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Sweden: the future of pandemic response?

We are becoming public health experts with this pandemic. Which is not bad. It is always better to appeal to the intelligence of the people, to give them all the information needed for an informed decision/consent, then just ask them to follow the government blindly. Whichever way you count, freedom and flexibility usually perform better than central command. In lots of countries around the globe, people do not trust their government. In the public health world, there is the concept of 3T’s of disease control: Testing, Tracing and Trust. People will not follow the restrictions their government is telling them to follow if they do not trust the government to start with. This is an important point that I will come back to later.

Sweden was seen and perceived as an anomaly, an outlier, to the general responses of the governments around the world to this COVID-19 pandemic. Sweden gambled on a less stringent approach, letting the disease run relatively free. They did do isolate the elderly and vulnerable and (just) asked the general public to practice physical distancing.

The same could be said of Japan, of some sorts, which refused to impose general lockdowns with the severity that other Asian countries applied. They do have a tradition of wearing masks, bowing instead of shaking hands (true to many other Asian countries) and scrupulous hand-washing. They are notorious for the cleanliness ideology that permeates their society. Their cases were not that bad in the end.

But back to Sweden. Sweden pursued a “common sense” approach that kept the country operating, while also protecting its most vulnerable. The country has banned gatherings of more than 50 people, closed high schools, colleges and universities, and has urged isolation for citizens over the age of 70 or for those with underlying medical conditions who may be vulnerable to COVID-19. That means elementary schools, most restaurants and most businesses have remained open. The decision to do so has drawn criticism from inside the country and outside.

Sweden had decided to play the long game. So smart.

It was claimed that Sweden was trying to develop herd immunity (that would require between 60% and 80% of the population becoming immune to the virus) by letting the infection spread through the country like this but the Sweden officials denied that, saying that the herd immunity was not their target and that Sweden shared the same goals as all other countries – to save lives and protect public health.

Was this the right approach? In my mind I think it was. The future will tell.

Sweden was able to bet on this approach mostly because of the third T in the trifecta of infection disease control: Trust.  Most of the Swedish trust their government and follow public directives.  They are also few than average multi-generational households (the way Italy and China have) while many of the young adults live alone and enjoying it too….

Beside this, another key point that I want to draw attention to is that Sweden has realized from the beginning that this COVID-19 is going to be here for the long run. It is not going away in 3 months. We can’t Whack-A-Mole it in a few months. This is here to stay. This understanding, I believe, was critical to their approach too. They realized, early on, that we HAVE TO live (co-habit) with this virus for the following year at least and the stringent measures put in place by other countries, the total lockdowns, will do “flatten the curve” but also will destroy their economies too… for a virus that will come back in the fall… 80% of the people show no symptoms…80% resolved without any complications…so is it worth it?

Sweden relied on citizens’ sense of civic duty. There is “social cohesion” in Sweden. It’s a mono-cultural country too. Citizens trust that their government is mindful of the public good. The Swedish people were asked to take personal responsibility and they did (I see a similar responsibility in Canada too).

I decided to write this article because I liked the more balanced approach of Sweden with this pandemic. They did not only think of the health measures that need to be put in place at all costs, they realized the long term implications of this pandemic and decided to appeal to their citizens to do “the right things” and not lockdown the entire country on the so –pervasive idea that “let’s close this down first and think later how are you going to respond” that was so prevalent around the world. Countries panicked and wanted to buy some time. The more we learn about the disease the more it seems that countries around the world have overreacted. Canada too.

Sweden officials thought of the consequences a lockdown measure will bring about and read the numbers pretty well in terms of transmissibility and mortality of his virus. And they decided to play the long game.

Ultimately, Sweden makes for a “good case study,” and will be an important test to see whether they got things right or not. The pandemic is still on.

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