Is Sweden getting it right with its COVID-19 approach?

President Donald Trump has often described this pandemic as our “war” with an “invisible enemy” — the coronavirus. That war metaphor is wrong and misleading.

Wars are fought and won by humans. But when you’re in a struggle with one of Mother Nature’s challenges — like a virus or a climate change — the goal is not to defeat her. No one can. She’s just chemistry, biology and physics. The goal is to adapt.

Mother Nature does not reward the strongest or the smartest. She rewards the species that are the most adaptive in evolving the chemistry, biology and physics that she has endowed them with to thrive, no matter what she throws at them.

And that’s why I believe one of the most important questions we need to answer, as these lockdowns end, is this: Are we going to adapt to the coronavirus — by design, the way Sweden is attempting to do — or are we going to go the same direction as Sweden — by messy default — or are we just going to say “the hell with lockdowns” and go 50 different ways?

In case you’ve missed it, Sweden has taken a radically different approach in dealing with the coronavirus. It has essentially opted for a strategy of “herd immunity” through exposure.

This strategy posits that most people under age 65 who get the coronavirus — if they do not have major preexisting medical conditions — will either experience it as a typical or tough flu, or asymptomatically, and the number who will get so sick that they require hospitalization or emergency care will reliably be less than the number of beds needed to care for them.

So, if you do your best to shelter and sequester all of those over 65 and those with serious preexisting conditions — notably heart and lung disease and diabetes — and let much of the rest of the population circulate and get exposed and become naturally immune, once about 60% of your population has gone through this you’ll have herd immunity and the viral transmission will be blocked. (This assumes that immunity for some period of time results from exposure, as most experts think it will.)

After all, herd immunity is our goal — either from vaccination or from enough people building natural immunity. Those are the only ways to achieve it.

The upside of Sweden’s strategy — if it works — is that your economy does not take such a deep hit from lockdowns.

Anders Tegnell, chief epidemiologist at Sweden’s Public Health Agency — the nation’s top infectious disease official and architect of Sweden’s coronavirus response — said in an interview published in USA Today on Tuesday: “We think that up to 25% people in Stockholm have been exposed to coronavirus and are possibly immune. A recent survey from one of our hospitals in Stockholm found that 27% of staff there are immune. We could reach herd immunity in Stockholm within a matter of weeks.”

It has come with a high cost, though. As USA Today noted: “As of April 28, (Sweden’s) COVID-19 death toll reached 2,274, about five times higher than in

Denmark and 11 times higher than in Norway.”

Here’s the stone-cold truth: There are only different hellish ways to adapt to a pandemic and save both lives and livelihoods. I raise Sweden not because I think it has found the magic balance — it is way too soon to tell — but because I think we should be debating all the different ways and costs of acquiring immunity.

When I look across America, though, and see governors partly lifting lockdowns — because they feel their people just can’t take it anymore for economic or psychological reasons, even though their populations have little or no immunity — I worry we may end up developing more herd immunity but in a painful, deadly, costly, uncoordinated way that still leaves room for the coronavirus to strike hard again and overwhelm hospitals.

Herd immunity “has historically been nature’s way of ending pandemics,” said Dr. David Katz, the public health physician who helped kick off the debate in an essay he wrote in The New York Times on March 20 and in a follow-up interview we did together.

“We need to bend with her forces — even when we as a species are responsible for unleashing them,” Katz said.

That means a designed strategy, based on risk profiles, of phasing back to work those least vulnerable, so we gradually cultivate the protection of herd immunity, “while concentrating our health services and social services on protecting those most vulnerable” until we can sound the all-clear.