Sweden’s Controversial Covid-19 Strategy

Sweden’s Controversial Covid-19 Strategy

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Sweden’s Controversial Covid-19 Strategy

Sweden never imposed a strict lockdown to combat Covid-19, unlike most other countries. The only official rules put in place are a ban on gatherings of 50 people or more and a ban on visitors to nursing homes.

The nation’s Chief Epidemiologist, Anders Tegnell, MD, PhD, says Sweden’s strategy is based on the assumption that Covid-19 isn’t going away any time soon, and that severe lockdowns can’t be maintained for very long and will prove to be ineffective over the long run. Strict lockdowns may temporarily contain the virus, but won’t prevent it from returning, according to Tegnell.

In an interview with Swedish Public Radio on June 24, Tegnell said that Sweden has followed the “classic pandemic model” that he had been discussing with international colleagues for 20 years. Tegnell characterized lockdowns as flying in the face of what is known about handling viral outbreaks. “It was as if the world had gone mad, and everything we had discussed was forgotten….The cases became too many and the political pressure got too strong. And then Sweden stood there rather alone.”

Sweden, which has a population of 10.1 million, has recorded 65,137 cases, 2,407 intensive care admissions and 5,268 deaths from Covid-19 as of June 25, according to the Public Health Agency for Sweden. More than half of the Covid-19 deaths in Sweden have occurred among its nursing home residents.

Covid-19 deaths in Sweden are much higher per capita than its nearest neighbors (Finland, Norway and Denmark), which had strict lockdowns. However, its per capita death rate is lower than some other European countries that had strict lockdowns, such as Belgium, Britain, Spain and Italy.

Sweden New Covid-19 Cases 7 day moving avg
Swedish Covid-19 ICU-Admissions
Daily Deaths Covid-19 Sweden
Encouraging News From Initial Covid-19 Prevalence Studies

Encouraging News From Initial Covid-19 Prevalence Studies

Encouraging News From Initial Covid-19 Prevalence Studies

Preliminary results from a growing number of antibody prevalence studies indicate that the Covid-19 virus has spread more widely and has a lower fatality rate than previously expected.

Stanford University School of Medicine

Between 48,000 and 81,000 residents in northern California had been infected by Covid-19 as of April 1. This is more than 50 times higher than the official count at the time of 956 cases, according to a prevalence study conducted by researchers at the Stanford University School of Medicine. The Stanford study was based on 3,300 blood samples that were taken from volunteers in Santa Clara County in early April and tested for antibodies to Covid-19. Based on 100 estimated Covid-19 deaths in the county and 48,000-81,000 cases, the Stanford researchers estimate an infection fatality rate of between 0.1% and 0.2%. The Stanford research team is conducting similar antibody prevalence studies in Los Angeles County as well as a national study of 10,000 athletes and employees from 27 Major League Baseball teams. “We’re hoping that once we get accurate numbers in place, we’ll be able to quell the fear that’s out there,” said Jay Bhattacharya, who holds an MD and PhD in economics from Stanford University.

Massachusetts General Hospital

Pathologists with Massachusetts General Hospital have found that Covid-19 is far more widespread than the official case count in the Boston area. MGH set up a testing tent in the middle of Bellingham Square in Chelsea, MA, in mid-April and took finger-prick blood samples from 200 healthy-looking residents. Samples were tested using a ten-minute rapid test made by BioMedomics. The device hasn’t yet been approved by the FDA, but MGH has validated the test. The researchers found that one third of study participants (64 people) had Covid-19 antibodies. “The bad news is that there’s a raging epidemic in Chelsea, and many people walking on the street don’t know that they’re carrying the virus, according to John Iafrate, MD, PhD, Vice Chairman of MGH’s pathology department and the study’s principal investigator. “On the good-news side, it suggests that Chelsea has made its way through a good part of the epidemic.”

University of Bonn

Preliminary results from a study focused on a small German town named Gangelt indicate that about 15% of its population has been infected Covid-19. Located near the border with the Netherlands, Gangelt has been dubbed “Germany’s Wuhan” because it was hard hit by Covid-19 after a February 15 carnival celebration drew thousands to the town (population: 12,529). In early April, researchers from the University of Bonn performed antibody testing on 1,000 people from the town and found that 15% of the population had been infected and the process towards herd immunity is already taking place. The mortality rate among the studied population was 0.37%, five times lower than that currently registered in Germany, which corroborates the suspicions that the number of infected is much higher than the diagnosed. “It is important to obtain this data in order to make sure that decisions are taken based on facts rather than assumptions,” according to Hendrik Streeck, MD, PhD, Head of the Institute of Virology and Institute for HIV Research, University Hospital Bonn.

More Testing Needed So Policy Makers Can Make Rational Decisions

More Testing Needed So Policy Makers Can Make Rational Decisions

More Testing Needed So Policy Makers Can Make Rational Decisions

Right now, sample collection kit shortages in the United States mean that Covid-19 testing has rightly been focused on the most severe symptomatic patients. But this is skewing our understanding of the virus and its true risks. And policy decisions that will have tremendous consequences are being made based on this incomplete data.

The Diamond Princess Case Study

An outbreak of Covid-19 on the Diamond Princess cruise ship was started by a single symptomatic passenger from Hong Kong who boarded the boat on January 20. He disembarked on January 25, and tested positive for the virus on February 1. This led to a quarantine of approximately 3,700 passengers and crew that began on February 3, 2020, and lasted for nearly four weeks at the Port of Yokohama, Japan. During the “quarantine,” the crew continued to prepare and deliver food, and health workers moved throughout the ship.

The Diamond Princess offers a real-life controlled experiment where 100% of passengers and crew were tested. It has everything all the other Covid-19 stats are currently lacking in order to accurately estimate the fatality rate for Covid-19: an undisputable numerator (10 deaths) and a complete 100% accounted for denominator (712 positive cases). The Diamond Princess provides a worst-case scenario where basically a bunch of older people were trapped in a large container with the virus for a month.

Here’s what the data from the Diamond Princess showed:

  • A total of 3,711 people were onboard (1,045 crew/2,666 passengers)
  • The overall median age was 58 and 33% were 70 or older.
  • Most of the passengers were from Japan (1,281) and the United States (416).
  • Most of the crew was from Philippines (531) and India (132).
  • 712 people (19.2%) tested positive for Covid-19, including 567 passengers and 145 crew members.
  • About half (46.5%) of those who tested positive showed no symptoms at their time of testing.
  • Ten people died from Covid-19.
  • All deaths were among passengers age 70 or older.
  • The case fatality rate was 1.4% (10 deaths/712 cases).

The Diamond Princess case study stands in sharp contrast to initial reports from the World Health Organization which wildly overestimated the global case fatality rate of Covid-19 to be 3.4%.

Applying the Diamond Princess’s infection rate of 19.2% and case fatality rate of 1.4% across the entire U.S. population of 330 million would lead to estimates of 63.4 million cases and 887,600 deaths.

However, the median age of passengers and crew on the Diamond Princess (58) was about 20 years higher than the median age of the U.S. population (38).

After adjusting for the age difference, John Ioannidis, MD, an epidemiologist and biostatistician at Stanford University, has calculated that a reasonable estimate for the fatality ratio in the general U.S. population falls in a range of 0.05% to 1%.

In a March 17 opinion piece for STAT, Ioannidis said that the huge range in potential case fatality ratios markedly affects how severe the pandemic is and what should be done. “A population-wide case fatality rate of 0.05% is lower than seasonal influenza [0.1%]. If that is the true rate, locking down the world with potentially tremendous social and financial consequences may be totally irrational.”

Ioannidis said that testing for Covid-19 should be conducted in a random sample of the population and repeated at regular time intervals to estimate the incidence of new infections. In the absence of data, prepare-for-the-worst reasoning leads to extreme measures of social distancing and lockdowns that may or may not work. “If we decide to jump off the cliff, we need some data to inform us about the rationale of such an action and the chances of landing somewhere safe,” wrote Ioannidis.

Link to Ioannidis article:
A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data