To Be or Not to Be Locked-down: Sweden’s Response May Influence U.S.

The federal government appears ready to duplicate Sweden’s controversial approach to accept the spread of COVID-19, instead of stopping it.

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The rate of COVID-19 infections in Pierce County initially decreased in September, but as people spend more time indoors and local schools welcome at least some students back to classrooms, the threat of a second wave increases, according to the Tacoma-Pierce County Health Department.

At the end of August, a new health adviser to President Donald Trump, Dr. Scott Atlas, a neuroradiologist and frequent Fox News guest, reportedly urged Trump to try developing herd immunity in the U.S. by exposure instead of locking down, mirroring Sweden’s approach.

That country did not mandate a lockdown or enforce social distancing measures and suffered a far higher casualty rate than any of its neighbors. Its death rate even exceeded that of the U.S.

But now Sweden has one of the lowest infection rates in Scandinavia.

Sweden conducted 120,000 tests the first week of September, a record for the country, with a positive rate of 1.08% — far below its 19% positive rate at the height of the outbreak. The positive rate in Pierce County the last week of August was 2.9%.

Atlas explicitly denied pushing herd immunity in an NPR interview Sept. 4, but at the same time the Trump administration continued to pressure states to reopen, curtailed testing for asymptomatic people — making the outbreak harder to track — and directed hospitals to bypass the Centers for Disease Control and Prevention to report data directly to its parent agency, which has been altering them since April to align with Trump’s agenda. This is according to reports in The New York Times, Politico, Healthcare IT News, and confirmed by HHS spokesman and Trump appointee Michael Caputo in The Washington Post Sept. 12.

Herd immunity occurs when enough of a population has immunity to a disease, preventing further spread. This can range from 50% to 90% of a population depending on how infectious the disease is, according to the Bloomberg School of Public Health. It said that most experts agree immunity is best achieved by prevention and vaccination, since letting a virus of unknown contagiousness and effect – like SARS-CoV-2 – burn through a population would cause many more people to fall ill, perhaps seriously (so-called “long haulers”), or die before the threshold is reached.

A model from the University of Washington’s Institute for Health Metrics and Evaluation published in September predicted a daily COVID-19 death toll of more than 1,900 Americans by November, up from approximately 800 a day at press time. It predicted over 410,000 deaths by the end of the year.

Dr. Anthony Fauci, the physician and immunologist who has served as director of the National Institute of Allergy and Infectious Diseases since 1984, said achieving herd immunity by exposure to COVID-19 instead of vaccination would require millions of infections and tens or hundreds of thousands more deaths.

“We need to hunker down and get through this fall and winter, because it’s not going to be easy,” he said in September.

In a revealing contrast, Sweden — a wealthy, developed nation with a standard of living comparable to the U.S. — took a significantly different approach than its Nordic neighbors to combat the pandemic last spring. Instead of imposing expensive public health restrictions, the Swedish government depended on its citizens to voluntarily comply with social distancing guidelines.

The result was that, at its height, Sweden had 40% more deaths per million than the U.S., 12 times more than Norway, seven times more than Finland and six times more than Denmark, according to the Johns Hopkins School of Medicine, which tracks COVID-19 infections around the world.

An analysis published in July by researchers at Uppsala University in Sweden and the University of Virginia School of Medicine in the journal Clinical Infectious Diseases found that while more people died of COVID-19 per capita in Sweden than in many other countries, the nation’s health care system was not overwhelmed by it.

However:

“Analyzed by categorical age group, older Swedish patients with confirmed COVID-19 were more likely to die than to be admitted to the ICU, suggesting that predicted prognosis may have been a factor in ICU admission,” the researchers wrote. “This likely reduced ICU load at the cost of more high-risk patients dying outside the ICU.”

Sweden’s central bank said GDP fell 8.6% in the second quarter, the biggest drop since 1980, and its economy is expected to shrink by 4.5% in 2020. The unemployment rate climbed from 7% to 9.2% between March and July, its highest since 1998.

By comparison, Denmark expects its economy to contract by 4.1% this year while unemployment rose from 4% in March to 5.2% in July.

Still, Sweden’s economy declined at a lower rate than that of many other European countries where COVID-19 cases are increasing. The EU as a whole saw its GDP decline 11.9% during the second quarter, comparable to the U.S.

But Sweden experienced a much higher death rate than its cohort without an appreciable economic benefit. The lack of stay-at-home orders appeared to impose its own cost on both lives and the economy.

Sweden’s state epidemiologist, Anders Tegnell, said in August that the approach was not to enforce rules but to win people over with a public health policy that stressed social distancing and remote work, even over mask-wearing.

“Of course, we will not let people fall ill just to achieve herd immunity. That’s not the way we’re working. We have a very high level of trust among the population,” he said, citing an 80% public compliance rate.

A Pew Research Center survey conducted over the summer found that 61% of Swedes approved of their government’s response to the pandemic. Denmark had a 95% approval rating. In the U.S., it was 48%.

Almost 180,000 Americans had died from COVID-19 by the end of August. A CBS News/YouGov poll conducted in the last week of that month found that 57% of registered Republican voters considered that “acceptable” when “evaluating the U.S. efforts against the coronavirus pandemic,” compared with 31% of voters overall. Ninety percent of Democrats and 67% of independents said the death toll was “unacceptable.”