{"id":48640,"date":"2020-09-23T11:06:24","date_gmt":"2020-09-23T10:06:24","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=48640"},"modified":"2020-09-29T12:38:08","modified_gmt":"2020-09-29T11:38:08","slug":"richard-smith-could-sweden-have-got-it-right-with-covid-19","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/09\/23\/richard-smith-could-sweden-have-got-it-right-with-covid-19\/","title":{"rendered":"Richard Smith: Could Sweden have got it right with covid-19?"},"content":{"rendered":"<p class=\"standfirst\">Pandemics are unpredictable and it is too soon to say, argues Richard Smith<\/p>\n<p><!--more--><\/p>\n<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/richard_smith_2014.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-33037\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/richard_smith_2014-150x150.jpg\" alt=\"richard_smith_2014\" width=\"123\" height=\"123\" \/><\/a><span style=\"font-weight: 400\">Sweden stood alone in Europe in not opting for a severe lockdown when cases of covid-19 began to rise in the spring. As a result, the <\/span><i><span style=\"font-weight: 400\">New York Times<\/span><\/i><span style=\"font-weight: 400\"> called Sweden \u201ca pariah state,\u201d and Sweden has had higher death rates than most countries in Europe, although lower than Britain. But, as I write this on 20 September 2020, the difference in the number of cases in Sweden and most of the rest of Europe is striking. <a href=\"https:\/\/coronavirus.jhu.edu\/map.html\">Most countries in Europe have a rapid rise in cases<\/a>, whereas Sweden does not. Spain, which had one of the most severe lockdowns, has one of the steepest increases.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The reason for the difference may well be that Sweden has more immune people, probably mostly younger people. But another possible explanation is that Swedes have followed the rules more dutifully than in other countries\u2014perhaps because they trust the public health officials, understand what they have to do and why, and have avoided the stop-go confusion that besets Britain and other countries.<\/span><\/p>\n<p><span style=\"font-weight: 400\">We knew from the beginning of the pandemic that it was likely to last years and that most of us had no immunity. We would either catch the infection or try to avoid it by minimising our contact with others. Eventually either enough of us would have caught the disease to generate the much-maligned herd immunity or many of us would be vaccinated. Either way it was going to be a long haul, and years of minimising contacts would mean no work, schools, or fun.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Sweden could behave differently from other countries because public health officials not politicians decide how to respond to the pandemic. It\u2019s very hard for politicians to do things differently from other countries. Putting health officials rather than politicians in charge sounds like the <a href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/08\/11\/richard-smith-the-faults-and-dangers-of-an-iatrocracy\/\">creation of an iatrocracy<\/a>\u00a0<\/span><span style=\"font-weight: 400\">and frighteningly anti-democratic, but the decision to do it this way was reached through democratic means.<\/span><\/p>\n<p><span style=\"font-weight: 400\">In an <a href=\"https:\/\/www.ft.com\/content\/5cc92d45-fbdb-43b7-9c66-26501693a371\">interview in the <\/a><\/span><i><span style=\"font-weight: 400\">Financial Times<\/span><\/i><span style=\"font-weight: 400\">,<\/span> <span style=\"font-weight: 400\">Anders Tegnell, the chief public health official in Sweden, describes the thinking of him and his colleagues:\u00a0 \u201cAt the outset we talked very much about sustainability, and I think that\u2019s something we managed to keep to. And also be a bit resistant to quick fixes\u2026We see a disease that we\u2019re going to have to handle for a long time\u2026\u201d Tegnell describes a lockdown as \u201cusing a hammer to kill a fly.\u201d You need \u201ca strategy that can work for years if need be, rather than constant chopping and changing as seen in the rest of Europe.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400\">Crucially to my mind, Tegnell and his team thought about \u201cpublic health in the broadest sense,\u201d recognising the importance of education, work, and meeting with friends for health. \u201cWe are not just working with communicable diseases, we are working with public health as a whole.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400\">Sweden has concentrated its efforts against the virus on places where it\u2019s most likely to be spread\u2014places of entertainment where many people gather. Those places have strict rules on social distancing. Tegnell is unconvinced by the value of face masks, and they are not much seen in Sweden. Face masks are \u201cmore of a statement than actually a measure\u2026Face masks are an easy solution, and I\u2019m deeply distrustful of easy solutions to complex problems.\u201d I\u2019m also wary of simple solutions to complex problems, but I can understand why easy solutions and quick fixes are attractive to politicians.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The same thinking makes Tegnell cautious about the \u201csilver bullet\u201d of a vaccine. The idea that \u201conce vaccine is here we can go back and live as we have always done\u2026[is] \u201ca dangerous message\u2026because it\u2019s not going to be that easy.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400\">David Nabarro from the World Health Organisation emphasises that the people not governments hold the key to responding to covid-19. We need to follow simple rules, and I can see why people in Sweden might be much more able and willing to follow the rules than people in other European countries. Most people in Europe must have heard the messages about these rules, but in Britain they are mixed with lots of conflicting messages. The stop-start messages from the British government are confusing, and many people don\u2019t understand why they should follow the rules. Worse they don\u2019t trust the government, and in Britain you don\u2019t have to go far to see people breaking the rules. People may wonder why they have to follow the rules if others aren\u2019t.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Sweden has avoided the stop-start messages, and the <a href=\"https:\/\/covid19-survey.org\/results.html\">Swedish government is more trusted<\/a> than the British one.<\/span><span style=\"font-weight: 400\">\u00a0Plus importantly Sweden has emphasised that the pandemic will last a long time (avoiding things like British politicians saying it might be over by Christmas), and it has not asked Swedes to make such extreme changes, meaning surely that it\u2019s easier to sustain the changes in behaviour.<\/span><\/p>\n<p><span style=\"font-weight: 400\">When the <\/span><i><span style=\"font-weight: 400\">FT<\/span><\/i><span style=\"font-weight: 400\"> journalist spoke to Tegnell in the spring he said that \u201cit would be in the autumn when it became more apparent how successful each country had been.\u201d As Britain looks close to going into another national lockdown, some are arguing that Sweden seems to have adopted a better strategy. But all judgements must be provisional as pandemics are unpredictable, and Tegnell does expect local spikes in cases.<\/span><\/p>\n<p><em><strong>Richard Smith<\/strong> was the editor of <\/em>The BMJ<em> until 2004.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Pandemics are unpredictable and it is too soon to say, argues Richard Smith [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/09\/23\/richard-smith-could-sweden-have-got-it-right-with-covid-19\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":48641,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[955],"tags":[],"class_list":["post-48640","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-richard-smith"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Richard Smith: Could Sweden have got it right with covid-19? 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