As deaths soar, should Sweden have imposed lockdown earlier?

LAST night, the local indie duo Bells Fell Silent was due to take to the stage at Malmö’s Plan B club to perform atmospheric songs in what may be the only music gig in Europe.

It is nearly two weeks since Sweden’s Civil Contingencies Agency (CCA) warned that Swedes’ adherence to even the light, mostly voluntary, restrictions issued by its Public Health Agency (PHA), is relaxing. But Carlo Emme, the venue’s manager, is adamant the gig – with a total of 45 people in the room – is not a sign of slippage. “I don’t think what we’re doing is worse than having 300 people drinking beers in a restaurant in town,” he said.

Over the last seven days, Sweden has reported the highest coronavirus death rate in the world, with an average of 6.05 deaths per day per million inhabitants.

That recent death rate still falls far short of the 28 figure reported by Belgium in mid-april, and over the course of the pandemic, Sweden’s per capita death rate remains behind that of Belgium, Spain, Italy, the UK and France.

But it has thrown further doubt over its decision to leave schools, restaurants and bars open, to allow public gatherings of up to 50 people and to trust the public’s good sense rather than imposing restrictions. Annika Linde, Sweden’s former state epidemiologist, this week became the first senior member of Sweden’s public health establishment to judge Sweden’s strategy a mistake in hindsight.

“I think we should have locked down much harder in the beginning,” Ms Linde, told the Dagens Nyheter newspaper.

“A lockdown would have given us a chance to prepare, think things through, and minimise the spread of infection.”

Sweden’s no-lockdown strategy is also based on the idea that voluntary guidelines are more sustainable than imposed ones. But if adherence to voluntary guidelines is starting to slip, might that also be a misjudgement?

“We’re seeing that the numbers [of people who are changing their habits] are falling,” Svante Werger, a special adviser at the Civil Contingencies Agency, warned earlier this month.

Earlier this week, Sweden announced plans to fast-track a law allowing councils to close restaurants and bars without first going through infectious disease doctors – a sign that they recognise the current system is not managing to prevent crowding.

And as spring turns to summer, the temptation for Swedes to stop social distancing, to travel more and to drop good hygiene practices will only grow.

The PHA will issue new restrictions tailored to the summer months.

“People want to go out and have fun and I think it’s important that we have recommendations that are possible to follow, that make sense to people, so they feel, ‘OK, we cannot do this and that, but we can actually do this in a good way from a pandemic perspective,’” said Mr Werger.

His agency still believes in the voluntary approach. “We are very sceptical of hard policies against people’s behaviour. We have a lot to gain from being able to cooperate with the general public, so that everyone can feel actively that ‘I’m part of the solution’ and not just an object for the government’s measures.”

Frode Forland, Norway’s state epidemiologist, said that what had made Sweden’s strategy different from other countries was that its public health authorities had stuck to a pandemic strategy set long before the crisis began.

“We always had in mind that a new pandemic would spread like an influenza epidemic: that 25 per cent of the population would get seriously ill and that the spread would eventually cover maybe 70 per cent of the population until you get herd immunity,” he said.

With influenza, which has negligible asymptomatic spread, a strategy like

‘The danger of letting this slow until we get to herd immunity is that you are causing a lot of people to die’

Sweden’s, which relies on people selfisolating if they feel sick, might work, he explained. But even by March, it was clear that coronavirus was different.

“It was also much more contagious, and much more serious, with a fatality rate maybe five times as high and infectiousness maybe three times as high.”

That’s why Mr Forland’s team decided at the last minute that an influenza strategy would have meant too many deaths.

In Norway, 234 people have died with coronavirus, while 3,831 have died in Sweden, a per capita death rate nearly nine times as high.

Anders Tegnell, Sweden’s state epidemiologist, said that his modelling suggested that those with immunity in the capital was around 20 per cent – but Mr Forland was sceptical.

Even in Spain, he pointed out, only about five per cent of the population appeared to have been infected. “That’s extremely far away from something which can be called herd immunity, and the danger of letting this slow until we get to herd immunity is that you are causing a lot of people to die.”