Features Australia

Has Sweden really pulled it off?

The nightmare of trying to compare Covid strategies

19 September 2020

9:00 AM

19 September 2020

9:00 AM

Those who question Australia’s official coronavirus narrative are met with the dismissive retort: Australia with 25 million people has 770 deaths (9 September); Sweden with 10 million people has nearly 6,000 deaths. Comparing Australia and Sweden is questionable. What’s the baseline for cross-country comparison: population, age profile, political system, geographic region, racial mix, industrialisation and income levels, proximity to virus hotspots?

The virus response spectrum has four policy settings: ‘let it rip’ do nothing; flattening the curve; community suppression; and elimination. Belarus seems to have got away with the first, but Brazil has paid a heavy price. At the other end, elimination is also dangerously delusional. It requires local, national and global eradication as was done with smallpox. Coronaviruses keep circulating, albeit with progressively decreasing virulence.

The rest divide between the second and third options. Although Premier Daniel Andrews ‘is going for elimination, not suppression’, the rest of Australia began with flattening the curve – reasonable and realistic – but morphed quietly into community suppression. Australia’s coronavirus paradox is that infections and deaths are near the bottom in global comparison, yet many lockdown stringency measures have been over the top. The shocking case of Zoe Buhler has drawn widespread condemnation and will be a permanent stain  on Andrews’ name. Will Australian governments hand back power they’ve seized from citizens for our own good?

Countries that locked down hard and those that did not have widely varying mortality rates. In the first group are Peru (907 deaths/million), Belgium (854), Norway (49) and Australia (30). The second includes Sweden(577), Belarus (76), Taiwan (0.3) and Vietnam (0.4). A wide range can also be seen among US states, from New York (1,701) and Massachusetts (1,326) with tough lockdowns, to North and South Dakota (205, 196) with no lockdowns. Forget causality; there’s not even a clear correlation in either direction. This makes it easy to cherry-pick examples to fit the preferred narrative. Why is Sweden a better benchmark for Australia than hard-lockdown Belgium and Peru on one side, or Taiwan and Vietnam on the other?

The effectiveness or futility of lockdowns cannot be proven conclusively. The only non-lockdown country in the top dozen mortality rates is Brazil. A Lancet study concluded: ‘Rapid border closures, full lockdowns and wide-spread testing were not associated with Covid-19 mortality per million people.’ A study of US states offered two conclusions: lockdowns didn’t help to contain the spread of the virus and opening up didn’t hurt.

The Centers for Disease Control and Prevention has the stunning statistic that just 6 per cent of US Covid deaths don’t have another serious illness; 94 per cent had 2.6 comorbidities on average. In Australia, Epidemiology Report 22 recorded only 9 per cent with no comorbidity in Covid-19 hospital admissions for the fortnight ending 2 August. This adds grist to the controversy mill over dying of or with Covid. The impossible distinction distracts from a deeper reality. Across all age groups, including the elderly, the ‘marginal’ risk of death caused by Covid is small. There is no justification for turning a national health service into a national coronavirus service.

Herd immunity – where ‘the chain of contagiousness toward the vulnerable’ is broken when enough of the population has immunity to an infection – is very controversial. In July, the Australian was criticised by Dr Jim Newcombe, infectious diseases specialist at Sydney’s Royal North Shore Hospital, for ‘a dangerous misrepresentation of the scientific data’ by giving publicity to Sunetra Gupta’s views on herd immunity. She’s just a Professor of Epidemiology at Oxford.

Lockdowns are the experiment that departed from the prevailing orthodoxy summarised in a WHO report last October. In a 2006 study led by Thomas Inglesby, Director of Johns Hopkins’ Bloomberg School of Public Health, concluded that ‘communities faced with epidemics or other adverse events respond best and with the least anxiety when the normal social functioning of the community is least disrupted.’ Sweden’s policy to flatten the curve was orthodox and may have produced herd immunity as the outcome, not as the driving strategy. This means there is much scientific uncertainty rather than consensus on lockdowns and herd immunity – all the more reason to give voice to contesting viewpoints and base policy on informed scientific debate.

Herd immunity is in fact the goal of all countries. The difference is in the choice of routes by which to get there and how to minimise casualties until then. It can be achieved most effectively with a vaccine. Herd immunity for many illnesses through vaccines is commonplace and uncontroversial: to oppose herd immunity is to be an anti-vaxxer. The risk of lockdowns until a vaccine is discovered, tested (fast-tracking would worry me) and mass manufactured, is the growing trail of harm to lives, livelihoods and the social fabric that binds a community.

The natural route to herd immunity is through cell-based immunity and antibodies that could permit a gradual but controlled spread of the virus without overwhelming the health system. The reason most governments shied away from the herd strategy was the belief that this requires 60-70 per cent of the population to be infected. With the initial alarming case fatality rates reported from China, the horrific scale of lives this would have sacrificed was unacceptable. However, more recently researchers have begun to suggest, not without pushback, that the immunity threshold could be as low as 20 per cent and fatality rates are much lower than initially projected by the fear-mongering modellers.

There are two notable features about the recent rise in infections across Europe. First, increased infections are accompanied by flatlined deaths. This might suggest that the rise in infection numbers is an artefact of increased testing, with ultra-sensitive testing possibly picking up fragments of dead virus from old infections; and also perhaps that de facto herd immunity has been achieved in some countries. Second, the infection as well as death curves are flat for Sweden. Its economic damage has been well below the average, prompting Allister Heath to comment: Sweden ‘has pulled off a remarkable triple whammy: far fewer deaths per capita than Britain, a maintenance of basic freedoms and opportunities, including schooling, and, most strikingly, a recession less than half as severe as our own.’ The real test of how successful Sweden has been compared to other European countries will come next winter.

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