Many people feel that Anders Tegnell’s approach has been overly laissez-faire and that even now, he should be introducing more draconian measures. A model this week from his Health Agency suggested as many as 3000 additional deaths may be seen in Sweden in the next year — shouldn’t he do more to stop that happening?
He insists that those projections are only models, and that he hopes and expects to achieve a much better result. But he is also mindful of whether these draconian measures may do more harm than good:
“Of course we are trying to keep the mortality rates as low as possible, but at the same time we have to look at the draconian measures you are talking about. Are they going to produce even more deaths by other means than the disease itself? Somehow we need to have the discussion of what we are actually trying to achieve. Is it better for public health as a whole? Or is it trying to suppress Covid-19 as much as possible? Because getting rid of it I don’t think is going to happen: it happened for a short time in New Zealand and maybe Iceland and those kind of countries might be able to keep it away, but with the global world we have today, keeping a disease like this away has never been possible in the past and it would be even more surprising if it were possible in the future.”
One type of intervention that does not appear to have adverse effects is encouraging, or mandating, the use of masks. This has become an intensely political issue in the US and more recently in the UK. In Sweden mask use is minimal in almost all settings. Why is he not even recommending use of masks?
“One reason is that the evidence base for using masks in society is still very weak. Even if more and more countries are now enforcing them in different ways … we haven’t seen any new evidence coming up, which is a little bit surprising. The other reason is that everything tells us that keeping social distance is a much better way of controlling this disease than putting masks on people. We are worried (and we get at least tales from other countries) that people put on masks and then they believe they can go around in society being close to each other, even going around in society being sick. And that, in our view, would definitely produce higher spread than we have right now.”
The emphasis on spread of the virus to the exclusion of everything else Dr Tegnell believes is misguided, as the number of cases is less and less correlated to the number of deaths.
“Deaths are not so closely connected to the amount of cases you have in a country. There are so many other things that influence the amount of deaths you have. What part of the population gets hit? Is it the elderly people? How well can you protect people in your long-term facilities? How well does your healthcare system continue to function? How can we improve the treatment in ICUs? All of these things have been changing a lot in the past few months… Those things will influence mortality a lot more, I think, than the actual spread of the disease.”
His belief is that, in the final account, the Infection Fatality Rate will be similar to the flu: “somewhere between 0.1% and 0.5% of people getting infected, maybe … And that is not radically different to what we see with the yearly flu.”
On the controversial question of immunity, he suggests that a larger percentage of the population in Sweden is already immune than antibody studies suggest.
“There are a number of small studies already that show that of people who had been diagnosed with Covid-19 with PCR, not all of them develop antibodies. On the other hand we have quite a lot of evidence that falling ill with Covid-19 twice seems to be extremely rare… Obviously there is also quite a big part of the population that has other kinds of immunity and T Cell immunity is the one that is most likely.
“What we see right now is a rapid fall in the number of cases, and of course some kind of immunity has to be involved in that as nothing else has changed. That means that immunity affects the R value quite a lot in Sweden today.”
Further readingWhy we aren't wearing masks in Sweden
By Freddie Sayers
Does that mean that Sweden will be better placed to limit second waves and future flare ups than countries that have had minimal infection levels so far?
“I think it’s likely that those kinds of outbreaks will be easier to limit in Sweden because there is immunity in the population. All our experience with measles and other diseases shows that … we know that with large immunity in the population it is much easier to control the outbreaks than if you don’t have immunity in the population.
“There is now a number of countries in Europe that have a fairly low level of spread for a very long time, which is very unusual with a disease that seems to be so contagious, and where there is so little immunity in the population. If that is really a sustainable way for the disease to exist we will wait and see — I think the fall will show if it is possible or not.”
The eyes of the world have been on him for the past few months. How would he like to be judged, and when?
“It is better to have a more complete discussion around this in say 12 months, after next summer, then I think we can more fairly judge what has been good in some countries and bad in other countries.”
He has promised to talk to us again at that time. 23rd July 2021 – it’s in the diary.
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