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May 18, 2020

Judging the Swedish Experiment with Covid-19

Only time will tell

Unfortunately discussion about Covid-19 in the US has become highly political. Contrary to what both Donald Trump and his adversaries in the mainstream media think, it’s not all about him and his reelection chances. Lives and livelihoods can both be saved by learning what there is to learn about dealing with this virus; that learning can’t happen with partisan blinders on.

Sweden has taken a different course than much of the rest of the world. They haven’t shut down their economy; they haven’t closed their schools; they haven’t told people to stay at home. As quoted in The New York Times, Sweden’s state epidemiologist, Anders Tegnell said: “Once you get into a lockdown, it’s difficult to get out of it. How do you reopen? When?” Much of the US is facing that problem now.

Sweden’s infection and death rates are higher than neighboring Scandinavian countries, which did lock down. Does that mean that the Swedes were wrong to take this approach? We don’t know yet.

On the other hand, estimates are that as much as 25% of the Swedish population may have been infected by May 1 without overwhelming their medical system. Sweden’s death rate is much lower than that of hard-hit European countries like Spain, Italy and France and about the same as Ireland (locked down). It’s quite possible that Sweden will be less affected than its neighbors by whatever next wave of the virus hits because of partial “herd immunity”. Does that mean they were right to take this approach? We don’t know yet. Maybe there’ll be a vaccine by this fall (don’t count on it) and herd immunity will be injectable everywhere.

Obviously, all things being equal, you’ll have a higher initial death rate if you don’t lock down than if you do. On the other hand, if Sweden has minimized the danger from future waves of the virus, it’s death rate over time may be equal to or lower to its neighbors. The Swedish experiment would have obviously been a failure if their health care system got overwhelmed, but it didn’t. If Sweden has a roughly comparable mortality experience to its neighbors over time and has better preserved its economy, their experiment will have been a success although probably not one that could have been replicated everywhere.

But was Sweden right to take this risk even if things turn out well? Nassim Taleb, a wizard of black swans, says you don’t congratulate someone who wins at Russian Roulette. Were those leaders who called for a more severe lockdown wrong if their countries do no better or perhaps worse than Sweden? Maybe not. They had to make decisions with what they knew at the time. I think I would’ve chosen lockdown over the possibility of an overwhelmed health system. Bending the curve to below our hospital capacity made sense to me and, in general, the US has succeeded at that (for now).

But the history of viruses is that, once they evolve into dangerous pathogens, they don’t go away. Their effect can be minimized by vaccination (if it’s invented), treatment (once it’s invented), herd immunity, and contact tracing as we have done successfully (so far) with Ebola. Continuing shutdown to suppress the number of cases far below our treatment capacity may lead to more infection later and the perceived need for a ruinously long lockdown.  

How do we decide?

We must decide what levels of risk we are willing to take. “Zero” is not an answer; it’s always been riskier to leave the house and drive to work than to stay home. There’s always been risk of contagion in public places; the more crowded the more the risk.

We must look dispassionately at the results of experiments like Sweden’s and the US State of Georgia. We must ignore what is or isn’t good for Donald Trump. And we should judge our leaders by whether what they did seemed right at the time they did it, not with 20-20 hindsight.

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