Why rebel Sweden got it right during the pandemic

In 2021, the British government had to apologize to its citizens for having used panic incitement techniques on them to comply with the strict rules of confinement, distancing and wearing masks in the pandemic. There was a whole academic musing behind the frightening deception, from mathematical models of exaggerated results to the theory of the “little push”. The scandal was only second to the “partygate”, the revelation that Prime Minister Boris Johnson was throwing parties full of people while ordering the population to stay isolated at home.

But there was a moment when the British signaled that they would act differently, at the beginning of 2020. They, along with most of the world, missed the opportunity to follow the example of Sweden, which dared to keep freedoms for the most part intact in the face of the threat. viral and remained a point out of the curve even regarding the vaccination of children against Covid-19. The world condemned Sweden, which almost alone swam against the grain. And now the world will have to admit that it was wrong.

The story of how it was possible for Sweden to be so independent is told in the book The Herd, launched in March by Swedish journalist and writer Johan Anderberg. In free translation, the full title is The Herd: How Sweden Chose Its Own Path Through Worst Pandemic in 100 Years.

Anders Tegnell, the stubborn

After the February 2020 school holidays, four authorities met in Sweden to talk about containment measures for the virus that was already wreaking havoc in Italy and Spain. Jan Albert, professor of infectious disease control at the Karolinska Institute; Johan von Schreeb, Swedish medical celebrity who founded the local section of Doctors Without Borders and won the title of ‘Swede of the year’ in 2014 by Fokus magazine; Denis Coulombier, French department head of the European Center for Disease Prevention and Control (ECDC), based in Sweden; and the last to arrive at the March 6 meeting, Anders Tegnell, the state’s chief of epidemiology.

The projections Jan made for Stockholm were troubling: “There is an opportunity to act now,” he said. One in five hospitalized patients needed intensive care in Italy, added Johan. Children’s return to school will be an event that amplifies infections, warned Denis.

“No need,” Anders replied, to the astonishment of the other three. He hadn’t yet seen community transmission, Swedes infecting Swedes. Even Anders’ previous actions seemed to contradict that stance, as he had vaccinated Sweden’s entire population against swine flu in 2010. No one else in the world has done that. Perhaps this action was one of the lessons that the epidemiologist took into account. Hundreds of young people suffered from narcolepsy as a result of that vaccine, while the swine flu turned out to be mild and soon fell by the wayside.

Anders Tegnell’s co-workers, according to the book, say he is prudent, controlled and calm in the face of pressure and stress. This sexagenarian describes himself as a “square” man, sometimes drawing a square in the air. He has always preferred patients who want a clear and objective message to those who demand that he sweeten the pill and ease the situation. For his career, he had already lived in Ethiopia and Laos, so he had already been through hardships. In the course of the path that led him to be that way and decide to go against the tide in the pandemic, he was greatly influenced by Johan Giesecke, his predecessor in the position of epidemiologist at the Swedish Public Health Agency, who is also his mentor.

The two met in the 1990s at a meeting of epidemiologists. When Anders, still with his Lao tan, opened his mouth, his future mentor thought, “Wow. This guy is completely apolitical” – which was a compliment. “I want him. Go work in Stockholm.” Twenty years later, in 2013, the apprentice took the master’s chair.

The voice of experience

In the first chapter, Johan Anderberg presents Anders Tegnell’s mentor as follows: “Many doctors were forced into the profession by their parents. We will meet some of these in this book. For Johan Giesecke, it was the opposite. When he came home one day and said he wanted to study medicine, his father replied ‘Why?’ ‘I want to work with people,’” Giesecke replied. His father, influential in Sweden, would prefer that his son one day be boss at Ericsson or Volvo.

Not only did Giesecke become a doctor against his father, but he married a doctor and had three children with her who also became doctors. He became the first chief scientist of the ECDC, which he helped found. As an epidemiologist for the Swedish agency, he faced HIV, and Asian, swine and avian flu, and witnessed the Asian flu (also coronavirus) in China itself at the beginning of the millennium. Already retired, at age 70, he found out about the new coronavirus in January 2020, visiting a website interested in pathogens that he has frequented since the internet was created.

That month, the World Health Organization (WHO) had declared that the Wuhan virus in China was not able to pass from one person to another – believing in the Chinese dictatorship. On the 20th, China admitted that this was not true. Four days later, Tegnell himself told the Swedish people that there was no reason for concern. At the same time, on the exact same day as the declaration, a Swedish woman infected in Wuhan was returning to Sweden. She came to the hospital a week later and was one of the first 150 cases outside China.

In March, after that meeting, the pressure was already high. Epidemiologists who had Tegnell’s employees as doctoral students and had a personal relationship with Giesecke called for more restrictions. Medical publications added up to hundreds of important names in national medicine angry with the Public Health Agency in the comments. Italy and Japan closed their schools, France did not call students back to school after the holidays, Germany registered everyone who entered the country. But Anders Tegnell held out with the tenacity that had impressed his predecessor.

A clue as to exactly how Johan Giesecke influenced his pupil to nurture independence of thought is in a text that the mentor published in 1992 in the newspaper Nyheter Dagens. “Don’t listen to the medical sciences!”, with an exclamation, is the title. In the column, he explains that it was not medical advances like drugs and surgical technologies that extended life in the rich world. It was basic sanitation, food security and the best housing. It was not so much science, but society: democracy, market economy and institutions. “Be careful when changing a habit you enjoy, or when starting a lifelong preventative treatment, simply because research has found it could help with a specific disease,” advises Giesecke, then a professor of infectious diseases, ‘speaking ill’. of the area itself. In his lectures, he said that the death rate in Sweden was 100%. “If we can stop people from dying from a certain disease, what else is going to kill them?” he says in the article. It is a point of view of compensation between evils, rather than offering perfect solutions.

In the fateful month of March 2020, the mentor returned to active duty at the invitation of the mentee to a group of experts that would discuss the new virus. Giesecke received data from Italy, thanks to his previous work at ECDC with a collaborator who was native there. Analyzing the high rate of asymptomatic, he bet that Sweden was already in the pandemic phase and, therefore, it would not even make sense to trace contacts of infected people. In a month or two, he gambled, the country would have herd immunity, a concept that came under attack from alarmists at this stage of the pandemic. The other team had already achieved some victories: banning gatherings of more than 500 people and canceling trips to Sweden. These measurements made no sense to him, as they would be like wiping ice at that point. A focus on vulnerable groups would make more sense. So Giesecke suggested banning visits to senior citizens’ shelters. Tegnell agreed.

As for closing schools, Giesecke was absolutely convinced that it would be the wrong way to go. It wouldn’t be fair to the kids. He remembered studies showing that absence from school has an adverse effect on them well into adulthood. In addition, no outbreaks of Covid-19 had been observed in schools. He also used knowledge of history: 102 years earlier, during the Spanish flu pandemic, a New York City health official had kept schools open. Again, as in the 1992 article, Giesecke used knowledge from other areas to criticize his own. In meetings with experts like the three at the March meeting, he was uncharacteristically quiet. He just needed to convince his pupil Tegnell, who had the decision-making power.

At the height of the pressure, when neighboring Denmark and Norway closed schools, Johan Giesecke reassured Anders Tegnell with a quote in an email: “An nescis, mi fili, quantilla prudentia mundus regatur?”. The Latin phrase is from a letter from the 1640s from Sweden’s High Chancellor Axel Oxenstierna to his son who was anxious about his trip to the peace negotiations in Westphalia. The translation: “Do you know, my son, with how little wisdom the world is governed?”

As for the ghastly Imperial College model that led the UK to lockdown and school closures, Giesecke once again pointed to the past: the same Imperial College research group got it wrong during the mad cow outbreak in 2001: “They thought 50,000 people would die. So how many died? 157.” The alarmist forecast led to the slaughter of millions of cattle. Four years later, they predicted that 150 million would die from bird flu. 455 died. And another four years after that, they predicted 65,000 deaths from swine flu, the real number was 474. “They missed the mark well”, observed the Swede.

a matter of institution

With the pair of rebellious scientists resisting pressure from the world and from their own colleagues, among whom even friends, the Swedes continued their lives in almost complete normality. No mandatory masks or closed schools. “A disaster,” said Time magazine. The bad example “is a lesson to the world,” said the New York Times. “Fatal nonsense,” added The Guardian.

Francis Fukuyama, in the book Political Order and Political Decay, makes a diagnosis of the reasons why the American government is doomed to be inefficient. “The United States is stuck in a bad balance. Because Americans have historically distrusted government, they are typically unwilling to delegate government decision-making authority in the manner of other democratic societies. Instead, Congress sets complex rules that reduce government autonomy and make decisions slow and expensive. So the government does not do well, which confirms the original distrust of the people”.

Scandinavia as a whole has high levels of trust in government compared to other regions of the world. In Sweden, the Constitution gives government agencies extreme autonomy in their area of ​​operation, in addition to emphasizing the right to come and go within the country. But for Johan Anderberg, the author of the book, the best explanation is that the Swedes simply looked at the data and gave an alternative interpretation to it. They didn’t believe the apocalyptic scenario that captured the imagination and anxiety of the rest of the world, especially the one presented by Imperial College, which took over social networks even in Brazil.

Consistent with its track record, the Imperial College prediction applied to Sweden was badly wrong. By July 2020, Swedish academics who applied the model predicted between 85,000 and 96,000 deaths. The actual death toll was 6,000 — with free travel, gyms and schools open. Sweden’s educational indicators remained the same as before the pandemic. Other countries, including Brazil, cannot say the same.

As they say in medical studies, Sweden was the “control group” in the world. It is the comparison group that is not given the pill—in this case, the bitter pill of deteriorating education and commerce. According to the World Health Organization, Sweden had an excess of deaths in 2020 and 2021 of 56 in 100,000. One of the smallest in Europe, below the global average. The UK had a death rate of 109 out of 100,000. Brazil, 160.

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