A few weeks ago, an emergency physician working in Sweden, Dr. Sebastian Rushworth, asked me if I would be willing to replicate an article from his blog on mine. I was more than happy; it was a great article. The only problem being that his writing puts mine to shame – in a second language. Although he did later tell me he had been to boarding school in England for several years. So, I feel a bit better. If not much.
He has now done an update, outlining how things are getting along in Sweden. I thought it would be of great interest for people to get news from the front line, so to speak.
As many of us know Sweden, alone in Western Europe, decided not to impose a tough lockdown. In fact, the only forcible restriction that was imposed was to ban people meeting in groups of more than fifty. Slightly later, a further restriction was placed on nursing home visits.
Apart from this, all other Government recommendations were purely voluntary [Imagine that, a Government treating its citizens as responsible human beings].
When Sebastian wrote to me recently, I sent him back this e-mail.
“Great article. Could you send it in Word format? I will obviously link back to your blog.
Also, would it be possible to put in an additional section – to go at the front of the piece – as to what measures were taken in Sweden, and what the average person in Sweden actually did. The narrative we now have (from the pro-Lockdown lobby) is that the people of Sweden, being so law-abiding and community aware, essentially locked themselves down.
Which meant that the Swedish partial lockdown was more effective than, for example, the UK ‘harsh’ lockdown. Because the Swedes self-policed themselves, and the Brits did not. This is usually stated with great confidence from people who provide no evidence to back this assertion up. People who have probably never been to Sweden, nor ever talked to anyone from Sweden, and probably couldn’t point to Sweden on a map.
I understand schools stayed open, bars and restaurants stayed open. Gatherings of more than five hundred people were prohibited etc. What did Swedes do with masks, and going to work, for example? I think that information directly from the front line in Sweden, on these things, would be useful for people to know.”
So, Sebastian added a bit onto the front as follows:
“At the beginning of August I wrote an article about my experiences working as an emergency physician in Stockholm, Sweden during the COVID pandemic. For those who are unaware, Sweden never went into full lockdown. Instead, the country imposed a partial lockdown that was almost entirely voluntary. People with office jobs were recommended to work from home, and people in general were recommended to avoid public transport unless necessary. Those who were over seventy years old, or who had serious underlying conditions, were recommended to limit social contacts.
The only forcible restriction imposed by the government from the start was a requirement that people not gather in groups of more than fifty at a time. After it became clear that COVID was above all dangerous to people in nursing homes, an additional restriction was placed on nursing home visits.
At no time has there been any requirement on people to wear face masks in public. Restaurants, cafés, hairdressers, and shops have stayed open throughout the pandemic. Pre-schools and schools for children up to the age of sixteen have stayed open, while schools for children ages sixteen to nineteen switched to distance learning.
My personal experience is that people followed the voluntary restrictions pretty well at the beginning, but that they have become increasingly lax as time has gone on. As a personal example, my mother and my parents-in-law stayed locked up in their homes for the first six weeks or so of the pandemic. After that they couldn’t bear to be away from their grandchildren any longer.
In my earlier article in August, I mentioned that after an initial peak that lasted for a month or so, from March to April, visits to the Emergency Room due to COVID had been declining continuously, and deaths in Sweden had dropped from over one hundred a day at the peak in April, to around five per day in August.
At the point in August when I wrote that article, I hadn’t seen a single COVID patient in over a month. I speculated that Sweden had developed herd immunity, since the huge and continuous drop was happening in spite of the fact that Sweden wasn’t really taking any serious measures to prevent spread of the infection.
So, how have things developed in the six weeks since that first article?
Well, as things stand now, I haven’t seen a single COVID patient in the Emergency Room in over two and a half months. People have continued to become ever more relaxed in their behaviour, which is noticeable in increasing volumes in the Emergency Room. At the peak of the pandemic in April, I was seeing about half as many patients per shift as usual, probably because lots of people were afraid to go the ER for fear of catching COVID. Now volumes are back to normal.
When I sit in the tube on the way to and from work, it is packed with people. Maybe one in a hundred people is choosing to wear a face mask in public. In Stockholm, life is largely back to normal. If you look at the front pages of the tabloids, on many days there isn’t a single mention of COVID anywhere. As I write this (19th September 2020) the front pages of the two main tabloids have big spreads about arthritis and pensions. Apparently, arthritis and pensions are currently more exciting than COVID-19 in Sweden.
In spite of this relaxed attitude, the death rate has continued to drop. When I wrote the first article, I wrote that COVID had killed under 6,000 people. How many people have died now, six weeks later? Actually, we’re still at under 6,000 deaths. On average, one to two people per day are dying of COVID in Sweden at present, and that number continues to drop.
In the hospital where I work, there isn’t a single person currently being treated for COVID. In fact, in the whole of Stockholm, a county with very nearly two and half million inhabitants, there are currently only twenty-eight people being treated for COVID in all the hospitals combined. At the peak, in April, that number was over a thousand. If twenty-eight people are currently in hospital, out of two and a half million who live in Stockholm. Which means the odds of having a case of COVID so severe that it requires in-hospital treatment are, at the moment, about one in eighty-six thousand.
Since March, the Emergency Room where I work has been divided in to a “COVID” section and a “non-COVID” section. Anyone with a fever, cough, or sore throat has ended up in the COVID section, and we’ve been required to wear full personal protective equipment when interacting with patients in that section. Last Wednesday the hospital shut down the COVID section. So, few true cases of COVID are coming through the Emergency Room that it no longer makes sense to have a separate section for COVID.
What about the few formal restrictions that were imposed early in the pandemic?
The restriction on visits to nursing homes is going to be lifted from October 1st. The older children, ages sixteen to nineteen, who were engaging in distance learning during part of the spring, are now back in school, seeing each other and their teachers face to face. The Swedish public health authority has recommended that the government lift the restriction on gatherings from fifty people to five hundred people.
When I wrote my first article, I engaged in speculation that the reason Sweden seemed to be developing herd immunity, in spite of the fact that only a minority had antibodies, was due to T-cells. Since I wrote that article, studies have appeared which support that argument.
This is good, because T-cells tend to last longer than antibodies. In fact, studies of people who were infected with SARS-CoV-1 back in 2003 have found that they still have T-cells seventeen years after being infected. This suggests that immunity is long lasting, and probably explains why there have only been a handful of reported cases of re-infection with COVID, even though the virus has spent the last nine months bouncing around the planet infecting many millions of people.
As to the handful of people who have been reported to have been re-infected. Almost all those cases have been completely asymptomatic. That is not a sign of waning immunity, as some claim. In fact, it is the opposite. It shows that people develop a functioning immunity after the first infection, which allows them to fight off the second infection without ever developing any symptoms.
So, if Sweden already has herd immunity, what about other countries? How close are they to herd immunity? The places that have experienced a lot of COVID infections, like England and Italy, have mortality curves that are very similar to Sweden’s, in spite of the fact that they went into lockdown. My interpretation is that they went into lockdown too late for it to have any noticeable impact on the spread of the disease. If that is the case, then they have likely also developed herd immunity by now. Which would make the ongoing lockdowns in those countries bizarre.
What about the vaccine? Will it arrive in time to make a difference? As I mentioned in my first article, lockdown only makes sense if you are willing to stay in lockdown until there is an effective vaccine. Otherwise you are merely postponing the inevitable. At the earliest, a vaccine will be widely available at some point in the middle of next year.
How many governments are willing to keep their populations in lockdown until then? And what if the vaccine is only thirty per-cent effective? Or fifty per-cent? Will governments decide that is good enough for them to end lockdown? Or will they want to stay in lockdown until there is a vaccine that is at least ninety per-cent effective? How many years will that take?
So, to conclude: COVID is over in Sweden. We have herd immunity. Most likely, many other parts of the world do too, including England, Italy, and parts of the US, like New York. And the countries that have successfully contained the spread of the disease, like Germany, Denmark, New Zealand, and Australia, are going to have to stay in lockdown for at least another year, and possibly several years, if they don’t want to develop herd immunity the natural way.