Thursday, March 31, 2022

Sweden Now Has One of the Lowest COVID Mortality Rates in Europe

Early in the coronavirus pandemic, I asked a simple question. Could Sweden’s laissez-faire approach to the coronavirus actually work?

Unlike its European neighbors and virtually all US states, the Swedes had opted to not shut down the economy. The country of 10 million people took what was at first described as “a lighter touch.”

While other countries closed schools and businesses, life in Sweden stayed pretty normal. Kids went to public pools and libraries, while adults sipped wine and had lunch in local bistros. Though mass gatherings were prohibited, children kept going to school, though students older than 16 were encouraged to attend classes remotely. The Swedish government also encouraged people to work remotely and asked people over 70 to isolate themselves, if possible.

For taking this approach, Sweden—and the architect of its public health policies, Anders Tegnell—was widely condemned.

It was an avalanche of criticism Sweden received for not locking down its economy like other governments around the world.

The Other Side of the Story

I spent a great deal of time in 2020 and 2021 arguing that the media was getting the narrative wrong on Sweden, pointing out that Sweden’s response had resulted in exponentially fewer deaths than modelers had predicted and lower mortality overall than most of Europe.

The BBC also noted Sweden’s economy had not suffered nearly as much as the economies of other European nations, and, more importantly, as other countries were implementing more lockdown measures in 2021, daily COVID deaths in Sweden had reached zero.

That was nearly 9 months ago, however. How does Sweden rank compared to other European countries today?

Like many countries, Sweden saw cases spike with the arrival of Omicron, which resulted in a new wave of COVID deaths. However, the wave was much smaller than in other countries. In fact, Sweden’s overall COVID-19 mortality rate throughout the pandemic is one of the lower rates you’ll find in all of Europe.

The Costs of Lockdowns—New and Old

The point in sharing this information is not to take a victory lap. The point is to learn from the mistakes made during the pandemic.

In March of 2020, when public health officials realized COVID-19 was more deadly than they previously believed, they panicked. Instead of pursuing similar courses humans had pursued in previous pandemics, public health authorities decided to copy the strategy of China—one of the most totalitarian regimes on the planet—and use the government to force entire sectors of the economy to shutdown. (Americans were told this was just for 15 days to “flatten the curve,” something that was quickly proven to be untrue.)

The strategy failed miserably. Study after study after study has shown the lockdowns failed to adequately protect populations, which is why non-pharmaceutical interventions (NPIs) have been scrapped by countries around the world.

Shutting down society, however, came with serious and deadly consequences. The World Bank reported last year that global poverty surged during the pandemic, with 97 million more people living on less than $1.90 per day. In the United States, 8 million more people fell into poverty in 2020, tens of millions lost jobs, and hundreds of thousands of businesses went under. To mitigate these harms, the government “flooded the system with money,” which has resulted in surging inflation. The losses went beyond financial costs, of course. Cancer screenings plunged and drug overdoses reached record highs, resulting in an untold number of deaths.

And on Tuesday, The New York Times revealed the latest unintended consequence of the government’s lockdown experiment: a new study shows alcohol-related deaths spiked in 2020, increasing 25 percent from the previous year.

“The assumption is that there were lots of people who were in recovery and had reduced access to support that spring and relapsed,” said Aaron White, one the report’s authors and a senior scientific adviser at the National Institute on Alcohol Abuse and Alcoholism.

The Lesson of Secondary Consequences

Public officials made two serious mistakes above all others in their response to the virus. The first was assuming they possessed the knowledge and ability to contain a highly contagious respiratory virus through lockdowns and other NPIs.

Many world-leading epidemiologists at the time, like Tegnell, saw the futility of such an approach.

“In early March 2020, when Italy and Iran started to report many COVID deaths as the first countries outside China, it was clear to any knowledgeable infectious disease epidemiologist that the virus would eventually spread to all parts of the world,” Martin Kulldorff, a biostatistician and professor of medicine at Harvard Medical School from 2015 to 2021, told me. “At the time, we only knew a small proportion of the actual cases, so it was clear that it had already spread elsewhere and that it would be futile to try and eliminate the disease with contact tracing and lockdowns.”

The second mistake public officials made was not considering the unintended consequences of their actions. The writer and economist Henry Hazlitt once pointed out this is one of the perennial flaws in policymaking.

“[There’s a] persistent tendency of men to see only the immediate effects of a given policy,” Hazlitt wrote in Economics in One Lesson, “and to neglect to inquire what the long-run effects of that policy will be not only on that special group but on all groups.”

Hazlitt described this as “the fallacy of overlooking secondary consequences.”

Anders Tegnell, the architect of Sweden’s strategy who recently joined the World Health Organization, was one of the only public health officials in the world who acknowledged these secondary consequences, predicting that “the consequences of shutting down the economy [would] far outweigh the benefits.”

Tegnell was right, the data show. And the critics of Sweden’s policy should acknowledge that.


Omicron BA.2 sub-variant now globally prevalent

A sub-variant of the highly transmissible omicron version of coronavirus known as BA.2 is now dominant worldwide, prompting surges in many countries in Europe and Asia and raising concern over the potential for a new wave in the United States.

BA.2 now represents nearly 86% of all sequenced cases, according to the World Health Organization. It is even more transmissible than its highly contagious omicron siblings, BA.1 and BA.1.1, however the evidence so far suggests that it is no more likely to cause severe disease.

As with the other variants in the omicron family, vaccines are less effective against BA.2 than against previous variants like alpha or the original strain of coronavirus, and protection declines over time. However, according to UK Health Security Agency data, protection is restored by a booster jab, particularly for preventing hospitalization and death.

The rise of BA.2 has been blamed for recent surges in China as well as record infections in European countries like Germany and the UK. Yet some European countries are now seeing a slower uptick in new cases, or even a decline.

BA.2 has been called the "stealth variant" because it is slightly harder to track. A missing gene in BA.1 allowed it to be tracked by default through a common PCR test. BA.2 and another sibling, BA.3, which is also increasing in prevalence but is currently at low levels, can only be found by genomic sequencing, which some countries do more of than others.

A key concern about BA.2 was whether it could re-infect people who had already had BA.1, particularly as a number of countries seemed to be experiencing "double peaks" in infection rates surprisingly close together. But data from both the UK and Denmark have shown that while omicron can reinfect people who had other variants, such as delta, only a handful of BA.2 reinfections in people who had BA.1 have been found so far among tens of thousands of cases.

Scientists say a possible explanation for the recent rise in BA.2 could be that the global uptick happened at the same time that many countries lifted public health interventions.

"In some ways, it could just be that BA.2 was the variant that was circulating when all these people stopped wearing masks," said Dr Andrew Pekosz, a virologist at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

Study shows higher diabetes risk after COVID infectionVideo
As such, other U.S. experts such as Eric Topol, director of the Scripps Research Translational Institute in La Jolla, California, said it was "a little too early" to call whether the U.S. too would see a significant BA.2 wave.

But whatever the reason for BA.2's rise, scientists said it was a reminder that the virus continues to cause harm, particularly among unvaccinated, under-vaccinated and vulnerable populations.

"It is still a huge public health problem and it is going to continue to be," said Mark Woolhouse, an epidemiologist at the University of Edinburgh.




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