by UnHerd
Thursday, 22
October 2020
Spotted
15:15

Why Sweden is no longer shielding the elderly

The change stems from an egalitarian ethic
by UnHerd
People play chess at a park in Stockholm. Credit: Getty

There has been much attention on the new local restrictions introduced in the town of Uppsala in Sweden, a university town that, like many universities in the UK, saw a surge in cases when term got going. It looked like a change of strategy.

A closer look at the Health Agency’s advice reveals that, for a period of two weeks, the people of Uppsala are recommended to (1) avoid travelling by public transport (2) avoid going to parties and social gatherings and (3) avoid having physical contact with people other than those you live with, as much possible.

So, a tightening in Swedish terms but not exactly a local lockdown.

At the same time, the Swedish authorities have removed the special advice nationwide given to older people, so now all age groups have the same advice.

“It is not reasonable that risk groups should have to bear such a heavy burden for society in the long run, especially when we can see that the mental and physical consequences are significant for those who have been isolated,” said Johan Carlson, head of the public health agency.

“We can see that many lack social contact, they feel frustrated that they are treated differently in a stigmatising way. Anxiety has increased among those who suffer from poor mental health.”

However, Mr Carlson emphasised that there is still a much greater risk of suffering from serious illness if you are older. “Therefore you must make your own assessment of what risk you are prepared to expose yourself to,” he says.

What is interesting is that this apparent liberalisation of the rules is based on the opposite principle to the authors of the ‘Great Barrington Declaration’, who are arguing for shielding of the elderly only. It comes out of an egalitarian ethic, emphasising how everyone in society must be involved together. Here’s the Minister of Social Affairs Lena Hallengren:

“Basically, this means that everyone in Sweden has the same responsibility to protect themselves and others. This means that it becomes even more crucial for each of us to follow the advice that the government and others are calling for.”

It’s the latest example of the complexity of this debate: the Swedes are drawing on the principles of both sides of the argument as framed in the UK and US.

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Anna Burke
Anna Burke
2 years ago

This is so good to see the older more vulnerable people should just be left to live and make their own decisions and do what is best for their own individual needs. The fall out of the lockdowns have had a more disasterous effect than the virus itself.

ard10027
ard10027
2 years ago

Hmmm…no nationwide panic, no authoritarian commands from on high, no lockdowns of questionable legality but guaranteed to create resentment from the general population, just a calm assessment of the facts coupled with an honest declaration of same to the citizens and an acceptance than adults get to make their own choices. I dunno, are you sure Sweden practices socialism?

Daniel Björkman
Daniel Björkman
2 years ago
Reply to  ard10027

Well, more of it than Americans practice, yes. But our system is explicitly a compromise between capitalism and socialism. We never claimed, or wished, to be some sort of communist dictatorship.

tkreider2030
tkreider2030
2 years ago

Nah. Sweden has been as capitalist as the U.S. for 30 years, a country that also mixes the two.

Trish Castle
Trish Castle
2 years ago
Reply to  ard10027

And they followed an established epidemic response plan rather than copying China and opting for a totally experimental system of “lockdowns”. Look where that’s got so many other countries of the world which blindly followed each other 🙁

Roland Ayers
Roland Ayers
2 years ago

Although this approach obviously differs from that advocated by the Great Barrington declaration, I’m not sure it’s quite the opposite exactly. The situation has dragged on for six months now. It’s got to the point where arguably the negative effects of isolation, outweigh the risks of disease, even for the vulnerable, although this judgment will vary from individual to individual depending on how much socialising matters. If the Great Barrington signatories are right about the potential for the risks to be dramatically reduced within three months by means of herd immunity, there is no need for isolation to drag on intolerably long.

Elaine Giedrys-Leeper
Elaine Giedrys-Leeper
2 years ago
Reply to  Roland Ayers

And where is the evidence that any country could achieve herd immunity in 3 months without an effective vaccine ?
Please direct me to a modelling study that shows this because I haven’t found one yet.
Thank you

Trishia A
Trishia A
2 years ago

If there’s no natural herd immunity, there can be no vaccine herd immunity.

Elaine Giedrys-Leeper
Elaine Giedrys-Leeper
2 years ago
Reply to  Trishia A

Que ?
I don’t understand.
You can be rendered immune either by catching the disease and mounting an effective immune response that may last for a variable amount of time or you can be rendered immune by having a vaccination.

https://www.gavi.org/vaccin

psciagar
psciagar
2 years ago
Reply to  Roland Ayers

Also ‘shielding’ referred to in the GBC is not described and could be as simple as offering good resources e.g. shopping, checking up on by GP, community nurse etc. to minimise trips outside of the house, not ban them.

Trish Castle
Trish Castle
2 years ago
Reply to  psciagar

Yes exactly. I don’t think those who drew up the GBD were suggesting that what they said in there was the end of the matter. It was just a case of starting up a conversation about other ways to proceed rather than “locking down” the entire population. The billions which have been spent either directly or indirectly in an effort to minimise the chance of the at risk groups suffering could have been directed at providing a different model of elder health care.

Alex Lekas
Alex Lekas
2 years ago

“Therefore you must make your own assessment of what risk you are prepared to expose yourself to,” he says.
Well, yes. That’s how it should always be. Outsourcing risk to a third party with no stake in the outcome isn’t a strategy. There have been a few stories that have trickled out re: people who died because they were effectively denied medical care when Covid became the only condition that mattered. I suspect we’ll soon hear stories of seniors who isolated, despondent, cut off from friends, relatives, and normal human contact due to frantic people demanding that govt “do something.”

Jeremy Smith
Jeremy Smith
2 years ago
Reply to  Alex Lekas

“Outsourcing risk to a third party with no stake in the outcome isn’t a strategy”
Who is this 3rd party?
Nursing home in UK are private companies, do you see UK GOV saying it has nothing to do with us, it is a private matter?

Last Jacobin
Last Jacobin
2 years ago
Reply to  Alex Lekas

So, older person makes their own assessment, takes the risk, catches Covid and ends up in an ITU bed that results in someone else dying from something else because the bed was not available. That older person outsourced their risk to the person who died because they were in the bed. Is that the strategy you are encouraging?

Chris Clark
Chris Clark
2 years ago
Reply to  Last Jacobin

This is nonsensical. When we get ill or injured and require hospital care, we don’t and shouldn’t feel guilty because our needs might edge out someone else’s. Lots of illnesses and injuries are theoretically preventable – eg. injuries from car accidents – but we don’t suggest everyone stop driving because of limited hospital beds. As societies, we accept that at some point, all of us will require medical care, we all deserve access to that care in a timely fashion, and guilt is NOT part of that consideration.

Elaine Giedrys-Leeper
Elaine Giedrys-Leeper
2 years ago
Reply to  Chris Clark

Guilt doesn’t come into it. I would call it “being a responsible citizen” or “good manners”.

We might all deserve equal, timely access but in real life that has not happened in the UK since the introduction of waiting lists (and probably way before that).
The problem with Sars Cov 2 is that it transmits indiscriminately among those who choose to socialise and IF you get ill and require hospitalisation you will require much more care and for a longer time (up to 10 – 12 weeks in the worst case scenario) than an average flu patient – this is the ultimate example of bed blocking.
This transmission and hospitalisation problem is manageable IF people change their behaviour.
It would appear that Swedes have done this i.e. they listen to what their PH bods say and comply, whereas other countries haven’t + the Swedes have a BIG social advantage – almost 40% of households are single person entities – probably a game changer given that the majority of the spread with this little beastie occurs within households.

Trishia A
Trishia A
2 years ago

“bed blocking” like all the smokers, junk food eaters, non-sleepers, non exercisers?
that is not how healthcare systems work!

Elaine Giedrys-Leeper
Elaine Giedrys-Leeper
2 years ago
Reply to  Trishia A

Bed blocking in the NHS historically has been down to a chronic lack of appropriate care in the community for (mainly) elderly bods requiring rehabilitation at various levels.

Same problem now.

Isla C
Isla C
2 years ago

Elaine please explain what you mean when you say “it transmits indiscriminately among those who choose to socialise”

Does this mean the virus does not transmit amongst those who say don’t socialise but go to the supermarket, work in a school or public transport.. they are not socialising, so does the virus not transmit indiscriminately at these times?

I am just trying to understand your logic. Thank you

Elaine Giedrys-Leeper
Elaine Giedrys-Leeper
2 years ago
Reply to  Isla C

So my reading of the evidence right now is that the majority of transmission occurs when people gather together, unmasked in enclosed spaces, and in particular in households. Meeting outdoors is much safer because the droplets carrying the virus are very rapidly dispersed and diluted.

There is a nice BMJ Editorial about this with references from Aug 14 :
Covid-19: breaking the chain of household transmission (Published 14 August 2020)

A Prof Mike Weed has also done a couple of narrative reviews looking at indoor and outdoor transmission – I can only find the outdoor one which is a pre print : Rapid Scoping Review of Evidence of Outdoor Transmission of COVID-19 on Medrxiv Posted Sept 10 – this paper has a nice set of diagrams at the end running through the factors one should take into account when assessing the risk of transmission – how closed is the environment; how crowded; how much mixing of bodies is going on; how long you are going to be in the environment etc.

This is in no way an exact science. Each individual is supposed to do a wet finger in the air assessment and choose whether they want to enter a specific environment.

Isla C
Isla C
2 years ago

Also, could you explain perhaps how you would account for asymptomatic transmission?

Elaine Giedrys-Leeper
Elaine Giedrys-Leeper
2 years ago
Reply to  Isla C

My understanding is that anything from 20 – 40 % + of cases are asymptomatic judging by what happened on the Diamond Princess, the Charles de Gaulle aircraft carrier and in Vo, Italy (to name just a few studies).

The Vo study where they tested almost the entire population of the village (>2,500) on 2 occasions determined that the asymptomatics had as many virions up their noses as the symptomatics. There are other studies that show this as well.

So, asymptomatics and presymptomatic adults are as likely to transmit, given the right circumstances as someone who has developed a temperature.

Isla C
Isla C
2 years ago

Forgive me but I have to say you are on shaky ground if you are basing your understanding on only a handful of studies, you could have easily have quoted the study by University College London which tested thousands of households across the UK and found 86% of all cases were asymptomatic. This study was used by the Office of National Statistics.

Or if we take the VO study to which you refer, part of it says

“if we find a certain number of symptomatic people testing positive, we expect the same number of asymptomatic carriers that are much more difficult to identify and isolate.”

So they recognise that asymptomatic people, as you would expect are much more difficult to identify, and as such we should assume that there are much more of them than can be tested and accounted for.

Which leads me back to my point…
What do you do about asymptomatic transmission…

As you say they carry the same viral load. So logic would dictate that unless we lockdown the whole world everywhere, stop all international travel, then you are not going to eliminate the virus from our shores no matter how many fire breaks, circuit breaks, mini lockdowns you want to have.

I’m not trying to be difficult, just realistic.

Jane In Toronto
Jane In Toronto
2 years ago
Reply to  Isla C

Would we be doing ANY anti-covid measures if there were no such thing as a PCR test, and all we had were numbers for deaths and hospitalizations?

Alex Lekas
Alex Lekas
2 years ago
Reply to  Last Jacobin

it’s amazing how people instantly resort to the saddest, worst-case imaginable scenario in trying to put words in the mouths of others. The older person could end up in the same bed without making his/her own assessment, by following all the dictates but contracting the virus anyway.

As it is, NO ONE has died of covid for lack of a bed, at least not in the States. The same cannot be said of other conditions, where people were effectively denied treatment because nothing mattered but this virus.

Elaine Giedrys-Leeper
Elaine Giedrys-Leeper
2 years ago
Reply to  Alex Lekas

Well we hope no one has died from lack of a bed in the UK (unlike Italy) however, what is rather more important is the quality of care you receive once you are in an ICU (in particular), notably the nurse : patient ratio (normally 1:1 in a UK ICU but not during the spring) + the speed and efficiency with which ancillary services work e.g. how quickly do you get blood results back; how quickly can your microbiologist culture and identify opportunistic bacteria in a urinary catheter; how rapidly does your hiccoughing ventilator get fixed; how efficient is your local nursing bank at finding replacement nurses ? etc. etc.

Unfortunately with Covid 19, once you need hospitalisation, it is a resource hungry disease.

As for urgent non covid related treatments, I have 2 pals whose cancer treatment continued unabated throughout the spring. I am sure they weren’t exceptions.

John Chapman
John Chapman
2 years ago

I was due a biopsy for prostate cancer in late March, which was cancelled. Instead I now have had an MRI a week ago and a review in January 2021.

Isla C
Isla C
2 years ago
Reply to  Alex Lekas

Thank you Alex, I agree people often do jump to worst case scenarios, long covid comes to mind also…
And as for lack of a bed, in Glasgow the much fan fared Louisa Jordan hospital was set up in just 2 weeks during April, at a cost of £70 million, and has yet to see one covid patient!!!!

Pete Kreff
Pete Kreff
2 years ago
Reply to  Last Jacobin

So, older person makes their own assessment, takes the risk, catches Covid and ends up in an ITU bed that results in someone else dying from something else because the bed was not available.

That could equally apply to an old person who has a weak heart but decides to go for a walk anyway. The old person then suffers a heart attack and has to go into hospital for urgent treatment.

Old people face greater risk from numerous health factors. By your logic, that old person acted irresponsibly and should have stayed at home. Is that right?

Ted Ditchburn
Ted Ditchburn
2 years ago
Reply to  Last Jacobin

The fact is with the average age of death from Covid-19 being higher than avergae life expectancy the people blocking the beds seem to be the people who would be in them suffering from something else.

That was indicated by the excess deaths turning negative for a number of weeks.

But even so, we can’t set about trying to balance off smokers, chubbies, drinkers, people who take drugs then smash up their cars, or even madcap extreme sports people who bash in their heads or create long term damage to joints etc. to try and decide on the worthy sick and separate from the unworthy?

Kelly Mitchell
Kelly Mitchell
2 years ago

Don’t agree that it contradicts Barrington. They never said to forcefully isolate anyone. Just support people’s personal intent in whichever direction.
Also, Sweden may be calculating in the arrival of Herd Immunity there, meaning – the Barrington approach is in the rearview mirror. Mission accomplished.

Elaine Giedrys-Leeper
Elaine Giedrys-Leeper
2 years ago
Reply to  Kelly Mitchell

Herd immunity has never been top of the list as far as the PH professionals in Sweden are concerned :

Tegnell in the Telegraph 30.09.20

“While playing down reports that Swedes may have developed “herd immunity”, Tegnell said the differences between his country and the likes of Spain and the UK are clear.
He said: “I’m not sure that the level of immunity in Sweden and in Spain differs very much.
“I think the main difference between Sweden and many other countries is that we have had the same kind of restrictions and recommendations in place the whole time.
“And we have a really big adherence from the population to those recommendations.
“And that makes a difference, that makes us hopefully less susceptible to a second wave.”

and from the horse’s mouth :
https://www.youtube.com/wat

and according to the Swedish PH agency at week 18 the population seroprevalence was 3.7 – 7.3% and a study in September showed a seroprevalence of 8% in Swedish HCW (where you would expect a higher seroprevalence) https://www.news-medical.ne

so ….. no sign of herd immunity developing any time soon.

Laura Creighton
Laura Creighton
2 years ago

In Sweden, at any rate, we now know that a large proportion of the people who caught covid in March, were tested with the swab test, so we know for absolutely certain had the disease, do not test for antibodies when people went looking in March.

I don’t know why you can post links but whenever I try my posts never come through. Google up ‘Karolinska Intstitute Immunity to covid is probably higher than tests have shown’

In this study they were finding that twice as many people had t-cell immunity as test positive with antibody tests. Since there is only one confirmed case of a person in Sweden
catching covid twice, there is certaintly something that is making test negative testers immune to catching covid a second time, or else the hospitals would be filling up with them now. Since there seems to be a relationship between
how severe your covid was and whether antibodies are detected later, we really have no clue how many people who had mild symptoms, stayed home, got better and never were tested and are immune now. They are likely to test negative for antibodies whether or not they had a disease.

But the t-cell test is apparantly to expensive and time consuming to do on a large scale, even though there are many people in Sweden who would gladly pay for one were it available.

Laura Creighton
Laura Creighton
2 years ago

If you google up “Karolinska Institutet Immunity to COVID-19 is probably higher than tests have shown” you will discover that in Sweden where this was researched 2x as many people have no detectable antibodies to covid but do have t-cell immunity compared to those that do have testable antibodies. Since there is a relationship between how severe your covid was and whether we detected antibodies later — the sicker people were more likely to have them — the real number for how many people are immune but have no detectable antibodies ought to be much higher than 2x.

(ps — I pasted in the link and my comment was rejected as spam. Wish I knew how you get to post yours.)

Alex Collinson
Alex Collinson
2 years ago

It does bug when documents like the GB Declaration are used to make unnecessary inflammatory remarks. Whilst it says the emphasis should be placed on protecting the vulnerable, the GB Declaration clearly states that all individuals should be allowed to judge their own risk. This is exactly what Sweden is now doing and is 100% aligned to the GB Declaration.

Well done Sweden. The epidemic is over, with marginal levels of risk. Let the people decide by informing them with the facts and not lies like SAGE in the UK designed to keep people in perpetual fear.

Rob Alka
Rob Alka
2 years ago
Reply to  Alex Collinson

“Protect the vulnerable” but “let everyone judge their own risk” is the necessary two-way face the GB declaration has to wear if they are to persuade the meek to if not to inherit the earth at least remain on it.

Fran Martinez
Fran Martinez
2 years ago

There is no contradiction with the ‘Great Barrington Declaration’. They clearly state that everyone should be free to choose whether to self-isolate or not. What they said, is that the government should give you the tools (accurate information, economic help, etc.) to self-isolate if you decide to do so. But that those that choose not to (whether because they are young and fit or because they value more spending time with grandkids that living extra time in isolation) can keep going on with their lives.

Sadly, another big misinterpretation of the ‘Great Barrington Declaration’.

chrisjpj1977
chrisjpj1977
2 years ago

An over simplistic description. Social norms of behaviour are extremely strong in Sweden. While this policy might work there its very unlikely to translate to the UK. In practice I expecte the consequences will be a rise in mortality. But perhaps that’s accepted as long as you know what you are doing.

Pete Kreff
Pete Kreff
2 years ago
Reply to  chrisjpj1977

Google Mobility data has shown that Swedes spent much less time in their homes during the spring than the populations of countries where lockdown was imposed. Swedes spent more time at work, used public transport more and spent more time on recreation and retail.

The idea that all Swedes stayed at home because they’re such obedient citizens is nonsense.

stephensjpriest
stephensjpriest
2 years ago

Hello Unherd

Brilliant Speech – everything you would want to say
“Herd stupidity!” Desmond Swayne calls out coronavirus fearmongering
Conservative MP Desmond Swayne gives a passionate speech in the House of Commons on fearmongering around the coronavirus pandemic and subsequent lockdowns.
YOU TUBE watch?v=pl3d8DZwQlo&list=WL&index=68

****************************

Restaurant owner punished for opening door on a hot day speaks out on ‘Tucker’
You Tube watch?v=paqGbcVtYIk
****************************

Melbourne’s ‘Dan Andrews apologist’ Lord Mayor must be voted out
YOU TUBE watch?v=tIgQuHG9zq0

Sky News host Alan Jones says Victorians have a chance to vote out Melbourne’s Lord Mayor Sally Capp, a “Dan Andrews apologist” who pretends to be independent.

stephensjpriest
stephensjpriest
2 years ago

Amazing Debate on Lockdown Ideology versus Scientific Approach – Unmissable!!
YOU TUBE watch?v=Qgn4B2Iq2cg

Ivor Cummins
Wow – this one really covers the reality – excellent debate, and finally we are seeing it televised on mainstream!

Rob Alka
Rob Alka
2 years ago

Sweden’s “apparent liberalisation of the rules is based on the opposite principle to the authors of the ‘Great Barrington Declaration’, who are arguing for shielding of the elderly only.”

Great Barrington Declaration is understandably reluctant to admit to a Swedish outlook, which recognises that elderly/vulnerable people are not children and are capable of making their own decisions, including asking other people or state institutions for help or protection if they so wish. The idea of announcing a policy or strategy to help vulnerable people to avoid dying unnecessarily is pathetic. Our new policy: to be nice rather than beastly. Wow, how daring! Has humankind descended to such a dystopian level when society generally and government specifically can’t exercise that instinctive behaviour without it being a specific policy? It is partly that we are descending in that way and maybe that is way society and government now seek to wear on their sleeves a touchy-feely attitude to practically everything, just to make it clear to everyone else that they are not the devil incarnate.

I’m sure the team behind The Great Barrington Declaration realise that it is an uphill climb to persuading society to come to terms with the inescapable fact that life on earth offers zero guarantees about everything and anything and therefore the least the Great Barrinton team can do is to appeal to a touch-feely virtue signalling society that the oldies must be shielded …….whether they want to be shielded or not ……. even if that is how carers morph into patronisers, condescenders and even Nurse Ratchetts. Thank heaven for mortality!

Jon Hunter
Jon Hunter
2 years ago

“What is interesting is that this apparent liberalisation of the rules is based on the opposite principle to the authors of the ‘Great Barrington Declaration’, who are arguing for shielding of the elderly only.”

Actually this move by Sweden is the ultimate outcome of the Great Barrington Declaration as that document envisions shielding the elderly for a period of time (until enough of the rest of the population have gotten the virus such that population immunity is achieved and the the now endemic virus enters into an equilibrium with society whereby you get small outbreaks among some people much like other common respiratory viruses). Even though there has been a slight rise positive tests results in Sweden, deaths have still remained fairly low, so Sweden’s approach is consistent – continuing to advise the elderly to shield when deaths have fallen and remain low is unwarranted.

Sweden is just ahead of the curve in relation to the Great Barrington Declaration’s envisioned procedures and timing of events.

jkellymetal
jkellymetal
2 years ago

Old peoples’ health care costs more. That is exactly why Gov’ts who offer Free health care need them to die earlier.

Ted Ditchburn
Ted Ditchburn
2 years ago

The very latest figures are showing cases rising in Sweden again…later than us and Southern Europe, France, Germany, but rising.

The Swedish example seems to rely as much on projecting supposed social differences and so on as actual facts relating to how effective *light touch* regulation is being in this.

Just to chuck something else in, I feel that socities that were divided and with very adversarial media embodying those divisions have done worse than either less divided socities, or socities were divisions have not been so amplified.

I mean the USA (Trump: for or against) us (Brexit) Spain (Catalonia and left vs right) and France (Gilets Jaunes, Islam situation etc).
Sweden has problems, and I am talking ‘from afar’ and no expert but it seems to have to have a less overtly antagonistic broadcast and print media constantly criticising the government across successive news cycles and switching the criticism from point to point all the time?

Such as toggling rapidly between *Covid deaths* and *economic Harm* constantly.

If common-sense and following the basics of hand washing, distance where necessary and so on is all that’s needed that we would be following that as a baseline set of behaviours and seeing similar levels as Sweden? Or even lower given *harsher* lockdown measures over and above the basics.

If this isn’t the case, and it isn’t, then we have to look at ourselves as individuals for not doing sensible stuff and (My point anyway) the way our divided societies and divisive media scene impact negatively on behaviours at an individual level.

stewartdredge
stewartdredge
2 years ago

“Therefore you must make your own assessment of what risk you are prepared to expose yourself to”
This is a bit simplistic. When an individual “takes a risk” in such circumstances, he or she does not take that risk alone.
Other people are placed in danger too, often in circumstances over which they have no control.
Sweden still seems unable to decide whether the right to individual self-indulgence outweighs the responsibility to protect everyone in their community.

chris sullivan
chris sullivan
2 years ago
Reply to  stewartdredge

Many elderly are saying ‘do not wreck the system for us – it is a form of ageism in that we are not permitted to make our own decisions and are viewed as at least semi-incompetent’. Many, if not all of us, have spent our lives making autonomous risk assessments as a matter of course and now a bunch of youngsters are making laws that diminish our remaining years and worse emotionally blackmail the whole population into reinforcing that. Maybe done with the best intentions but rather fascist given the collateral damage and lack of consultation – yes yes it was an emergency scenario but it aint now !

Roland Ayers
Roland Ayers
2 years ago
Reply to  stewartdredge

Some people’s behaviour could be seen as self indulgence. Yet Homo sapiens is an inherently social species. That’s not going to change, so any policy attempting to supress this natural behavioral trait cannot continue indefinitely, unless we become an authoritarian police state. Armed police did shut down a gym in Liverpool recently, so perhaps that’s one way things could go?