Has Sweden's COVID-19 approach paid off?

At the very beginning of the pandemic Sweden received huge amounts of attention for its unique approach to COVID-19.

While other countries implemented strict lockdowns in an effort to stop the spread of the virus, Sweden instead relied on voluntary social distancing.

Businesses and schools were allowed to remain open but large public gatherings were banned.

This approach received widespread criticism, however the Public Health Agency's lead epidemiologist Anders Tegnell defended it at the time, saying the country was simply taking a different approach.

"Sweden has gone mostly for voluntary measures because that's how we're used to working," Tegnell told CNBC in April.

"And we have a long tradition that it works rather well. So far, it's been working reasonably well."

But how has that approach stood up over time?

While recently the daily death rate has been dropping as well as the number of new cases, University of Auckland microbiologist Siouxsie Wiles says this doesn't mean Sweden's approach is working.

"There are lots of reasons why the death rate may have fallen, including that doctors have been getting better at treating the disease," she said.

"It's also the case that much of Sweden has been on holiday for the last few weeks, so we may see cases start to rise again as people return to work and schools reopen."

Wiles also warned that Sweden's approach risks the lives of vulnerable people and fails to take into account the long term health impacts.

"It is very difficult to protect all those who would be vulnerable to having a severe COVID-19 infection, so comes with the risk that many people will die unnecessarily."

"Another problem is that there are more and more reports coming out of people experiencing symptoms for months and months and the risk that even a mild infection could cause long term health problems. It's a very risky approach."

And while the death rate has been dropping, 5802 people have still died from the virus and there are 85,411 confirmed cases. This is close to six times worse per capita than Denmark and about 12 times worse than Norway, both of which implemented lockdown measures.

Long term health implications is a concern shared by University of Otago professor of public health Michael Baker who said the perceived benefits don't outweigh the risks.

"Taking a 'herd immunity' approach would result in large numbers of deaths and people left with severe chronic illness."

One of the biggest arguments in favour of looser lockdowns is the economic benefits of allowing businesses to operate freely. But Baker said lockdown measures, like New Zealad's, are actually less disruptive to business than being in a constant state of lockdown like areas overseas.

"Elimination offers economic benefits by providing a return to near-normal functioning of the internal economy and a degree of business certainty."

However, University of Auckland senior lecturer of Epidemiology Dr Simon Thornley told Magic Talk on Wednesday that Sweden's approach shouldn't be written off.

Thornley, who is the part of the COVID Plan B group which has raised concerns about New Zealand's lockdown, says when compared to other countries Sweden is not doing too badly.

"There are a number of us [people who are sceptical of lockdowns] who think that the Swedish model of opting for social distancing and protecting the elerdely is the best approach."

"Swedish is not doing as badly as a number of other countries that have had harsh lockdowns.

"It's very hard to trash Sweden's approach...the UK has had much higher per capita deaths and cases from COVID than Sweden and yet no one is pointing the finger at them."

He pointed to the falling death rate as a sign of the country's success.

"If you look at the deaths in Sweden the outbreak is almost over now. Deaths have been very low and you can see the curve has gone up and now it has come down and they are not facing the prospect of long border closures and long lockdowns," Thornley said.

Thornley isn't alone in his views with professor of infectious disease and epidemiology at Stockholm's Karolinska Institute, Joakim Dillner, telling ABC Sweden's approach has worked.

"We've had a rather open society, based on recommendations. We've not really had draconian measures, but it's still obvious that it worked."

Dillner did however acknowledge that the country should have tested more at the beginning of the pandemic.

"There was no screening of the healthcare workers in homes for the elderly, and I think at least in the scientific community, we're upset about that," he told ABC.

"We feel that when the WHO said 'test, test and test again' -- we should have done that."

But Dillner said it will take time to see whether Sweden's approach has paid off or not.

"This is the big worry, no-one knows what will happen in the future," he told ABC.

In April University of Canterbury professor of epidemiology Dr Arindam Basu warned that if New Zealand adopted an approach similar to Sweden, and even a conservative 10 percent of the population caught COVID-19 that would still be 500,000 people which could overwhelm hospitals.

Instead New Zealand went into a strict lockdown and Auckland has since been placed in a second alert level 3 lockdown in an effort to stop the virus from spreading.

New Zealand has a total of 1,649 confirmed cases and 22 deaths.

Internationally, New Zealand has a high prevalence of asthma, with one in seven children (13 percent) aged 2–14 years (110,000 children) and one in eight adults (12 percent, 452,000 adults) and that is reporting taking current asthma medication. (whilst not the highest in the world it would have been taken into consideration when making the decisions). Add to this number around 200,000 Diabetics.

Asthma and diabetes being on the high-risk list for COVID-19. Now add in your elderly with past medical issues and any other New Zealander with any medical problems... it is a huge chunk of the small population at high risk. Also, New Zealand's first case of COVID happened in February, and the lockdown happened in March which is the beginning of Autumn. Currently, August middle of winter New Zealand is in the middle of its Flu season. So extra precaution needs to be there as well.

New Zealand only has around 358 ICU beds and only about 334 ventilators spread around the country in its various hospitals. The whole idea of any lockdown is to not overwhelm the health system so that there are always ICU beds and Ventilators available for COVID-19 victims and other emergency victims.

As Dr Arindam Basu warned that if New Zealand adopted an approach similar to Sweden, and even a conservative 10 percent of the population caught COVID-19 that would still be 500,000 people which could overwhelm hospitals. And that's when more deaths would happen from COVID-19 and other emergencies as the health system is overwhelmed.

Also, remember Auckland is not in full lockdown at the highest alert level before lockdown Alert Level 3 and the rest of the country is only at Alert Level 2) The whole plan from the beginning was isolate any outbreak before it gets out of hand in any way which would result in another countrywide lockdown. Having small outbreaks and controlling them as fast as possible means the health system can keep up.

Economically speaking at Alert level 4 (full lockdown) it was estimated 50% of workers were at home, alert level 3 around 20%, alert level 2 6-10% and Alert Level 1 was all business can operate. We are still aware and taking various precautions at the border etc. But mistakes happen, human error happens and we will most likely have a few more outbreaks here and there till a vaccine is available.

Throughout the full lockdown, import and exports still happened, while many local businesses struggled many found new ways of doing things and while yes, some went under, many found it was not as bad as they thought it would be and have had to pay back the wage subsidies. But no matter which way you do it every country will have a downturn.

As for the myth of it being no worse than a bad flu year and fewer deaths than influenza. The World Health Organisation says COVID spreads faster, and
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-similarities-and-differences-covid-19-and-influenza

So please take this into consideration when you start any criticism.