Science Vs - Coronavirus: Sweden Goes Rogue

Episode Date: May 22, 2020

While a lot of countries have put in strict measures, like lockdowns, to stop the coronavirus, there’s been a conspicuous outlier: Sweden. The country has carved a different path, trying to keep its hospitals from being overrun while allowing society to function as normally as possible. So, is the Swedish model working? To find out, we talk to medical epidemiologist Dr. Emma Frans, Professor Annelies Wilder-Smith, Dr. Gary Weissman, and Dr. Eric Schneider. Also: ANCHOVIES! Here’s a link to our transcript: https://bit.ly/2XiRsYT This episode was produced by Meryl Horn, Wendy Zukerman and Rose Rimler with help from Mathilde Urfalino, Michelle Dang, and Sinduja Srinivasan. We’re edited by Blythe Terrell with help from Caitlin Kenney. Fact checking by Diane Kelly. Mix and sound design by Peter Leonard. Music written by Peter Leonard, Marcus Bagala, Emma Munger, and Bobby Lord. A huge thanks to all the researchers we got in touch with for this episode, including Dr. Kirsty Short, Prof. Keith Humphreys, Prof. Paul Franks, Prof. Wouter Metsola van der Wijngaart, Assoc. Prof. Niclas Roxhed, Dr. Tobias Brett, AnnaSarra Carnahan, Dr. Alisdair Munro, Alessio Capobianco, and Dr. Mahshid Abir. All the folks in Sweden who helped us out including Johan Seidefors, Niklas Wahlén, Emil Sahlén, Amie Bramme, Dr. Arne Jonsson, Ann-Mari Darj, Shayan Effati, Erik Hedlund, Rebecca Heine, Srour Haddad, Harpa Kristinsdottir, Sven Larsson, Justinas Legas, Agnes Nygren, Lova Seidefors, Marcin Wolniewicz, John Kvarnefalk and Alexander Nordström. And special thanks to Christopher Suter, the Zukerman family and Joseph Lavelle Wilson. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hi, I'm Wendy Zuckerman, and you're listening to Science Versus from Gimlet. So for weeks, months, what is time anyway, a lot of us have been twiddling our thumbs at home, doing puzzles, getting bored, and mainly going out only for stuff like groceries. All around the world, people have been doing this. In China, in Italy, and yeah, here in New York. But from the beginning, there was one country that took a totally different approach here. Sweden. Sweden. Sweden. That's right. While restaurants around the world shuttered, we've been hearing that it's all meatballs and fika for the Swedes. Today, I actually went to to a really nice lunch place.

Yeah, I've gone out to have a beer. And I've actually, I went to the movies as well. Me and my family went to the swimming pool. I went to a party with maybe 20 people. I have actually hugged quite a lot of people the last few weeks. They never had a strict lockdown. You can still go to parks and playgrounds. And kindergartens and elementary schools, they never shut.

So for kids over there, life sounds pretty normal. They wake up, they go to school. I mean, I don't think that there are any changes. My daughter is three years old. She does not even know that this is going on at all. One time she was like, what is corona? And some have been arguing that the Swedish model is what we should be doing here in the US.

While others are saying no. But I know that people are like, you're crazy. What are you doing? So are they crazy? For a while, it looked like this Swedish strategy might be working out for them. But is that right? Today, we're going to look at what is actually going on in Sweden and what can it tell us about how things might go in the US as we start to reopen.

When it comes to this pandemic, there's a lot of... What is corona? But then there's science. Science versus impeccable Swedish design is coming up just after the break. It's season three of The Joy of Why, and I still have a lot of questions. Like, what is this thing we call time? Why does altruism exist? And where is Jan 11? I'm here, astrophysicist and co-host, ready for anything.

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And don't forget to subscribe wherever you tune in. Welcome back. Today, we're talking about what is going on in Sweden. So, as many countries around the world decided to do strict lockdowns, hoping to make their new cases drop really low and then pick up surges with things like testing and contact tracing, Sweden had a different plan altogether. They wanted to keep their hospitals from being overrun while still keep society functioning as normal as possible.

They wanted to find a balance here. So what did they actually do? Well, they took precautions. Public gatherings of more than 50 people were banned. And even though restaurants could stay open, they couldn't let as many people in. So when we spoke to our Swedes, they told us that it's not really that magical land we've been hearing about.

No, it's not a magical land. No, no, no. We cancelled our son's fifth birthday party with his friends. All cultural events are cancelled. Everything is cancelled. And there's been some restaurants that have been really crowded that have actually been like closed down. In grocery stores, in gyms, in restaurants or in shops, they have all these tapes set up on the floor where to stand and where the next person should stand. Yeah, it's very different. Even though people in Sweden weren't required to socially distance, they were strongly encouraged to. And it looks like a lot of people did it. For example, according to data of people's movements

released from Google, people in Stockholm aren't going on public transport or walking around as much. So that was the plan, to find a balance between social distancing and keeping life going as normal as possible. So how did this go for them? We called up a Swedish researcher to find out. Hi. Hey, my name is Emma Franz. I'm an epidemiologist. Emma works at the Karolinska Institute in Stockholm.

And as you might imagine, she's been following what's going on in her country very closely. And she told me that at first, the Swedish strategy didn't seem strange. It was just Sweden's thing. But then she looked all around Europe and realised they were becoming the odd one out. You could see other countries around us locking down the whole society. Did you ever have a moment of like, huh, should we be doing what the rest are doing? Yes, of course. I think everybody has had that moment. So the first thing we wanted to look at with Emma was hospitals. One of the big goals of

the Swedish approach was to make sure they didn't with Emma was hospitals. One of the big goals of the Swedish approach was to make sure they didn't overwhelm their hospitals. Early on in this pandemic, this had happened in parts of Italy. Hospital hallways were lined with COVID patients and doctors were forced to ration care, saving ventilators for younger patients. This put the world on high alert and models predicted that the same thing was going to happen in Sweden. So the Swedes got ready. They added beds in hospitals. And we also kind of built a new hospital as well outside Stockholm.

And then they waited for the patients to come. So that new hospital, how many people are in it at the moment? How many patients? Well, we haven't even been, we haven't had to use it. Oh, wow. So it's still empty. You built a whole new hospital and you haven't even needed it yet. Yeah, yeah.

According to Stockholm officials, hospitals have empty intensive care beds. And that new hospital, it's ready for use if they need it. Now, it's possible that things could get worse over there. But at least for now, Emma says that what they're seeing is reassuring. The number of people needing intensive care is actually going down. Yeah, so for the past three weeks, the number of people in ICU beds in Sweden has actually been going down. So it looks like, at least for now,

they've been able to keep the hospitals going okay. But of course, that's not the only thing that matters here. Another big question is how many people are getting sick and dying. Even early on, it was pretty clear that Sweden's death rate was much higher than its Nordic neighbours, like Norway and Denmark. Sweden is doing much worse. The death rates are much higher. In the capital, a lot of people have died.

So far, around 3,700 people have died in Sweden, and the hardest-hit group are its older folks. About 90% of those who have died are over 70. I'm really upset that we haven't been able to protect the elderly. So this is definitely a failure, I would say. Now, deaths in Sweden are going down. And it's been argued that maybe in the long run, the country's stats will look better overall.

And that's because if more people are infected now, they'll probably develop immunity, which will help them ride out a second wave or a third wave of this pandemic. So far, though, in an official test from the Swedish Public Health Authority of more than 1,000 Swedes, in Stockholm, where the most people in that country

have been infected, only 7% had antibodies. 7%. And in the rest of the country, it was even lower. So if that thousand are representative of the Swedish population, this is far below the 60 or 70% that's estimated places might need for herd immunity. But still, by not doing a lockdown,

Emma says that Sweden might have avoided some other really nasty things. Things that can happen when people are stuck in unsafe homes. Things like depression, domestic violence, child abuse. We don't know if Sweden has fared better here. We'll have to wait and see. It's quite difficult to consider the different risks. It's very easy to only look at the single aspects of death rates. But I think it's also important to consider, you know, domestic violence, psychological health, education. So I think the jury's still out.

The Swedish strategy was not the disaster that was predicted. Yes, they had more deaths. But they're balancing some tricky pros and cons here. And they did achieve their goal. They never overwhelmed their healthcare system. And the big question is why? Like, why didn't their hospitals get overwhelmed? And let's look at the school's decision first, because you might have thought that that would have really screwed them, keeping elementary schools open. But it's looking like that decision actually wasn't as dangerous as we first thought. For kids, even though there are some unknowns here,

like this weird inflammatory syndrome that's now popping up, it's actually rare for kids to get very sick from this virus. And research is suggesting that kids also aren't driving the spread of this disease. That is, they aren't the little typhoid Marys running around that we thought they might be. Here's Emma. Yeah, I think actually it was the right decision to keep schools open in Sweden.

I have two children and I haven't really been worried about them. And I'm also quite happy that their lives are actually going on quite as normal. Because, you know, it's really difficult times. And when it comes to stopping the spread of a virus, Sweden has some other things going for it. We talked about them with Anneliese Wilder-Smith, a professor of infectious disease who has a post at Umeå University in Sweden. And Anneliese says that what really helped Sweden here is that people aren't living on top of each other. Sweden has very low population density. By definition of the country, they have

what I call natural social distancing. So the capital of Sweden, Stockholm, is fairly dense on par with Philly or WashingtonC. But once you get out of the capital, forget about it. Their second biggest city, Gothenburg, if you're doing a crossword puzzle, has a population density that's a touch over that of Boise, Idaho. There's probably more Allen Keys than people in Sweden. Houses, you know, you go to the village, the houses, they're all like one mile apart.

So there is already a culture of less social mixing and more social distancing, even without COVID. So for example, many people in Sweden live alone. And we know that a lot of people who get infected with this virus catch it from someone they live with. And if you have less social contact, the virus spreads less. So without even trying, Sweden had a head start here. I must say Sweden, I think, did do quite well. But you also have, there was also a price, there was a cost. And that cost was, of course, the number of people who died. And there was also this hope that Sweden's

approach could help them avoid economic disaster, the kind that other countries have faced. But that hope has also kind of gone out the window. Early research is showing that Swedes cut their spending on things like eating out and shopping. In March, it was by 25%, almost as much as the drop that we saw in Denmark. And just this week, their nation's central bank gave more bad news to the nation. They're predicting that Sweden's GDP will drop by at least 7%. Again, it's similar to what's predicted in Sweden's neighbouring countries, The ones that did lockdowns and now have lower death rates. So the Swedish dream? It's looking more like Nordic noir.

So what does this all mean for what's happening in the US now? We're totally screwed. That's coming up just after the break. Welcome back. We just heard that much like an Ikea bed, the Swedish model looks great in pictures, but the reality is a little more rickety. Life is not back to normal for many Swedes. They're still having to social distance. And even though they haven't overwhelmed their hospitals in Sweden, relatively speaking, a lot of people over there have died. Plus, it's looking like they may not have saved their economy either.

So what does all this mean for what's happening in the US? Well, many states like Georgia, Texas and Oklahoma have gone out of lockdown while they still have quite a few cases each day. And by reopening, they're now walking away from that strict lockdown model where you stay shut until you have basically no new cases and then contact trace any new infections that pop up. Annalise says that these states, they're popping the champagne early. The US has not really even seen real flattening. You want to see a bending of the curve, a decline, daily consistent decline in new cases down to zero. That's what you want.

And then you can live a life again. But instead, what these states are doing is kind of sliding into an American version of Sweden. And, you know, some of these US states have pretty low densities. So from that perspective, they might be okay. But if they really want to do what Sweden was doing, they have to keep social distancing, even when stuff opens up. And in some states, like Oklahoma and Texas,

when you look at movement data from Google, it looks like they're creeping closer and closer to normal. And this is going to be a problem because we could end up in a worst case scenario with no social distancing at all. And it's pretty clear what happens then. You know, if nobody does any physical distancing, if this virus really just burns through the population, we're totally screwed. This is Gary Weissman. He's a doctor on the front lines of this pandemic. And he's also a researcher at UPenn, where he's done some modeling on what happens if we don't have enough social distancing.

It's a very deadly virus. So sure, you could open all the bars and restaurants and movie theaters tomorrow. And I would still stay home and keep my kids at home. But for all the people who went out, I guess they would have fun, and maybe in the short term, there would be a more economic activity. But then the cost to that is a whole lot more people are going to get infected, a whole lot more people are going to die, and that's really the worst possible outcome. And by all that, Gary, doesn't mean that the U.S. will turn into I Am Legend, but rather that we will see more deaths. A paper out just this week concluded that most states are barely containing their outbreaks as it is, and they

predict that if we relax social distancing too much, we could see deaths double in the next couple of months. Now, we don't know what will happen in the future, but Eric Schneider, a doctor who's also a researcher at the Commonwealth Fund in New York, told us that even though states that have reopened, like Georgia and Oklahoma, haven't seen a spike yet, that doesn't mean that Oklahoma is okay.

You may think you're okay, but all it takes is one blaze to start up again. And as it stands right now, if we continue on what I think is sort of the Swedish approach of a little bit of opening here, a little closing there, that is a real problem. Point is, a little closing there. That is a real problem. Point is, fresh cases could pop up at any time and turn into big problems. And if we're not careful, we could suddenly lose control. And then, mamma mia, here we go again.

So how do we get out of this? What options are we left with? Well, we don't have all the answers here. We don't have a crystal ball. But many academics we spoke to said that what we've really got to do now is keep the lockdowns until the numbers go down really low and stay there. It's only then that we can play the testing and contact tracing game. And Eric says it's not too late. He talked with producer Merrill Horne about this. We could train a million contact tracers and if we got the testing and contact tracing program up and running, it would cost, I don't know, a few billion dollars probably for the whole nation and it would make a huge difference because we would

get the disease under control. Like is that really an option here? So I'm not at all skeptical that it could be done. I'm just completely mystified that something that is so basic and that we could do so effectively is not being done. And meanwhile, it felt like Sweden could have been the answer. We could get our lives back now and still not create a disaster. I talked to Eric about it. Everyone was talking about contact tracing and isolation. And it just felt like, oh, that's going to be so hard.

There's no way America can do that. And then everyone was like, wait a sec, Sweden. But then talking to you and doing the research, it's like, that's a mirage. And I just wanted to know how you feel about this discussion that's like Sweden. I think we are hopeful. I think we're just optimists and looking for easy answers to a really hard problem. We've never faced anything like this. This disease is perfectly designed to disrupt everything we're doing. And so it's really tempting. I mean, we all yearn to get back to something that looks like normal, but we really have a problem on our hands and we aren't going to solve it with easy answers. And now, time for a little NCVC. The modern anchovy is known for its role in the Caesar salad

and made infamous by the teenage mutant ninja turtles. It's usually a pretty small critter and has tiny teeth to chow down on plankton. But it turns out that they had ancient cousins that were quite long in the tooth. Really long. Recently, scientists took a close look at a skull that was found in Pakistan.

From the shape and structure, the team figured that this was a relative of the anchovy. But there was one very peculiar difference. This fossil had fangs and a saber tooth about an inch long. Researchers named the new species Monosmyllus chirolotus, after the mythical South Asian vampire demon known for its sharp fangs. These anchovies lived about 45 million years ago, and the saber-toothed anchovy, it's extinct now. But who knows? If things had gone a little differently,

maybe the vampire anchovies would have had us on their pizza. That's Science Versus. Hello? Hey Meryl. Hey Wendy. How many citations in this week's episode? We have over a hundred citations in this week's episode. Really? Over a hundred? Yeah, in a group effort this week. It really was. And if people want to find these citations,

where should they go? They can go to our show notes and then follow the links to the transcripts. Thanks, Meryl. Bye. Bye. with help from Caitlin Kenney. Backchecking by Diane Kelly. Mix and sound design by Peter Leonard. Music written by Peter Leonard, Marcus Begala, Emma Munger and Bobby Lord. A huge thanks to all the researchers we got in touch with for this episode, including Dr. Kirstie Short, Professor Keith Humphries,

Professor Paul Franks, Professor Volta Metsola-Vandervankart, Associate Professor Niklas Roxy, Dr. Tobias Brett, Anasara Kernahan, Dr. Alistair Munro, Alessio Capobianco, and Dr. Maschid Abir. Plus all the folks in Sweden who helped us out, including Niklas Wallin, Johan Seideerman family, Joseph Lavelle Wilson, Rebecca Heen, Sven Larsen, John Kvarnofalk and Ami Bramiser. And a special thanks to the Zuckerman family, Joseph Lavelle-Wilson and Chris Suter.

I'm Wendy Zuckerman. Back to you next time.