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Sweden did not introduce quarantine: how it affected the development of the COVID-19 pandemic

Unlike most European countries and Scandinavian neighbors, Sweden has abandoned tough coronavirus containment measures from the outset of the pandemic. This decision was vigorously discussed throughout the world throughout 2020. Edition Meduza told how the "Swedish way" turned out to be a radical social experiment, how it actually ended - and whether his ideologue, chief local epidemiologist Anders Tegnell eventually changed his point of view.

Photo: Shutterstock

The Swedish authorities banned the wearing of masks at the height of the epidemic. Even people in hospitals

Concerns about a new virus emerged in scientists in January 2020, when the first predictions were published in the prestigious medical journal The Lancet. SARS-CoV-2 arrived in Europe in February, and the end of the month was remembered by the world for an outbreak in northern Italy. At this time, the Swedish Public Health Agency did not take any action.

According to the famous Swedish-American journalist and former doctor Lena Einhorn, who spoke directly with Sweden's chief epidemiologist Anders Tegnell, the local medical department did not advise people to cancel their holidays in the Alps and observe quarantine when they returned from Italy.

At the end of March, when, after the publication of new forecasts for the development of the epidemic, many countries introduced tough measures, including the closure of public places and restrictions on the movement of citizens, Sweden also introduced restrictive measures. Namely, it banned mass events of more than 50 people, banned visits to nursing homes, limited the number of visitors to bars and restaurants, and transferred university students to distance learning. In addition, the Swedish Public Health Agency encouraged citizens to socially distance themselves and stay at home whenever possible.

It should be noted that in Sweden the level of trust in state institutions is high (for example, in March, opinion polls showed that about 70% of respondents trust the recommendations of the medical department), and according to both surveys and data from cellular networks, many people really sat at home and canceled Easter holidays. Thus, in the spring, the Swedes maintained voluntary self-isolation at a level comparable to that in Europe.

The fundamental difference between the Swedish epidemiological strategy was the rejection of the recommendation for wearing masks, not only in public places, but also in hospitals. When the European Agency for Disease Control (ECDC) released the document on April 8, Sweden's chief epidemiologist Anders Tegnell said there was not enough evidence to confirm the effectiveness of the measure and that the ECDC was not recommending it. According to Science respondents, the Swedish authorities literally banned the wearing of masks, arguing that their misuse can only harm, giving people a false sense of security.

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The second fundamental point is the limited number of tests for SARS-CoV-2. In mid-March, when neighboring Norway had already closed schools, restaurants and borders, the Swedish health agency decided to test only people with severe symptoms for coronavirus. This was followed by a directive for hospitals in Stockholm, which, in order to rationalize the use of intensive care facilities, ordered not to place patients in intensive care units with a minimum chance of recovering - over 80 years old or with severe obesity (body mass index over 40). In addition, the official position of the authorities, which justified the low testing rate, was that people without symptoms are not contagious.

Many Swedish scientists, including epidemiologists, did not support the "party line" and publicly appealed to the authorities, calling for measures to contain the epidemic, similar to those taken in other countries. For example, about two thousand researchers signed an open letter with a similar appeal at the end of March.

Sweden and the United States were the only "first world" countries that could not take the epidemic under control

The first outbreaks of viral infection began in nursing homes. The belated introduction of restrictions led to the death of a total of 7% of their inhabitants (one thousand out of 14 thousand). By the end of March, official statistics reported more than 300 new infections per day, and 90 daily deaths in early April.

Opponents of Anders Tegnell's policy compared the data with neighboring countries, where they introduced tougher measures. An initiative group of 22 scientists on April 14 published an article in the Dagens Nyheter newspaper "Health Agency Failed, Time for Politicians to Intervene", in which it calculated that more people died from COVID-7 per million in Sweden from April 9 to April 19 than in Italy, and ten times more people than neighboring Finland. The article caused a strong negative reaction in the press - however, confirming that most Swedes are loyal to the authorities.

As a result of the deliberately low testing rate, it is not known how many people in Sweden actually have had the coronavirus. However, the number of deaths from COVID-19 can be estimated by the excess mortality of the population during the first wave. Science cites official data for several countries, from which it follows that in mid-April, 75 more people died daily in Sweden than usual (per million population), while in neighboring Norway and Denmark this figure is several times lower.

At the same time, the leader in excess mortality in Europe was not Sweden, but England and Wales, where the authorities also could not agree on which restrictive measures to introduce for a long time.

In many other countries, where the onset of the epidemic was accompanied by high excess mortality, the situation had improved by early May (for example, in Spain and the Netherlands), but in Sweden the figures remained high. A comparative analysis published following the results of the “first wave” in 18 countries in the American medical journal JAMA, allows for this characteristic to unite Sweden and the United States - the only countries of the “first world” that could not (or did not want) to take the epidemic under control.

At the end of August, the Swedish State Statistics Office reported that in the first six months of 2020, a record number of people died in the country over the past 150 years (51,4 thousand people). The previous such "record" was recorded in 1869, when it was the result of a mass famine. From January to June 2020, 4633 more people died than the average for the same period in 2015-2019. At the same time, the number of confirmed deaths from COVID-19 at the end of June was 5346.

By the beginning of summer in Sweden, as in almost everywhere in Europe, the epidemic had subsided, thanks in part to the Swedes' tradition of going on vacation from cities to remote, secluded regions.

The absolute numbers of deaths from COVID-19 in Sweden do not look so scary - for example, they are comparable to the official data for Moscow, where slightly more people live than in the whole of Sweden (Sweden's population is 10,1 million), and where the authorities tried to impose severe restrictive measures.

In addition, now in terms of total mortality among developed countries, Sweden is only in fifth place, after Spain, the United States, Great Britain and Italy. However, it is incorrect to compare Sweden with Moscow and Madrid: there are fundamentally different population densities, different household structures and different trust in the authorities - and, therefore, commitment to following the recommendations.

Usually the results of the "Swedish experiment" are compared with neighboring countries with similar lifestyles: Finland, Norway and Denmark. There, since the beginning of the pandemic, excess mortality was 5-10 times less.

The ideologist of the "Swedish experiment" Anders Tegnell is also credited with striving to achieve the emergence of population immunity to SARS-CoV-2 among the Swedes as soon as possible, although he himself publicly denies this opinion.

In the summer, journalists published documents that give a little better understanding of how Tegnell reflects on what is happening in the country. In correspondence with his Finnish counterpart, Tegnell discussed the epidemiological policy for schools - and the related projected increase in mortality among the elderly. When Tegnell's interlocutor said that school closures would reduce infection rates among older people by 10%, Tegnell replied, “10%, maybe it’s worth it?”

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Be that as it may, after the first wave of infections in Sweden, only 7% of local residents on average were found to have antibodies to the virus (as of the end of May), which is not surprising, given that there were still restrictive measures in Sweden.

What's next

Already at the peak of the epidemic, the authorities admitted that mistakes were made in their strategy, in particular, it was necessary to close the nursing homes earlier. However, Anders Tegnell said in September that he believes his own containment policy is generally correct and intends to continue it. A significant plus of this strategy, according to Tegnell, is that it is easy to stick to for a long time.

Now in Sweden, as in almost everywhere in Europe, the number of new infections is increasing. So, in October, the daily increase in the number of infected was 700-800 cases. In addition, the "second wave" has led to outbreaks of disease in hospitals, where medical personnel are fighting for the right to use protective equipment. On September 27, at Falun Hospital, where the COVID-19 outbreak occurred, doctors were still allowed to use visors when examining patients.

The Swedish government has no plans to close schools again: according to the health agency, schoolchildren have not made a significant contribution to the spread of the disease. However, scientists interviewed by Science are perplexed as to how the authorities came to this conclusion, given that there was no mass testing of students or contact tracing in the country, and the number of severe cases among children was several times higher than half of the population. Finland. However, in September, the agency changed its position on testing children - now taking tests from schoolchildren with moderate symptoms of the disease is encouraged.

Under pressure from scientists, as in the case of protective equipment for doctors, the policy of testing the population is changing. In September, the number of tests per thousand of the population was already equal to that in Norway. In addition to strengthening testing, the agency is also establishing a contact tracing system for cases, and family members of people with confirmed cases of COVID-19 are encouraged to stay at home for a week. Apparently, Sweden nevertheless drew conclusions from the results of the "first wave" and adapted its soft containment policy to better control the situation.

COVID-19 cases are on the rise in other European countries as well.

“Many governments are now criticizing the Swedish model, when in fact they are guided by it, not acknowledging it out loud,” said Antoine Flao, director of the Institute for Global Health at the University of Geneva. "However, the Swedes are making a big mistake by continuing to ignore medical masks."

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