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Swedish Model | Munk Debates

EPISODE #41

Swedish Model

Be it resolved, Sweden is the model for how to fight this pandemic and the next.

Guests
Jonas F. Ludvigsson
Lena Einhorn
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About this episode

In a world where shutdowns and quarantines have become the norm, Sweden stands out for choosing a pandemic strategy that is markedly different than its peer nations. In Sweden, bars, restaurants, public spaces, and most significantly, elementary schools have continued to operate since COVID-19 began its spread through the country last March. The Swedish model for fighting the pandemic does not enforce quarantines for infected households let alone entire cities and counties. Mask wearing and social distancing are entirely voluntary. Supporters of the Swedish model argue that its strength lies in being sustainable over the long haul, grounded in the recognition that the virus will be with us for many years. Critics say this strategy has come at way too high a price. Almost 6,000 citizens have died from the virus, one of the highest per capita death rates in the world. At the same time immunity has not significantly increased, and the economy is not faring much better than countries enforcing stricter policies. They fear that without a complete rethink of its pandemic strategy the country is headed for a public health disaster in the autumn.

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Guests

Jonas F. Ludvigsson

"This is not about running one hundred yards. This is a marathon. Herd immunity is higher in Sweden than in many other countries."

Jonas F. Ludvigsson

"This is not about running one hundred yards. This is a marathon. Herd immunity is higher in Sweden than in many other countries."

Dr Jonas F Ludvigsson is a professor of clinical epidemiology at the Karolinska Institute in Stockholm, and a senior pediatrician at Örebro University Hospital. He has authored more than 400 publications including publications in the New England Journal of Medicine, The Lancet and JAMA in 2020. He is the former chair of the Swedish Society of Epidemiology (2011-14) and the Swedish Society of Pediatrics (2014-16). He is also adjunct professor at the Department of Medicine at Columbia University, New York, US.

Lena Einhorn

"Sweden is not a model to follow because of our really high death numbers in a sparsely populated country. We’re just letting the virus run the show."

Lena Einhorn

"Sweden is not a model to follow because of our really high death numbers in a sparsely populated country. We’re just letting the virus run the show."

Lena Einhorn is a physician with a PhD in Virology and Tumor Biology from the Karolinska Institute, Stockholm, and member of Sweden’s Scientific Forum on COVID-19. Her research ranged from tumor viruses, to the question of what it is in embryonic life that so strongly inhibits the development of cancer in fetuses and newborns.
 
In the late 80s, she changed professional course entirely. Living in the United States, she started working as Medical Editor at Lifetime Television in New York, where she eventually also started producing and writing medical documentaries. She continued producing documentaries in science and medicine, for independent production companies as well as for PBS.
 
In 1993, Einhorn started making television programs also for Sveriges Television (SVT), the Swedish public broadcasting service, and started moving from pure science programming to other forms of documentaries, as well as drama-documentaries.
 
In September 2019, her autobiographical novel, Den tunna isen (The Thin Ice) was published in Swedish at Norstedts.

Show Notes

Any discussion about Sweden as a model for fighting the pandemic refers back to the strategy’s chief architect, Anders Tegnell. Tegnell is the chief epidemiologist at Sweden’s Health Agency. Sweden’s constitution prohibits the government from interfering with the Public Health Agency’s decisions, giving Tegnell substantial power to steer the country’s strategy. In this April interview with Nature Tegnell describes Sweden’s approach. You can also watch a more recent interview with Tegnel where he continues to support the strategy despite the high number of deaths from COVID-19 in Sweden.
 
During the debate both Lena and Jonas refer to one of the first modelling studies to be published on the COVID-19 outbreak in Wuhan, which warned on January 31, 2020, that “preparedness plans should be readied for quick deployment worldwide.” You can read the study in The Lancet, here.
 
Part of the debate about the effectiveness of Sweden’s model for fighting the pandemic centres on the role that asymptomatic carriers of COVID-19 play in spreading the virus. Lena argues that Sweden’s pandemic strategy is based on the belief that asymptomatic carriers, including children, do not pose a significant risk. An asymptomatic carrier refers to somebody who has the virus but doesn’t show any symptoms. There are also pre-symptomatic carriers, who are in the early stages of infection, and so don’t yet show any symptoms. You can learn about some of the studies that examine whether asymptomatic and pre-symptomatic carriers help to spread COVID-19 here.
 
During the debate Jonas states that he believes Sweden’s number of COVID cases have started to dramatically decline because the country has now achieved some herd immunity. Herd immunity occurs in a community when enough people have become immune (through infection or a vaccine) that they interrupt the chain of infection. In a recent interview Anders Tegnell has also publicly stated his belief that herd immunity is operating in Sweden, with as much as 30% of the population now COVID-19 immune. A recent study by the Journal of the Royal Society of Medicine does not support this view, suggesting that only 15% of the Swedish population has been exposed to the virus
 
One of the key questions about COVID-19 is whether contracting the virus provides immunity and for how long this immunity lasts. During the debate Jonas refers to a high level of antibodies (protective proteins generated by the system when under attack from a virus) currently existing in the Swedish population. He also suggested that T-cells, another form of immune response, perhaps developed from viruses other than COVID-19, could also be an important player in helping Sweden through a second wave of COVID-19 in the autumn. You can learn more about how antibodies and T-cells can protect us from COVID-19 here and also here.
 
One of the key characteristics of the COVID-19 virus is how it targets vulnerable members of a community. Both Jonas and Lena acknowledge the significant number of deaths due to COVID in Sweden’s long-term care homes. Sweden is also similar to countries around the world in that low-income neighbourhoods, where new immigrants settle, have been particularly hard hit by the virus. Sweden’s second largest city, Gothenberg, has the highest rate of COVID-19 in the country, and one neighborhood in particular, Bjergsonn, has born the brunt of the disease. You can read more about Bjergsonn and the COVID-19 “neighbourhood trap” here.

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