As we try to extract ourselves from lockdown, one approach to move forward is based on Sweden’s response to the pandemic. For those who haven’t heard of Sweden’s approach, they are not doing universal social distancing, did not close down any businesses, and did not cancel any large events.
Sweden’s plan was crafted by their Head Epidemiologist Anders Tegnell, and it involves a quarantine for people who are infected, isolate and protect those who are at high risk because of pre-existing health problems, but put no restrictions on the rest of the population.
Despite not having universal social distancing, Sweden’s deaths per capita are almost identical to the United States. In addition, there has been no excess hospitalization or medical system trauma compared to the US. Part of this is due to their universal healthcare system, but Sweden’s healthcare is much less centralized other countries like the UK.
So, has Sweden identified an appropriate way forward for the US now that ongoing universal social distancing is becoming impractical? Obviously, there are problems adapting a system from a country the size of Sweden to one as large and complex as the United States. Despite this there are many attractive concepts about Sweden’s approach.
First, normalizing activity is a distinct positive. In Sweden large gatherings are not prohibited it is suggested that most individuals keep 6 feet between each other at most events. In addition, they don’t wear masks because they feel everyone will eventually get infected and the risks are minimal for most people. They want people to get infected and get it over with!
Secondly, they are aggressive in quarantining infected individuals and those who are at high risk for harm from being COVID infected. This is the way a quarantine is usually done; you don’t quarantine everyone but quarantine those who are infected to keep the infection from spreading. This requires substantial virus testing, essentially ongoing testing of the entire population. You’ve probably heard that the US government is trying to scale up testing to a point where they can identify all COVID infected and their contacts. The US must be able to test all people who have a potential infection for this approach to be feasible.
Finally, Sweden believes in herd immunity. They feel that the infections are occurring naturally result in less transmission overall because people who are immune are less likely to shed the virus. This is a concept I agree with, and even if immunity is not absolute, it is likely that individuals that have a secondary infection do not shed virus to the same degree and are not severely ill. Therefore, the concept that ongoing infections serve as a vaccination for most of the population, especially those at low risk for serious injury or death, is a positive one.
We could not have done the Swedish program as a first approach because the infection coupled with disparities in our healthcare system would have destroyed urban hospitals. But now that we have saved the health care infrastructure by social distancing, aggressively identifying those who become infected and protect those who are at high risk may be the best way forward.