Lockdowns will most probably result in more deaths

The other day, a presenter on BBC World Service gave us a story saying there is no social distancing in Sweden, showing people outdoors enjoying the spring weather in Stockholm.

The underlying assumption of this highly contested statement seems to be that if a country is not on an enforced lockdown, it is bound for failure, mass deaths and the people in charge will have blood on their hands. The lowest number of deaths becomes the only measure of success.

This is simplistic, untrue and misleading.

The effort around the world to prove Sweden’s more ‘lenient approach’ is not abating and I, as a Swede, became intrigued as to why this is the case. Are there deliberate attempts to make Sweden look bad to justify draconian measures elsewhere?

The Swedish approach is less lax than it appears and not so different than other countries, if one looks at the effects.

The coronavirus pandemic is not going to be over in weeks. It is a new virus with no immediate answers. It is, therefore, important to have acceptance among people of measures taken over the long haul.

Voluntariness and an educated public have always served Sweden well. People are sensible, considerate and have the ability to make informed decisions about communicable diseases, says Sweden’s head of the Public Health Agency, Johan Carlson.

It is not the number of deaths that answers whether these measures are sufficient or whether we made the right assessments.

Carlson concludes that we could have an answer, perhaps, in four or five years about the trade-offs Sweden made and other secondary effects on the general health situation and crowding-out effects at health services caused by the virus.

Hence, Sweden does not enforce restrictions but recommends (not ‘suggest’ as critics are saying). This means that most Swedes follow the recommendations without policing.

• Isolate risk groups (elderly and people with certain diseases such as lung disease and a low immune system)
• Stay at home if you have symptoms and stay at home at least two days after symptoms are gone
• Work from home
• People over 70 are told to meet as few people as possible
• Wash hands often
• Practice social distancing, avoid large gatherings and refrain from unnecessary travel.

But in general, the recommendations given by the Public Health Agency let people live a somewhat normal life.

However, business is not normal in Sweden, like everywhere else. So far, Sweden does not have political leaders who are into political grandstanding. There is a common approval of the approach by Sweden’s political leaders.

The other approach, the ‘European model’, of closing down society, lockdowns, curfews, closure of non-essential shops, schools and borders is expected to lead to a somewhat slower spread of the virus. In the short run, this will reduce the pressure on the health services and the need for intensive care facilities.

Depending on how risk groups are isolated, the number of deaths from the virus might be lower in the beginning.

However, the result of this policy seems limited, if you look at the number of deaths per million inhabitants in countries which got the epidemic at the same time as Sweden. The number of new admissions to Swedish hospitals by seriously ill people is not overwhelming health services.

There is a common notion outside Sweden that it has a policy of ‘herd immunity’ which is false. Rather there is an understanding that herd immunity is a consequence.

If there is no spread of the virus, there is no immunity. But the virus has spread around the world and the only way to stop it is a vaccine, which does not exist yet or that a sufficient part of the population gets immune.

If the virus spreads slowly as in the European model, it takes longer to acquire herd immunity. There is then an obvious risk for new waves of the epidemic. If this occurs after the restrictions have been lifted, the risk is high for new severe outbreaks, with a recurrence of increased need for intensive care and more deaths.

Closing down society for an extended period will lead to a serious economic downturn, mass unemployment and anxiety.

This will impact on people’s health for many years and cause increased illness and deaths from mental, cardio-vascular diseases and cancer. During the financial crisis 2008-o9 it is reckoned that around a quarter of a million people died of cancer alone.

The Swedish model is expected to lead to a quicker spread of the virus in society. The demand for health care and intensive care is at the same time increasing initially but flattens out later and decreases gradually.

It is difficult to see into the future so we will only know later what works and does not work.

However, calculations on lockdowns indicate that closing down societies as done around Europe will most probably result in more deaths in the coming years and an increase in the number of lost years of life in comparison to the Swedish model.

The Swedish model has challenged and even threatened many around the world, including scientists with a different outlook and politicians who are justifying measures that no-one knows will work.

The reasons behind the quick rush to introduce lockdowns has partly to do with the Chinese example, long before the virus became a threat elsewhere.

A government with a leader afraid of being seen weak and of taking risks with peoples’ lives found themselves in a corner and lost the bigger picture.

Enforcing draconian measures seemed right because it was about saving lives, without trying to strike a balance between protecting people against the virus and not destroying too much of the country in the process.

That’s what it seems Sweden is trying to do.

Anders Östman is a retired Swedish diplomat living in Nairobi