Is it possible to judge Sweden’s singular coronavirus policy yet? Denmark’s neighbor has diverged from the rest of the world in refraining from locking down large sectors of social and business activity. It has kept restaurants and schools open and has not issued social distancing rules. Like its Scandinavian neighbors, it citizens exhibit a high degree of social trust in one another and in the government, and it has relied on people to behave sensibly of their own accord. For a while it seemed to be working well. The number of infections and deaths in the country were not significantly higher than in similar countires. It was praised by critics of lockdown policies in other countries for showing the strict regulations that harm the economy are unnecessary. So what is the status of the experiment?
It has now reached almost 4,000 deaths (DK), in comparison with 562 in Denmark. Its population is around twice as large. It has 398 deaths per million persons in comparison with 98 in Denmark, 44 in Norway, and 55 in Finland. I have thought that the spread of the infection has been higher in Denmark than in Norway because the first cases involved superspreaders who returned from hotspot ski resorts in Austria and northern Italy, and Norwegians do not need to travel south to go skiing. So if Sweden’s most comparable neighbors are Norway and Finland, its fatality rate is about eight times higher.
Elusive herd immunity
The person behind the strategy, Anders Tegnell, the head state epidemologist, has defended the policy all along, contending that is too early to judge the results. If the objective was too reach “herd immunity” by allowing most of the population to become infected and afterward immune, then there would inevitably be more infections and deaths in the beginning stages. In countries that conduct extensive lockdowns, when people who have isolated themselves begin to emerge, many of them will become infected and the country will see additional waves of infection, goes the rationale.
On several days last week, the fatality rate in Sweden (DK) was the highest in the world. On day 60 of the epidemic, the rate was even higher than Italy’s at the same stage, and ten times as high as Denmark’s. And the country is still far from herd immunity. There were earlier predictions that around half of Stockholm’s population would reach immunity in June, but a recent count of persons who have developed antibodies to the disease was only 7.3 percent, and that is much higher than in the rest of the country. There is much uncertainty in identifying immunity, and the WHO had warned Sweden in April that not everyone who is infected develops immunity.
Unrealistic expectations
Now criticism is growing (DK) both inside and outside the country. For example, former state epidemologist Annike Lind said that if the country had closed down early it could have done more to protect the most vulnerable people. Tegnell had said that they would protect the elderly, she said, but it “had little relation to reality.” A large share of the deaths have come in nursing homes.
Tegnell denies (DK) that Sweden could have done anything differently to protect the elderly, arguing that the poor quality of Swedish nursing homes made them vulnerable. He also says that the objective has never been herd immunity, which is not possible until there is a vaccine. But he maintains that if people don’t change their behavior they will continue to see a decline in the number of infections.
Playing with statistics
Another Swedish researcher recently defended the strategy (DK). Matti Sällberg, a professor at the Karolinska Institute, argues that if you do not measure the epidemic by the fatality rate but rather by the number of deaths in relation to the number of infections, then there is little difference between Sweden and Denmark. With an infection rate of 6 percent in Sweden, the fatality rate is about 0.6 percent. In Denmark, the infection rate is about 1.0 percent and the fatality rate 0.8 percent. That is not necessarily the most significant statistic, says Søren Riis Paludan, Professor of Biomedicine at Aarhus University. It indicates that Sweden has been as good as Denmark in treating people who have become infected, but not whether not it has been successful in containing the epidemic.
Tegnell has maintained that it will be years before one can judge what strategy is best, and he thinks there may be not be large differences between the results in various countries. Does he have a serious case of confirmation bias or will he prove correct?
(No post tomorrow. Back on Thursday.)
While the administration is holding discussions about which parts of the economy to open next, some people are acting as though the risk of the infection spreading is over.
The weather has improved this past week, with the highest temperatures of the year. Danes are always eager to come out in the sunshine after the long, dark winter. But too many of them are forgetting to follow the guidelines (DK) for social distancing, say the police. “I am very upset and extremely disappointed,” tweeted Claus Oxfeldt, chairman of the Danish Police Union, about the crowds in certain areas of Copenhagen. He pointed specifically at the Islands Brygge neighborhood in Copenhagen, which has several large lawns along the harbor front, where 300-400 people were gathering, mostly in small groups of under 10 persons each but too close to one another. The police have issued warnings rather instead of giving fines immediately, and people disperse. But when the police return, they find that the same people have returned to the spot or others have gathered there. They are surprised that people care more about getting sun than their health and say they will begin to issue fines more quickly. The fine for violating the limit of a 10-person group is about DKK 1,500 ($215).
Crowded supermarkets and full busses
Employees in supermarkets have noticed similar behavior (DK): more people are no longer complying with the recommendations on social distancing. According to Per Tønnesen, section chairman for the retail trade union, the organization receives 15-20 reports per day that customers come too close together in certain areas, such as the produce and refrigerated sections, and they are not using sanitizer and disposable gloves. People are also shopping in groups, both young people and families. The problems are worst at the large supermarkets, where there is more room for customers to keep their distance from one another. Smaller grocery stores are better at limiting the number of customers on the premises at a time. One large supermarket chain, Coop, however, says that it has not received such complaints from employees and that customers appear to be adhering to the guidelines. That may be because employees are reluctant to take problems to their employers, comments Tønnesen. Jens Juul Nielsen, Coop’s information director, responds that union representatives should feel free to speak to their managers because they company wants to maintain the safest conditions possible in the stores.
A few days ago, TV2 News published photos of a bus full of passengers (DK) traveling across the country from Aalborg to Copenhagen. The sight angered Benny Engelbrecht, the Minister of Transportation, who asked the Minister of Health to issue an executive order that long-distance buses may not be more than half-full. At the time of the photo, the situation on the bus was not a clear violation of the law but went against the general recommendations that passengers in collective traffic maintain a distance from one another. If the bus company in question, Flixbus, does not comply with the rules, said Engelbrecht in a press release, its operating license will be withdrawn. The company apologized to any passengers who felt insecure about riding on a full bus.
Too early for zoos and cafes
Although the trend in infections and deaths is still on the right track, epidemiologists say that we shouldn’t become complacent because the reopening has begun. Allan Randrup Thomsen, Professor of Virology at University of Copenhagen and Jens Lundgren, Professor of Infectious Disease Medicine are both skeptical about proposals (DK) for opening additional parts of the economy. They warn that people must be careful to continue social distancing, and more testing is needed. Recently the police gave permission for zoos to reopen, but the government asked them to reconsider and the reopening was postponed. Others have proposed opening certain regions of the country on a staggered schedule, but the experts warn that the country is so small that such a policy could prompt people to travel to restaurants and cafes in the open areas. They stress the need for an overall plan for reopening gradually.
Five patients and 35 employees have been infected at Nykøbing Falster Hospital in southern Denmark. This is the second large outbreak inside a hospital (DK). The hospital believes that the outbreak began with an elderly patient who was admitted to the ward for treatment of liver disease in March without Covid-19 symptoms. Two weeks later, the patient and two other patients showed Covid-19 symptoms. The ward was also used for cardiology patients and staff. The infected patients were serviced by several nurses, doctors, physical therapists and others who began to show symptoms and tested positive. As soon as the symptoms were discovered in the patients, they were moved to a separate ward. Five of the 10 patients in the ward were infected, and it was closed afterward. The hospital had followed all the rules in effect at the time that the patients in question were admitted, when there was no policy on testing all new admissions. The Healthcare authority introduced such a policy only this week.
The Health Authority is finally making good on its intention to test more people for infection. Yesterday, nearly 8,000 people were tested (DK), an increase of 3,000 over the previous record. This week, the testing policy was changed to include people with mild symptoms. At the end of April, people without symptoms will also be able to be tested. This will cover people who have been in contact with an infected person or who work at a location where someone was infected. They will be tested at the new TestCenter that was set up in tents in Fælledparken in Copenhagen.
Update on the spread
The tests discovered 217 new infections, bringing the total of confirmed cases to 7,912 out of a total of 108,465 people tested. The number of deaths per day has fallen to the single digits this week, and total deaths now stand at 384. These figures may seem very small in relation to those in the US. For comparison, the number of deaths from Covid-19 per million inhabitants is 67 in Denmark versus 142 in the US. That is, even though the social distancing policy in Denmark appears to be working well and the Danish economy is reopening, the overall fatality rate for the US population is only little over twice as high. By this measure, the situation is much worse in other European countries, with 465 deaths per million in Spain, 414 in Italy, and 269 in the UK. Infections and deaths per day have begun declining in Europe, however, and they have not in the US.
Healthcare employees who become infected with Covid-19 can register their illness as a work injury (DK) and receive compensation for it. That policy was confirmed by Employment Minister Peter Hummelgaard in a press conference yesterday. According to the normal rules, an employee must document the specific situation in which she became infected and must test positive. The Employment Ministry has made an exception and will now honor claims if employees have worked in an ICU and have had contact with Covid-19 patients.
Debating herd immunity
Danish researchers dispute statements by Kåre Mølbak of the Statens Serum Institut (SSI) on the possibility of herd immunity (DK). Herd immunity requires that 60 percent of a population has recovered from infection and become resistant to it. According to Astrid Iversen, Professor of Virology and Immunology at Oxford University, that can take up to five years and immunity may last only one or two years. That has been the case with previous outbreaks of corona virus, the first SARS virus in 2003 and the MERS in 2012. There is much uncertainty about whether Covid-19 antibodies give protection against reinfection and about the effectiveness of herd immunity, and researchers believe that SSI has not explained this clearly.
