Sweden’s state epidemiologist Anders Tegnell has warned countries such as the UK not to reimpose lockdown measures to meet resurgences in coronavirus infections, arguing that this would be “really detrimental to trust” and “disastrous in many ways”.
But while other countries lifted restrictions from April, Sweden has left almost all measures in place, despite registering a rapid drop in the number of cases from over 150 cases per 100,000 people per fortnight in early July to about 30 on Friday.
We try to put measures in place that are sustainable over time, instead of jumping from the extremely high level of measures to no levels at allAnders Tegnell, state epidemiologist
“We try to put measures in place that are sustainable over time, instead of jumping from extremely high level of measures to no levels at all,” Tegnell told the Observer. “Lifting and closing things is really detrimental to trust and will also have a lot more negative effects than keeping some kind of level of measures all the time. Opening and closing schools, for example, would be disastrous.”
Tegnell also criticised the recent decisions of countries such as the UK and Norway to reimpose quarantine restrictions or reinstate advice not to travel after seeing upticks in infection.
Criticism of Tegnell’s approach started internationally then spilled over into Sweden’s national debate in June, after the country for a short period had the highest per capita death rate in the world, on a rolling seven-day average. The leader of the populist Sweden Democrats called for Tegnell to resign over the high number of deaths. Now at 5,763, almost five times as many people have died of coronavirus in Sweden as have in Denmark, Norway and Finland put together.
Tegnall said the turning point for the pandemic in Sweden took place at the start of July.
Because the decline began long after schools had broken up, and in the middle of most people’s summer holidays, Tegnell argues that the holiday itself could not explain the change. “Exactly why this happened at that time and why it was so quick and sudden, is difficult for us to understand,” he said. “But we believe that the increasing number of immune people in the population must have something to do with it.”
The scale of the drop would indicate an immunity in the Swedish population of “20%, 30%, maybe even slightly more in some areas”, he suggested, indicating that antibody tests in Sweden showing much lower rates were not telling the full story. “It’s very difficult to draw a good sample from the population, because obviously, the level of immunity differs enormously between different age-groups between different parts of Stockholm and so on, and that’s why when we measure one group we get 4% to 5%, and when we measure another group they’re up to 25%,” he said.
State epidemiologist Anders Tegnell, of the Swedish Public Health Agency. Photograph: Naina Helen Jama/EPA
Tegnell said that the big question now will be what happens when Swedes leave their remote summer cabins and return to school and work, although the country is continuing to recommend working from home for those who can.
With the first big wave of infections over in most countries in Europe, he said he expected a new pattern to develop in Sweden. “The most likely [scenario] is that we continue to have a spread in society, but on a low level, hopefully even lower than we have now. But then, there is always the risk of outbreaks. I do not believe that we’re going to have huge outbreaks, but we are most likely going to have outbreaks in similar ways that many other countries have had.”
He said that the last six months have shown that, unlike flu, Covid-19 displays an “uneven, haphazard, cluster-like” spread, which means that “finding those clusters early on, and taking them on very rapidly” will be the key to success in future.
“Of course, that means that you need to have testing in place, that you need to have quick contact-tracing to understand if you have a developing cluster.”
Since we have seen how the disease is acting very much locally, it doesn’t really make sense to have measures that affect the whole countryAnders Tegnell
The cluster-like spread will mean that regional health authorities need to be on continual alert, and that measures to contain outbreaks should in future be taken at a more local level than those imposed in March.
“Since we have seen how the disease is acting very much locally, it doesn’t really make sense to have measures that affect the whole country,” he said. “But on the other hand, I think it is important to have a level of measures in place nationwide.”
While Sweden’s steady-as-you-go strategy is starting to look more sensible as Denmark, Norway and Finland see a resurgence in cases, Tegnell said he now doubted if there would ever be a definitive answer over which strategy was best.
“It will be very difficult to to achieve any kind of really clear-cut answer as to what was right and what was wrong,” he said. “I think we’re talking years into the future before we can get any kind of consensus on how to deal with this in the best possible way.”