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Worrying statistics bring Sweden's laid-back approach into question

The laid-back Swedish model of dealing with COVID-19 has come under pressure as deaths rates start to rise, writes MedicalBrief.

With hundreds of cases confirmed at care homes in Stockholm, the worst affected region, and infections in homes across the country, The Guardian reports that pressure has mounted on the Swedish government to explain how, despite a stated aim of protecting the elderly from the risks of COVID-19, a third of fatalities have been people living in care homes. And, the report says, the country’s normally unflappable state epidemiologist Anders Tegnell has admitted that the situation in care homes was worrying.

“This is our big problem area,” said Tegnell, the brains behind the Swedish government’s relatively light-touch strategy. The report quotes Lena Einhorn, a virologist who has been one of the leading domestic critics of Sweden’s coronavirus policy, as saying that the government and the health agency were still resisting the most obvious explanations.

“They have to admit that it’s a huge failure, since they have said the whole time that their main aim has been to protect the elderly,” she said. “But what is really strange is that they still do not acknowledge the likely route… they will not acknowledge that pre-symptomatic or asymptomatic spread is a factor.”

The report says Einhorn argues that the reason why Sweden has a much higher number of cases in care homes than in Norway and Finland is not because of the homes themselves, but because of Sweden’s decision to keep schools and kindergartens open, and not to shut restaurants or bars. “It’s not like it goes from one old age home to another. It comes in separately to all of these old age homes, so there’s no way it can be all be attributed to the personnel going in and working when they are sick. There’s a basic system fault in their recommendations. There’s no other explanation for it.”

Tegnell’s colleague AnnaSara Carnahan is quoted in the report as saying that the number of deaths reported from old people’s homes was “probably an underestimate”, as regional health infectious diseases units were reporting that many elderly who died were not being tested.

Two weeks ago Tegnell ruled supreme in Sweden. According to a report in The Daily Telegraph, the number of deaths in Sweden, Denmark, Norway and Finland had not yet started to deviate sharply. Tegnell claimed that the Swedish Health Agency was on top of the latest and most reliable facts and models. During a period of hysteria, he was widely hailed as a hero for his calm and seemingly scientific focus. Schools, workplaces and restaurants remained open. Old people, claimed Tegnell, would be fine if younger Swedes refrained from visiting their elderly parents in retirement homes.

The report says this was a widely held view because, in consensus-oriented Sweden, no other views were taken seriously, until death rates started creeping up. Finland now counts 72 dead, Norway 150 and Denmark (the by far most densely populated Nordic country) 321. Sweden? 1,333. Moreover, the coronavirus has spread to a large number of retirement homes.

The report says numerous opinion leaders have invested plenty of personal prestige in Tegnell’s way of tackling the crisis. As a consequence, the critics have already been attacked with the type of sarcastic ferocity typical for those deviating from official Swedish positions, including accusations of shameful betrayal of the national effort. This time, the issue is extra sensitive since at stake is nothing less than ownership of the highly charged concept of solidarity.

The report says the consensus has nevertheless been dented meaning the supremacy of Tegnell, now increasingly evasive when asked about the development in other countries, is over. Also, the issue of “more could have been done” has a special significance in a country in which more still can be done

In most countries – including Denmark, Norway and in Finland – the report says the national health authorities tend to exaggerate risks, to be on the safe side. The government then decides the trade-offs necessary. In Sweden, the Public Health Agency has, astonishingly, played down the health risks.

The Daily Telegraph reports that it is now possible to conclude, sadly, that the more “relaxed” Swedish strategy is not likely to transform into a success story. Not only are death rates a lot higher than in comparable countries. Even the key economic argument – that the-show-must-go-on – might backfire. How so? Norway and Denmark appear to have the situation sufficiently in control to cautiously start opening up their societies.

The report says a recent study drawing lessons from the Spanish flu crisis, produced jointly by the US Federal Reserve and the Massachusetts Institute of Technology (MIT) – Sloan School of Management, suggests a period of pain and uncertainty might turn out longer without the early lockdown pill: “Cities that implemented early and extensive non-pharmaceutical interventions (like physical distancing and forbidding large gatherings) suffered no adverse economic effects over the medium term. On the contrary, cities that intervened earlier and more aggressively experienced a relative increase in real economic activity after the pandemic subsided.”

Abstract
What are the economic consequences of an influenza pandemic? And given the pandemic, what are the economic costs and benefits of non-pharmaceutical interventions (NPI)? Using geographic variation in mortality during the 1918 Flu Pandemic in the U.S., we find that more exposed areas experience a sharp and persistent decline in economic activity. The estimates imply that the pandemic reduced manufacturing output by 18%. The downturn is driven by both supply and demand-side channels. Further, building on findings from the epidemiology literature establishing that NPIs decrease influenza mortality, we use variation in the timing and intensity of NPIs across U.S. cities to study their economic effects. We find that cities that intervened earlier and more aggressively do not perform worse and, if anything, grow faster after the pandemic is over. Our findings thus indicate that NPIs not only lower mortality; they may also mitigate the adverse economic consequences of a pandemic.

Authors
Sergio Correia, Stephan Luck, Emil Verner

[link url="https://www.theguardian.com/world/2020/apr/19/anger-in-sweden-as-elderly-pay-price-for-coronavirus-strategy?CMP=Share_iOSApp_Other"]Full report in The Guardian[/link]

[link url="https://www.telegraph.co.uk/politics/2020/04/16/sweden-has-shown-not-tackle-coronavirus-fights-now-save-face/?WT.mc_id=e_DM1236809&WT.tsrc=email&etype=Edi_FAM_New_ES_Sat&utmsource=email&utm_medium=Edi_FAM_New_ES_Sat20200418&utm_campaign=DM1236809"]Full report in The Daily Telegraph[/link]

[link url="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3561560"]SSRN abstract[/link]

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