The U.S. is the accidental Sweden, which could make the fall ‘catastrophic’ for Covid-19

With the Covid-19 pandemic rampaging across the U.S. in April and 20 million people filing for unemployment in that month alone, libertarians thought there was a better way. The Heritage Foundation praised Sweden for “preserving economic freedom.” The Cato Institute said Sweden’s response to Covid-19 “may prove to be superior from a public health perspective.” In early May, Sen. Rand Paul (R-Ky.) said at a committee hearing that the U.S. “ought to look at the Swedish approach.”

The Swedish approach was to largely allow businesses to remain open. And at first, it seemed to work, with a death count nowhere near what it was in countries such as Italy, Spain, and the U.K. But even as Sweden was being hailed as a model, its cases were steadily rising, and its death rate now exceeds that of the U.S. Sweden also did not seem to stave off the economic damage it was aiming to avoid.

Sweden’s Covid-19 strategy, adopted in March, emerged from the country’s top epidemiologist and other leaders’ evaluation of what little science about transmission there was at the time, factoring in economic considerations, and making a considered — albeit controversial — decision to stop well short of the full shutdown that other countries in western Europe (and many U.S. states) adopted.

In early summer, parts of the U.S. began following a very similar path — but one it has stumbled onto, not chosen based on science. Now, the next few weeks will show the consequences of being the accidental Sweden.

“In some ways you could say we’re doing Sweden, but unintentionally” and, crucially, without the guardrails that kept that country’s case count from exploding, said physician David Rubin, director of PolicyLab at Children’s Hospital of Philadelphia (CHOP), whose Covid-19 model shows the epidemic resurging through early August almost everywhere in the U.S. but New England.

In addition to places like Arizona, Texas, and Florida that have been hammered since June, the latest run of the CHOP model identifies Las Vegas, Los Angeles, northern California, Kansas City, Mo., Tulsa, Okla., Greenville, S.C., and Atlanta as poised for widespread transmission. And there are early signs that the virus is moving up busy travel routes, spreading north to Baltimore, Philadelphia, and all of Ohio’s major cities.

By “doing Sweden,” Rubin and other experts mean Americans’ pullback from social distancing that dates from May, when states began lifting stay-at-home orders and other policies aimed at reducing viral transmission. The effect has had many of the failed aspects of Sweden’s approach, but with none of the steps that kept that country from being a total disaster.

Sweden never imposed a total shutdown of nonessential businesses. It closed universities and banned gatherings of more than 50 people, including sports events, and discouraged domestic travel. But most bars, restaurants, schools, salons, and stores were allowed to remain open, with largely voluntary social distancing. “If Spain and Italy got hit by an early Covid-19 tsunami,” said Peter Kasson of the University of Virginia School of Medicine and Sweden’s Uppsala University, “Sweden said, ‘let’s go swimming.’”

Many of its citizens, however, didn’t jump into the deep end. For one thing, “a lot of Swedes went well beyond the official recommendations for social distancing, individually taking the kinds of actions that in other countries were mandated,” said Kasson, co-author of a recent study of Sweden’s strategy. “A lot of people self-isolated at home, and companies promoted working from home even though it wasn’t mandated. That shows that individual decisions that reduce [viral transmission] can have a substantial effect on national outcomes.”

Among those individual decisions: 58% of Swedes didn’t meet friends, and 74% stayed home during their spare time, researchers reported in May.

Sweden also issued its distancing recommendations early. Imposing less restrictive policies right away can be more effective at slowing transmission and preventing cases than stricter measures later in an outbreak.

In contrast, if Swedes had done everything they were allowed to do (especially since face coverings were never required nationally), such as shop and socialize at the same levels they had pre-pandemic, “it would likely have led to runaway infection,” Kasson said. But “Sweden is a place with a very strong embrace of government authority.” When that authority said keep gatherings small, Swedes “took individual actions that went beyond the mandated measures,” he said.

Sweden is 18th in the world in Covid-19 cases per million people, with 7,524 as of Tuesday. That’s better than the U.S. (10,626), but much worse than European countries that imposed shutdowns. Sweden is seventh in deaths per million people (with 549; the U.S. is ninth, with 419), though the U.K., Spain, and Italy are worse, possibly because of older populations, denser cities, and more imported cases early on. But a death rate nearly 12 times Norway’s is hardly reason for celebration. (In fairness, however, there is evidence that one reason for Sweden’s high death toll is that when elderly people contracted Covid-19, they did not receive aggressive treatment, Kasson found; if they had, about one-third might have survived.)

Because factors that kept Sweden’s numbers from being even more dire are largely absent in much of the U.S., there is growing concern that this country will blow past Sweden’s death rate and exceed its case rate even further.

Source: Stat News