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Brutal Choices: Anders Tegnell and Sweden’s Herd Immunity Goal

If the title of epidemiological czar were to be created, its first occupant would have to be Sweden’s Anders Tegnell. He has held sway in the face of sceptics and concern that his “herd immunity” approach to COVID-19 is a dangerous, and breathtakingly cavalier approach, to public health. Tegnell T-shirts featuring him as a medieval liberator are available for purchase; fan pages can be found on Facebook abuzz with encouragement. Tegnell’s point, throughout, is that his approach is less than radical given the global lockdown formula that has perpetrated, almost overnight, the worst economic crisis in generations.

This is not to say that such herd immunity is being encouraged by a lax approach to public health regulations. As the World Health Organisation’s Mike Ryan has noted, a false narrative had been perpetrated about an absence of control measures in Sweden to halt the transmission of COVID-19. The focus in Sweden, rather, is on sensible, voluntary restraint, making sure that large gatherings are avoided, and, where people do gather (those of less than 50 are permitted), physical distancing is observed. But such a gamble is dependent on developing a critical, resistant core against re-infection, thereby protecting the vulnerable population. Viral transmission, it follows, will eventually be halted if a majority – say 60 percent of the population – have contracted it while the vulnerable are sheltered.

Karin Ulrika Olofsdotter, the country’s ambassador to the United Nations, has been tasked with promoting the Tegnell model to the world. On National Public Radio, her words had the authority of a proclamation. “About 30 percent of people in Stockholm have reached a level of immunity.” Daringly, she suggested that, “We could reach herd immunity in the capital as early as next month.”

The merits of such a position soon became matters of culture and ideology. The science becomes part of the context within which it is pursued – Sweden as unique; Sweden as peerless – or at least just that bit more peerless than its Nordic neighbours. Within the country, trust for the myndigheterna (the agencies) is unflappable, and if herd immunity be the policy, then so be it.

Attempts to deprive Tegnell of primacy and his sheen of confidence have not succeeded. In March, 2,300 academics signed an open letter to the Swedish government calling for stricter measures to contain the pandemic. As one of the signatories, Cecelia Söderberg-Nauclér of the Karolinska Institute wondered, “No one has tried this route, so why should we test it first in Sweden, without informed consent?”

An attempted scientific putsch by 22 researchers in April, launched in Dagens Nyheter, failed. In the open letter, the group took issue with the Public Health Agency’s approach, urging government intervention with “swift and radical measures” along the lines undertaken by the country’s neighbours. “In Sweden, there are now ten times more people dying than in neighbouring Finland where coffee shops and restaurants are closed.” Other comparisons were also cited, with a focus on the last three days before the Easter vacation. Between April 7-9, “10.2 people per million inhabitants died of COVID-19 each day in Sweden.” For the same number in Italy, it was 9.7; in Denmark, 2.9; Norway, 2.0 and Finland 0.9.

The authors also threw in a quote from an interview in the same newspaper with Finnish President Sauli Niinistö. It was a pointed remark on the failed credo of voluntary restraint. “You cannot ask people not to go out if the restaurants are allowed to stay open.”

Tegnell’s response was curt, claiming that the figures cited by his critics were marred by “a number of fundamental errors.” As is his wont, he drew upon technical qualifications to debunk the data, noting the line that country comparisons were always risky and deceptive propositions. “The death figures they quote are incorrect, they do not match the Swedish death figures.” Italy’s figures, for instance, only covered deaths in hospitals.

There is a certain brutal emphasis in the Swedish approach, an acceptance that a degree of suffering must be endured to reach sustainable levels of safety. The Swedish death toll from COVID-19 stands at over 2,600. Sweden’s National Board of Health and Welfare has also published its own set of figures suggesting that those of the PHA might be 10 percent lower than they should be.

All methods employed so far have been devastating to limb, life and economy; what makes Tegnell’s different here is the long run, one which will keep the financiers and market watchers happy. Finland’s Osmo Soininvaara, a former minister and member of the Helsinki City Council, sees more merit in it than his current colleagues. In his view, “once the coronavirus crisis is over, the number of deaths in Sweden and Finland is the same. The difference is that in Sweden the death toll has been reached faster. And our economy is in ruins, but the Swedish one will be the strongest in Europe.”

Praise and support for Tegnell can also be found among the Scandinavian neighbours. In Norway, epidemiologist Eiliv Lund has accused his counterparts of simply “pushing the problem out in front of us.” The Swedish approach had the merits of ensuring a higher infection rate “and thus a higher immunity.” Danish epidemiologist Christian Wejse lauds Tegnell’s infection formula, suggesting that the number of immune Swedes might be triple those of Danes. This would mean that Sweden “will be in a better situation if there’s a new wave.”

The Swedish model is being saluted from the stands of the corporate friendly New York Times, with the consistently shallow Thomas L. Friedman touting its virtues. He does, however, concede that responding to pandemics presents us with only “different hellish ways.”

Whatever Tegnell and his trusted underlings in the Swedish Public Health Agency claim, the herd immunity presumption has its fair share of dangers. Questioning the relative figures of other countries and their various measures has intellectual merit; embracing the herd immunity model, however, may not. As the authors of an article recently published by The Lancet warn, “There is no certainty as to the immunological correlates of antiviral protection or the proportion of the population who must attain them, making it impossible to identify a point when this level of immunity has been reached.”

There is also uncertainty over whether, on being cleared of the virus, reinfection can take place. Last month, over 260 COVID-19 patients in South Korea were reported to have tested positive, suggesting that grim possibility. The explanation offered since is that the method of detecting the coronavirus – polymerase chain reaction (PCR) – fails to distinguish between genetic material (RNA or DNA) from the infectious virus proper and lingering fragments present in the body after recovery. The herd immunity advocates, it seems, still have stilts to stand on, even if they find support among a good number of corpses.

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  1. Jack Cade

    Survival of the fittest is surely the eventual approach if the covid-19 virus sticks around and recurs. If there is not enough vaccine to go around, then the oldest, weakest and least viable in the human race will be expendable. The filthy rich (and what an appropriate adjective that is!) would ensure that THEY survived, but generally speaking it is right that help be given to an 18 year old than an 80 year old.
    I am not usually a pessimist, I’m an optimist. But in this case I am a realist. I would not be at all surprised if I, having enjoyed my ‘three score and ten’, am told by a medical practitioner that the nations medical resources were too precious to be wasted on me. And I don’t think I would object too loudly.
    That, of course, is the ‘herd immunity that ‘Blow Job’ Johnson was lauding before the virus singled him out.

  2. Matters Not

    While no-one knows the future, Sweden’s trajectory doesn’t look too healthy.

    New cases in Italy and Germany are rapidly falling: Germany by now is almost at the point where New Zealand was a month ago. Could some European countries move to eradication? In Sweden, by contrast, where a low-key permissive approach has been taken, the curve is still on an upward trend.

    Yes Sweden is on an upward trend. But maybe that gamble will pay off – for some at least. In Australia we are on a different course.

    So far 0.027 per cent of the Australian population has been infected, and there have been 93 deaths. If the virus were to spread to the rest of the population, assuming we could maintain our low death rate (1.33 per hundred cases), there would be 340 000 deaths in our country. Is mathematical incompetence a pre-requisite for acceptance into the right-wing bubble?

    Methinks it’s better we in Australia stayed well away from the ‘herd’ in this instance. More here with color coded illustrative graphs.


  3. Graham

    Three points.

    (1) Flattening the infection curve by social distancing and locking down the economy does not – of itself – reduce the number of deaths, it just spreads them out over a longer period. It may prevent the health system from being overwhelmed in the short term and the testing of anti-viral treatments and thereby reduce the total mortality figures but any way you look at it, this is a lose-lose situation.

    (2) Even with lock-downs, this virus is going to reemerge in every country once international travel begins again, so there will be flare ups until herd immunity is achieved via a vaccine or recovery from an infection.

    (3) The epidemiological studies mostly relied upon for policy making in the west use the AVERAGE reproduction rate (Ro) of the infected person and try and drive that down below 1 but if 95 percent of the infected population have a Ro = 0.1 because they are sitting in their basement playing video games and the other 5 percent have an Ro of 20 because they are party animals, you are going to have an Average Ro above 1 and outbreaks even when the Average Ro falls below 1.

    Have a look at the modelling here

    Sweden may be working on the basis that they don’t have too many party animals

  4. Matters Not

    Graham, you make good points but you also proceed on certain assumptions that bear further examination. Yes, flattening the curve spreads deaths out over a longer period but the number of deaths remain constant only if all things remain equal. More time is a variable of significance. Sure there’s no vaccine or treatment available at the moment or maybe even in the foreseeable future but the longer period to which you refer can (and hopefully will) change things significantly.

    If a treatment (as distinct from a vaccine) is found (say) next week, it follows that those who died ‘in haste’ as it were may have died unnecessarily. The hands off approach that just lets it happen may allow many unnecessary deaths. An extension of time may be of great importance.

    The claim that the virus is going to reemerge in every country once international travel begins again assumes that international travel will proceed using the same protocols. Almost sure that won’t happen. Just as the threat of ‘terrorism’ changed airline travel significantly, there’s little doubt that sovereign nations, once they have this virus under control, will not allow all and sundry to simply arrive and start the infection all over again. Already, Australians returning home face 14 days in quarantine. International travel will change dramatically. And those changes will begin before anyone gets on the plane – while they are in flight – and then when they land.

    Will be a new world of travel. Probably a big pain in the ar@e.

  5. mark delmege

    The thing is 500 (more actually) have been added to the death list in the past week. Darwinian Survival of the fittest is not particularly humane. Assumptions about final death figure are clouded in ideology and the things that we dont dont know we dont know. But (as MN said above) had they been more careful a lot of people who have died might have lived long enough for the next wave of antivirals to emerge or even maybe vaccines. My money has long been been on better management through antivirals and an understanding of the disease itself and even the risks posed by the very medications we use to keep us alive from other diseases. At the very least Sweden has killed a lot of its older people and for that it deserves a fail.

  6. Ben

    Binoy, Anders boss was now retired Professor Johan Giesecke.
    His interview on Lockdown TV is interesting, complementing your article in many ways.
    Why lockdowns are the wrong policy – Swedish expert Prof. Johan Giesecke

  7. Ben

    Binoy, you might like to add this to your Sunday lockdown viewing,
    ‘Dr Erickson COVID 19 FULL Briefing | deleted by Youtube –
    Nazis burned books and YouTube deletes videos that go again the elites narrative. 5 million views was too many eyes on the truth.
    The video will be gone soon enough, that’s how it rolls these days. Keep the public ignorant, great tactic for sure.

  8. leefe

    Have I missed something here? I have not read any evidence anywhere that contracting and surviving this virus confers immunity against future infection.

  9. totaram

    Ben: the video (linked by you) argues that not exposing yourself to a pathogen is bad for the immune system, hence let ‘er rip (implied). I would advise these two characters to give their immune systems good practice by going and treating Ebola patients without any protective covering of any kind. Good luck!

    Maybe they are not getting enough customers and would like more people to get ill. That would be good for their “economy”!

    Agree with Leefe as well.

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