As Sweden comes in from the cold, with its scientific advisers being granted audiences with governments around the world and Dorit Nitzan, the WHO’s regional emergency director for Europe, saying the country can ‘provide lessons for the global community’, attention has turned to the secret of its success.
Kim Sneppen, professor of biocomplexity at the Niels Bohr Institute in Copenhagen and a leading virologist, said this week: ‘There is some evidence that the Swedes have built up a degree of immunity to the virus which, along with what else they are doing to stop the spread, is enough to control the disease . . .They may now be finished with the epidemic.’
However, the role of immunity in Sweden remains contested. State epidemiologist Dr Anders Tegnell has downplayed it, answering a question this week comparing Sweden and Spain by stressing that achieving ‘herd immunity’ had never been a goal of Sweden’s strategy (despite emails surfacing which suggest otherwise).
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.’
Italy currently has even fewer ‘cases’ per 100,000 than Sweden (35 vs 37) but it would be hard to argue that Italians are a peculiarly compliant people in the way Dorit Nitzan does of Swedes. From the Guardian:
‘Nitzan stressed that Sweden’s approach may not be applicable everywhere. Other countries should take into account that in Sweden, the social contract between the government and its population is historically based on a very high level of trust, she said. “That is the way the Swedish people and the government interact.”
‘Following the Swedish example, therefore, should not mean adopting the exact same measures, she said. “There are lessons to learn from every country. None has done it perfectly; all have made mistakes. Each country’s strategy to curb COVID-19 should be based on its specific situation and context, and be both scientifically sound and culturally acceptable. This is Sweden’s approach”.’
When Boris Johnson claimed in the Commons that Brits are more freedom-loving than Italians as an explanation for why the UK is now faring worse than Italy he was rebuked by the Italian president, while the Italian national newspaper Corriere della Sera wrote on its front page:
‘Let me get this right – the country that invented queueing and immaculate lawns is not able to obey rules? Instead, group discipline is a trait of the Italians, a people who have a well-deserved reputation for disdain for regulations and individualism verging on anarchy?’
There is a danger that the important lessons of the epidemic will be lost in sub-scientific generalisations about supposed national character traits that wrongly imply lockdowns are right for some places but not for others – ironically, it appears, the more ‘freedom-loving’ a country is, the greater the need for a firm hand. When Nitzan and Tegnell claim that Swedes have been more compliant than Spaniards, what hard evidence is that based on? The Italians complain about the false stereotypes sent in their direction. We Brits should protest no less loudly about being so supposedly freedom-loving that only a good firm lockdown will break our spirits and keep us in line.
It also needs to be remembered that Spain had one of the longest and strictest lockdowns in Europe whereas Sweden never limited the size of gatherings to fewer than 50, never closed shops, restaurants, night clubs, schools under 16 or anything else, and never imposed or even encouraged face masks. Are we supposed to believe young people in Sweden stopped socialising and going to parties? What basis is there for thinking that? The pictures that went round in April of young people in Stockholm crowding into nightclubs and cafes shows this up for the nonsense it is, while a recent BMJ article quoted Karolinska Institute immunologist Marcus Buggert saying that social distancing in Sweden was ‘always poorly followed, and it’s only become worse’.
Furthermore, even if Swedes were more compliant with their government’s guidelines, the guidelines were so loose compared with those imposed elsewhere that it’s hard to see how the mere fact of compliance makes all the difference.
The antibody rates in Sweden are, as Dr Tegnell notes, similar to those found in Spain and Italy. But then maybe that is why Italy also has no second wave, and Spain’s second ripple appears to be peaking, with the Carlos III Health Institute pointing out that the data on PCR tests by date of symptom onset shows the epidemic topping out weeks ago, even before the end of August.
The evidence for the early emergence of collective immunity rooted in T-cell cross-immunity from previous cold viruses continues to mount. Which is why one of the world’s leading epidemiologists, Oxford’s Professor Sunetra Gupta, is convinced it is playing a major role. It may suit the governments of the world to pretend that it’s all about a myth of Swedish stoicism and not about immunity so that they can exculpate themselves for not taking the same path in March.
The danger is that the reality of immunity, which would allow countries to go back to normal (actual normal, not New Normal) becomes officially denied and buried. Even in Sweden the government has called a halt to the lifting of restrictions, with a cap of 50 people in a group now set to remain and local lockdowns being threatened should outbreaks occur. If Sweden can’t learn the lesson of Sweden, what hope is there for the rest of us?
Fraser Nelson in the Telegraph reports that Chris Whitty rejects the immunity idea because, he says, people aren’t immune to colds and so it is probably short-lived. I suggest that Professor Whitty urgently needs to widen his pool of advisers, starting with the immunologists and virologists who wrote this STAT article in August:
‘The experts who spoke with STAT all felt that the immune responses to this virus are exactly what you would expect to see . . . Angela Rasmussen, a virologist at Columbia University in New York who studies human responses to viral infections, said it is hard to be definitive, given the limited human experience with this new coronavirus, but she said she could see no reason to believe the immune system would behave differently to this respiratory virus than to others.’
As the autumn ripples in Spain, France and Britain fade, we need to make sure our leaders learn the right lessons, and can’t get away with crediting the new restrictions, the national temperament, the stars, or anything else except the only thing with hard scientific evidence behind it: immunity.