than during the 2008 crash. Restaurants, pubs and cafés remain open, which seems unfathomable to a Canadian. But “it’s a myth that it’s business as usual,” as Sweden’s deputy prime minister Isabella Lovin told the Financial Times this week.
Still, on the most basic of measures, Sweden is faring worse than its more-lockeddown neighbours: Norway has reported 30 deaths per million population, Denmark 58, and Sweden 139. As the National Post’s Colby Cosh noted earlier in the week, Anders Tegnell, Sweden’s epidemiologist-in-chief, defends this as a failure not of the approach, but of component systems: It turns out Swedish nursing homes are fantastically vulnerable to COVID-19 outbreaks, just like ours. Somali immigrants are hugely overrepresented among the infected. Tegnell suggested this was because they’re not doing the things public health officials are asking them to do, because they’re poorly integrated into Swedish society. (Swedes don’t need to be ordered around, because they are so trustful of officialdom, and of each other, that a kind request is all that’s needed — or so the story goes.)
It’s a mildly outrageous defence. Public health officials are supposed to design responses for reality, not some perfected version of it. But he might not be entirely wrong, and the rest of the world shouldn’t dismiss the Swedish model out of hand. Sweden’s deaths per capita figure is considerably lower than Switzerland, the Netherlands, the United Kingdom, France, Italy, Spain and Belgium. And its cases per capita figure (1,309 per million) is virtually identical to Norway’s (1,280) and Denmark’s (1,221). Together the Scandinavian nations are faring better than any Western European country.
In other words, Sweden’s deaths-to-cases ratio is high. That’s not good. But as they struggle to rebuild their economies, countries who fared better keeping COVID-19 patients alive may well look toward Stockholm with some degree of envy.
Sweden also presents as a fascinating sort of bizarro-world Canada. Here, we are constantly told governments are operating on expert advice. Politicians questioning experts are to be hissed and tutted at. And when expert advice changes, we are told, this is simply what experts do: They react to events with updated expertise. Canadian public health experts — the ones who are talking, anyway — seem nearly monolithic in supporting the lockdown.
In Sweden, meanwhile, where agencies like public health are constitutionally autonomous — “ministerial rule” is considered verboten — they have groups of scientists begging and petitioning politicians to usurp Tegnell and clamp down.
It doesn’t seem like Sweden accidentally appointed some rogue madman. Denmark and Norway are both keeping schools closed against Tegnell-esque advice from their own public health officials. Their British counterparts were preparing a relatively handsoff response until they got spooked. You certainly can’t accuse Theresa Tam, Canada’s chief public health officer, of having overreacted out of the gate. She hasn’t exactly sounded enthusiastic in discussing travel restrictions (which the WHO still forbids) or wearing masks (which the WHO still considers unnecessary). Perhaps Sweden is demonstrating what can happen when the public-health experts really are in charge.
That seems counterintuitive. But in a recent Twitter thread, Andrew House, who was chief of staff to the Canada’s minister of public safety and emergency preparedness from 2010 to 2015, said he detected a “quietly Malthusian” streak among some officials in the department — i.e., “(the) strong will live; (the) weak will perish; (it’s) nature’s way.”
“As a result,” he said, “these experts do not believe in the doctrine of containment. At all. They do not believe in closing borders. Ever. … They advise ministers accordingly, without revealing underlying world views.”
It is clear that the anti-COVID-19 measures in place in Canadian jurisdictions right now are a cocktail of expert advice and political necessity. When this is all over we deserve to know how many parts of each went in, and why.