Eating Some Swedish Humble Pie

The media has used Sweden as it’s whipping boy until this week. The mainstream narrative has now shifted from Sweeden being wreckless and irresponsible to something else. Let’s dig in.

The Media’s Whipping Boy

Sweden bucked the media narrative on COVID by staying open. It kept stores, businesses, and schools opened and asked for voluntary measures from its population. Hence, it wasn’t so long ago that one of the bastions of the COVID media hysteria narrative, the New York Times reported: “Sweden Has Become the World’s Cautionary Tale” (6).

A Change in Narrative

Frankly, the narrative on Sweden began to change with a University of Virginia study that showed that Sweden’s results were as good or better than many countries that aggressively shut down (1). That eventually led to this Washington Post headline: “Good COVID-19 News From Italy…and Sweden” (8). And then finally this headline from this week:

Swedish COVID Deaths

This graph above speaks for itself, the drop in deaths per day in Sweden is as good as any European country. Their daily death toll has fallen to near zero.

How is This Happening?

Sweden isn’t at what epidemiologists would define as “herd immunity”, which is about 70% of the population having antibodies. This means that there are more people in the population who can naturally kill the virus than not, hence the virus keeps finding hosts where it dies rather than spreads. In fact, antibody tests there show they’re not even close. The most generous estimates of the number of Swedes with antibodies to the novel coronavirus is only about 20%. So what’s going on?

There could be several reasons we’re seeing a radical drop in deaths:

Sweden is Better at Protecting the Elderly

The death toll in Sweden has always skewed far more towards the elderly than in other countries. For example, 7 out of 10 deaths have been in the elderly over 70 years of age (2). In fact, 54% have been in people over age 80. The head of Sweden’s COVID response has stated that many lessons were learned early in how to better protect this population.

T-Cell Immunity Isn’t Being Measured

If you want to be a glass is half-full pandemic watcher, then the T-cell immunity story could also explain what’s happening in Sweden. The story goes something like this:

• The level of antibodies to the SARS-CoV2 virus only gets to about 20-25% of the population and then deaths level off.
• Why?
• Recent research has shown that the memory T-cell system can also kill the virus (3). Hence, some people may not make antibodies that are detected by serum antibody tests but have T-cells capable of killing the virus.

Hence, there may be many more people in the Swedish population who don’t have antibodies, but who do have T-cells that have learned how to kill this virus. Meaning, Sweden may well be at or close to “herd immunity”.

Cross-Reactivity

There has been recent research pointing to the observation that certain people may have T-cells that have learned how to kill other coronaviruses (4). In fact, in the lab, the T-cells of patients who have never been infected with the coronavirus can kill the novel coronavirus virus. Hence, some Swedes are likely walking around without antibodies and the ability to kill the virus if infected.

The Young May Not Be Able to Get Sick

New research shows that the receptor used by the coronavirus to enter cells (ACE-2) is not as prevalent in the nasal passages of the young (5). Hence, many young people may simply not be able to be infected in the same way that adults can. Hence, the younger segment of the Swedish population is never going to show positive on an antibody test.

Sweden Benefitted from Not Locking Down

The media is finally catching up on the data that clearly shows that despite taking a hit because the rest of the world shut down, Sweden’s economy is in much better shape than the rest of Europe (7):

Meanwhile, media darlings like Germany, Spain, and France, once lauded for aggressively shuttering society are now seeing a resurgence in cases.

The Swedish Experience is More than Just Meatballs

IMHO It’s time that the world looks at Sweden’s public health data and takes note. This is likely a clear demonstration that lockdowns aren’t the only answer. I was cautiously optimistic about where Sweden’s data would trend over the summer, but the results are now in. It’s time that the media eat its humble pie and start holding Sweden up as an example of how to beat this thing without destroying the economy.

Or is what we’re seeing in Sweden chance? For example, I’ve written before that mask studies that seem to show a reduction in cases may really be measuring some other effect. Are Sweden’s deaths down due to something other than it didn’t shutter society? The answer to that question could become clearer by what happens in the fall.

The upshot? IMHO Sweden’s data is now very clear. It’s no lockdown strategy worked. Why it worked is likely related to what we’re just starting to understand about COVID. Hence, I would love to see the mainstream media begin to admit publically that they screwed up the reporting on Sweden.

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References:

(1) Shina C L Kamerlin et al, Managing COVID-19 spread with voluntary public-health measures: Sweden as a case study for pandemic control, Clinical Infectious Diseases (2020). DOI: 10.1093/cid/ciaa864

(2) Statistica. Number of coronavirus (COVID-19) deaths in Sweden in 2020, by age groups(as of July 8, 2020). Accessed 7/8/20.

(3) Altmann DM, Boyton RJ. SARS-CoV-2 T cell immunity: Specificity, function, durability, and role in protection. Sci Immunol. 2020;5(49):eabd6160. doi:10.1126/sciimmunol.abd6160

(4) Le Bert N, Tan AT, Kunasegaran K, et al. SARS-CoV-2-specific T cell immunity in cases of COVID-19 and SARS, and uninfected controls [published online ahead of print, 2020 Jul 15]. Nature. 2020;10.1038/s41586-020-2550-z. doi:10.1038/s41586-020-2550-z

(5) Bunyavanich S, Do A, Vicencio A. Nasal Gene Expression of Angiotensin-Converting Enzyme 2 in Children and Adults [published online ahead of print, 2020 May 20]. JAMA. 2020;323(23):2427-2429. doi:10.1001/jama.2020.8707

(6) New York Times. Sweden has become the World’s Cautionary Tale. https://www.nytimes.com/2020/07/07/business/sweden-economy-coronavirus.html Accessed 7/8/20

(7) Newsweek. Sweden’s Economy, After Not Having Lockdown, in Much Better Shape Than Rest of Europe. https://www.newsweek.com/coronavirus-sweden-economy-gross-domestic-product-eurozone-better-europe-1523359 Accessed 8/8/20.

(8) The Washington Post. Good Covid-19 News From Italy…and Sweden. https://www.washingtonpost.com/business/good-covid-19-news-from-italyand-sweden/2020/08/04/6e456656-d61d-11ea-a788-2ce86ce81129_story.html Accessed 8/8/20.