The Munk Debates Podcast - Be It Resolved: Sweden Is The Model For How To Fight This Pandemic And The Next

Episode Date: September 2, 2020

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. Supporters of the Swedish model argue that its strength lies in being sustainable over the long haul. 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. In this episode of the Munk Debates Podcast leading Swedish medical experts Dr. Jonas F. Ludviggson and Lena Einhorn debate the essence of these two competing arguments.Sources: Reuters, CBC, BBC, Sky News, PBS, WION, CNN, MSN, ITNBecome a Munk Donor ($50 annually) to get 72-hour advanced access to the full length editions of Friday Focus and Munk Dialogues. Go to www.munkdebates.com to sign up. Hosted on Acast. See acast.com/privacy for more information.

I think it's time for this toxic binary zero-sum madness to stop. We're not an imperial power. We're a revolutionary power. We are no longer in a world where you can plot out moves statesmen to statesmen like a chessboard. You don't know anything about my background to where I came from. It doesn't matter to you because fundamentally I'm a mean white man. We can't do this to the next generation because America will cease to exist. Welcome to the Monk Debates podcast. Every episode, we provide you with a civil and substantive debate on the big issues of the day. Free of spin, focused on the facts and animated by smart conversation.

To arm you, the listener, with enough information to make up your own mind. Today's debate, be it resolved, Sweden is the model for how to fight this pandemic and the next. crowded streets and children playing outdoors. Unusual scenes in these strange times. But Sweden is going it alone. One of the last year... In Sweden, life is just a little quieter than normal. Many businesses and schools are open,

and there are no internal travel restrictions. Stockholm feels like a parallel universe, where life, as we all once knew it, continues as if unchanged. It's about saving the restaurants. saving the pubs. It's about saving people's work. Maybe we have found a good balance. But let's see when it's over. Hello, I'm your moderator, Rudyard Griffith. While 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 pure nations. In Sweden, bars, restaurants, public spaces and most significantly, elementary schools have continued to operate since the COVID-19 pandemic, 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. 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 a recognition that the virus could be with us for many years to come.

This is the country's state epidemiologist and architect of the Swedish model explaining the strategy, Anders Tegnell. This level of measures that we have in Sweden, there is no problem for us to keep it running for months. Closing schools, more stringent measures like that, closing borders. You cannot do that for months or years ahead. But what we're doing in Sweden, we can continue to do for a long time. And I think that's going to prove to be very, very important in the long run. Critics say that Sweden's approach has come at way too high. higher 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, according to the latest surveys and studies, and the economy is not faring much better than countries enforcing stricter measures. They fear that without a complete rethink of its pandemic strategy, the country is headed for a second public health crisis in the odds. This, to me, sounds a bit like a madman. We are here playing Russian roulette with the Swedish population. On this installment of the Monk Debates podcast, we challenge the essence of these arguments by debating the motion, be it resolved, Sweden is the model for how to fight this pandemic

and the next. Arguing for the motion is Dr. Jonas Leuigsen, Professor of Clinical Epidemiology, at the Karolinska Institute in Stockholm. Arguing against the motion is Dr. Lena Einhorn, virologist and member of Sweden's scientific forum COVID-19. Lena Yunas, welcome to the Monk Debates podcast. Thank you. Thank you.

I'm really looking forward to today's conversation. I mean, of all the examples around the world, I think that we're each individually and collectively trying to think through, it is that of Sweden. And what does Sweden's response to this pandemic suggest for the rest of the world? As we think about the threat of a second wave of the virus this autumn and into 2021, so to have both of you here to talk about Sweden's experience, living there, working there, deeply embedded and passionate about this issue is a privilege indeed for our listeners.

So I want to begin this debate by putting a couple minutes on the clock for each of you to debate our motion, your opening statement on be it resolved, Sweden is the model for how to fight this pandemic and the next. Yonas, you're going to argue in favor of today's motion. So let's hear your opening remarks first, please. So the Swedish COVID-19 strategy can actually be illustrated by my family. My parents are almost 80 years old. When the first reports about the deadly virus were published, old people in Sweden age 70 years or above were told to isolate themselves. My sister, who lives nearby, began buying their groceries. I started calling them instead of visiting them. The top priority of the Swedish strategy was always to protect the elderly

and the risk groups. I've not hugged my parents for six months. At the time, my youngest son went to upper secondary school. While he was sent home in mid-March, the slightly younger boys and the football team that I coach were kept in school. Elementary schools were kept open because children have a right to learn, need social interactions at school, and because already in March, Data were clearly indicating that children did not become as sick as adults. So his second priority of the Swedish strategy was to keep schools open. My second son lost his job. He was too young for unemployment benefits, but the government immediately changed the laws

and launched a massive support package that also included him. So the third component of the Swedish strategy was to economically protect people. My wife and I are both physicians. My wife is a family physician responsible for a nursing facility. She and her colleagues started to go through the individual treatment plans of the elderly. I'm a pediatrician. I called the head of the intensive care unit and I told him I was willing to work extra. He said,

Jonas, you should stay in the pediatric department. Someone has got to lead the work there too, but I need your junior colleagues. So the junior physicians were sent to the COVID-19 department and I covered for them in the emergency department. I was not in the eye of the storm, but it was fairly close. And I'm proud to say the Swedish healthcare did not collapse even at the peak of the pandemic. So the Swedish strategy can be summarized as to protect the people most at risk, to keep elementary schools open, to economically support people,

and to avoid a healthcare collapse. And I could add to this to create measures that we as a people could keep up for a very long time, perhaps even for years. If I stood in front of a new pandemic, I would make the same choices again. Jonas, thank you for that succinct and clear opening statement

in favor of our motion, be it resolved. Sweden is the model for how to fight this pandemic and the next. Lena, you're going to give us your opening statement. about a different view. You're speaking against our motion today. Let's hear your opening remarks, please. On January 31st, it was an article published in The Lancet, projecting from the Chinese experience what was likely to happen in the world. And a very severe advice for the big metropolitan

areas that were connected to China to prepare immediately for a pandemic, basically. And so, I made contact with Anders Tignel, who was the state epidemiologist. I did this February 1st and I said, what's happening? It seems from these projections that we should prepare more. And he answered me and he said, well, you know, those are really loose projections. There's not much data. We shall see what happens. And I was watching what was happening in Sweden.

Nothing was happening. There was very little preparation with regard to both testing capacity and protective gear build-up. Then come the sports vacation at the end of February in Sweden. So people were asking questions of the public health agency and of Tengel. Are we really going to go? Should we really go? And he said, absolutely, you should go.

They were playing it down. And as people were coming back, it was obvious that, you know, this was a real severe epidemic in northern Italy. And a lot of people had traveled to the Italian Alps. And so people were asking, shouldn't they be in quarantine to see if they're sick? And again, Tengna said that they shouldn't be in quarantine. If they're going to school, they have to go to school. From that moment, they stated it clearly, unless you have symptoms, don't worry about it.

The idea of asymptomatic spread did not exist. And when our, you know, a lot of countries in Europe and our neighbors, Scandinavian, Nordic, neighbors had lockdowns in the beginning of March, Sweden did not. The outbreak started at the same time, basically, in the Scandinavian countries, but Sweden very quickly had a much more steep rise in cases and eventually deaths. Thank you, Lena. I want to now give you both an opportunity to react to what you've heard from each other in terms of your opening statements. So, Eunice, let's have your reaction. No, I mean, I think that Lena has a clear analysis of the very early start of how Sweden reacted, but she didn't say much

about how she disagreed with the current strategy, actually. She mostly focused on the early parts. And I also remember reading the paper in the Lancet. I actually gave my first talk about COVID-19 at Carolinas constituted on February the 3rd, which was recorded on YouTube, where I told people, I feel really worried about this pandemic and we need to prepare. However, the modeling study that she refers to, while it says that there should be a spread to metropolitan areas, this paper also illustrates the shortcomings of models because it told us that most of the spread would probably appear in Bangkok, which hasn't seen much of COVID-19 at all. And it's also clear from this model paper.

There will be huge outbreaks in Beijing, Shanghai, Chongqing, etc., because that's what the paper said. So I think that paper illustrates very well the shortcomings of models. Then I also had communication with Anders Thénel, also received, you know, thank you for your email. And I think he received a lot of emails. And that may be one of the reason why you stopped, you know, interacting later on. I also feel it took some time before we realized that asymptomatic disease could actually be a problem. I'm still of the opinion that on average an asymptomatic person is less likely to contribute to disease spread than someone who has. has severe symptoms, including fever and cough.

But I think I agree with Elena, there were things we could have done differently initially, clearly, but I also think there are things where Sweden could serve as a role model for future pandemics. Thank you, Jonas. Lina, let's have your rebuttal. Well, first of all, the issue was not whether there were limitations to the model of that paper, I mean, because the pandemic happened. So, I mean, whether it was Bangkok or Stockholm or somewhere else,

the crisis was upon us. And so it was a very relevant thing to prepare, which was not done in Sweden. The second thing is this issue with asymptomatic may sound like it's history, but it's not because it still drives the Swedish policy. They decided very early on at the public health agency and they acted on it that this was like SARS. and SARS is only contagious after you have heavy symptoms. That is why they are still opposed to face masks in this country. And it is still written on the webpage of the Public Health Agency of Sweden,

what do you do if someone in your household has COVID-19? Answer, you just go to school or to work as normal unless you have symptoms. And I really disagree with Jonas with regard to how important it is. I mean, there are so many studies that are looking at both viral load and actual transmission with and without symptoms. And most studies arrive at from anywhere from 20 to some studies go way over 50% of the transmission being from pre-symptomatic, mostly, perhaps also asymptomatic. Thank you for these opening statements and for your rebuttals. And I think it's important now to kind of dive into some of the key issues that are on the minds of our listeners. Eunice, I guess the first question is to you. And it really gets to, I think, what everyone has been focused on in terms of a metric to measure a success and failure. And that is death rates and death rates on a per capita basis. So what is your answer about just the hard numbers that show that. that Sweden currently has the ninth highest death rate per 100,000, roughly 58 people per 100,000

citizens who have died. It's a higher fatality rate than Brazil, the United States, Mexico, you know, France and Ireland. And I just, again, I'm not, I'm not making an accusation here. I'm just genuinely curious as to how we understand that number in the context of a strategy that you're arguing is successful. Yeah, I'm arguing that overall. the strategy is successful, but I'm not arguing that the high death rates are successful. And I think we have to acknowledge that Sweden failed many of its elderly people. However, as did the UK, Belgium, France, Italy and Spain. But I mean, these other countries did apply strict lockdowns.

And to me, it does not seem like lockdowns being the defining feature of success here. So I think the fact that Sweden has in the short term initially in this pandemic has had high death rates. does not mean that the model is flawed on a very long-term basis. I mean, this is not about running 100 yards. It's not about running a mile. This is a marathon. So I think that excess mortality, it's still a very early stage to evaluate that. And I think excess mortality is the best measure of health success,

but I think it should be evaluated at a later stage to see, okay, what is it in 2021? What is it into, after two years after the pandemic? But I do agree that we have failed many of our elderly people, and I'm truly sorry about that. So, Lina, let's have you come back on this point because Jonas brings up, you know, an issue we need to address here is that other countries like Belgium, the UK, Italy and Spain, who all had highly restrictive lockdowns, lockdowns that caused, again, children to miss school, explosions of mental health issues, profound economic consequences. they've ended up, at least so far, as of recording of this program in late August, early September, with a death rate per 100,000 that's greater than Sweden. So why isn't that a proof point that Sweden was right here to take more of a laissez-faire approach

when it came to the stricter measures that some of its neighboring countries introduced? Well, it's a known fact with lockdowns that they have to come early. If you do late, a desperation lockdown, let's put it that way, like the UK did, or France, for that matter, when the spread is so wide that it gets into a lot of the family structures, then it's too late because you cannot isolate family members from each other. And that's why you have to have an early lockdown. And the countries who did early lockdowns, like our Scandinavian neighbours, were very successful. If you can trust that with Norway, which imposed a full lockdown at a relatively early state of the crisis. At the moment, its death rate is 44 deaths in a million. You compare that to Sweden, which is on over 440 deaths in a million.

And as you say, that grim milestone. I mean, their death rates are infinitesimal compared to the Swedish death rates. And by the way, their case numbers are still today considerably lower than Sweden's. Thank you, Lina. So let's pursue this a bit further because, Jonas, I think there's a question here to answer, which is about exactly what Lina mentions, when the lockdowns come. Because if you look at China, for instance, it seems like it's been a remarkably effective strategy. And Lina's painting a picture here of a Sweden that kind of was,

sleepwalking its way into this pandemic that didn't really have a plan, and that the absence of a lockdown wasn't a conscious policy choice. It was, you know, just a de facto result of a false sense of complacency regarding the lethality of this virus and the seriousness of the threat. I'm not at the Swedish public health agencies. I don't know. And I can't say what were the discussions like at this time. But I mean, in mid-March, when Sweden was already struck by COVID-19, Leanna mentioned the people who traveled from Italy, but latest studies have shown that viral transmission also came from people traveling abroad to other countries. I think lockdown was already too late.

I mean, you can always argue that, well, the lockdowns in UK, Belgium, France, Italy and Spain, they were too late. But actually, the Italian lockdown, I mean, it came earlier than Sweden could ever have imagined a lockdown. And still, they've fared not so well. So I still think that potentially a geographical lockdown at the exact right moment, at the exact right time might have been beneficial. But overall, I still think that Sweden made the right decision, not to have a general lockdown. The Italian lockdown happened when Italy had a crazy epidemic.

The Nordic lockdown happened when the first deaths had just happened. So, I mean, Italy's pandemic started or epidemic started much before the Swedish was. So you cannot compare the timing there. This question is for Lena, and it's to jump forward to today, because what we're seeing right now in Sweden is an infection rate of roughly 37 cases per 100,000 people. This is significantly lower than France at 60 cases per 100,000. Spain up now at 152,000. So, you know, let's concede your argument that maybe mistakes were made.

Maybe the Swedish government was to. relaxed about this pandemic. I want to interrupt there because I just looked at the case numbers today. And there are, like the United States has a heavy load right now and so does France. But if you, I mean, Italy has 14 cases per million per day right now and Sweden has 24. Finland has five. Norway has eight. Canada has 10. So Sweden is not at the lower end of the spectrum. It still is at the higher end of the

spectrum. The number of cases is to somewhat misleading because it's very much dependent on the testing strategy. And I started arguing about more testing for COVID-19 in Sweden in March. Other people followed. And finally, we're setting up massive testing. And of course, that will pick up a lot of COVID-19. very often asymptomatic as well as commented on but if we look at the number of deaths I mean we're up at a hundred deaths per day in Sweden in mid-April and now we're down to single digits like two three deaths per day each of these deaths is a tragedy but still it points towards a clearly substantial improvement in the COVID-19 situation in Sweden and I can see that in the wards every day for sure the numbers

have gone down dramatically. Now, the public health agency would like to think it's because of herd immunity. I think that's likely the least likely reason. There are a number of reasons why the numbers have gone down. First of all, the care homes have different routines today, thankfully, than they had when they were blasted with this epidemic without any preparation. Also, the older people are self-isolating much more in Sweden now than in the other Scandinavian countries because the spread is higher in Sweden. But I think perhaps the most important reason for the case numbers going down in the summer is you have to know what the Swedish summer is.

Sweden closes down on the 20th of June and it opens up on the 20th of August, basically. It's a natural social distancing which you do not see in Canada or in the States because you don't have. vacations like we do. You can see it very, very clearly that once the testing got started, which was so late in Sweden, it sort of went to a tremendous peak in the end of June, beginning of July, a horrendous peak. But then suddenly it just went zoomed down, you know, a ski slope. And that is probably because of the social distancing that happened with the summer vacation. But I guess what I'm struggling with, and maybe, Jonas, you can talk about this is it seems as if compared to, let's say, what I'm experiencing right now in Canada or many of our listeners in the United States, in Sweden, you've got restaurants open, you have very low mask use, you have a society that is reacting to this virus in a way that is less strict and severe than many of your pure nations.

Yet, as you just mentioned, your death rate right now is very low. How is it possible to have a low death rate and presumably therefore a low infection rate but not have these mitigation measures in place such as ubiquitous mask wearing social distancing, the closing of offices and the closing of schools? From my experience, not everyone has vacation between July 20th and August 20th. It's much more spread out. So I don't think this summer vacation explains everything. But as opposed to Lena, I actually believe that we have reached some kind of herd immunity. The amount of people in Stockholm that have been infected so far should be over 20% by now. But it's a bit difficult to know.

We believe that the downward trend we see at least partly depends on that we have a lot more immune people in the country right now. I also believe, unfortunately, that some of the people who were most sensitive to COVID-19 have unfortunately died. We have currently an under-mortality. We do not have an excess mortality in Sweden, but an under mortality. So some of the people who might have died during summer died during spring because they were really sensitive to COVID-19. I'm very sorry about that. I disagree that the social distancing only came into effect during summer.

I do agree with Leanna that the preparation in elderly homes, nursing facilities were not appropriate. And unfortunately, that led to many deaths. That is something we must learn from and something we must. do differently during the next pandemic. But I don't see major changes during the summer in how we take care of people in the nursing facilities. So there's something else happening. And I think that's partly herd immunity.

I don't see that social distancing now is more strictly abided by than it was during spring. So I don't think that is the reason. I agree. The social distancing among people who are 50, 60, 70 plus happened already in March. And those are not predominantly the people who died. The people who died were either the ones in the care facilities or the ones who were in the home care. Because they had to interact all the time with people who came without face masks. Because the public health agency were down talking face masks also in the care facilities.

In the Swedish hospitals, people do not wear face masks until this day. So they were really exposed. I do not agree with Jonas that basically all the people who are going to die died because I'm very familiar with one particular elder care facility which has 78 people living there. And it was one of the hardest struck one and they had 14 deaths. So there are another 64 people who are equally vulnerable who could be infected. But what made its stop there was that they, implemented their own precautions that were different from the ones that the public health

agency advocated. They started using face masks and visors and separating the personnel between sick and non-sick long before the public health agency suggested it. And the last thing I want to comment that Yonah said was that he believes that what we're seeing is because of herd immunity. I mean, the testing that's going on, not only in Sweden, but around the world, shows that the rate of infection, or the antibody of seropositivity in Stockholm is not above 10% and maybe around 10%. And Stockholm is the hotspot in Sweden.

So I would be very surprised if herd immunity is an important contributing factor. Jonas, maybe you could just go a bit deeper for us on what you think the Swedish experience is with herd immunity right now. And maybe what that makes you think about, what could happen this autumn in Sweden and into 2021. Yeah, I mean, I can't cite an exact figure of the proportion of people in Sweden or particularly in Stockholm with antibodies. I think I've seen figures above 10% rather around 20%. But I've also seen that a substantial proportion of people seem to have some kind of T-cell response to COVID-19.

New Swedish research on 200 people found those with more severe disease were likely to have long-lasting antibodies. But those who had mild symptoms or even none at all still had raised levels of T cells, another sign that their immune system had fought off the virus. It could mean almost a third of the population has some immunity to the coronavirus, many more than antibody tests would suggest. I also know that some people speculate that the, antibody levels are low in some people who have had the disease, but still they may have some kind of herd immunity. So the proportion of people who may have some immunity to COVID-19,

I believe, is higher. I also think that there could be people who have had other coronavirus who may not be as sensitive to COVID-19 so that they become severely sick. I think the herd immunity is higher in Sweden than in very many other countries. So I'm positive about autumn, I believe we will have unfortunately local outbreaks, but probably not a major national outbreaks and definitely not the way we had this spring. What's your view, Elaine, on the autumn? My guess is that we won't see the high number of deaths that we saw in the spring because, as we both said, people who are older and who are more vulnerable or more likely to die

are self-isolating. So my guess is that the numbers will. go up of cases because people are going back to school, people are going back to work, but hopefully the death rates will not be as high. Now, with regard to the T cells, I mean, yes, of course T cells are very important with regard to the immune system, but to think that the T cells are there like some ghosts in the background, you know, protecting us while nothing is visible among the antibodies, I think, is very unlikely. And I agree with you and us that there's probably some cross-reactivity from T-cell defense

against other coronaviruses, but that cross-reactivity was there, you know, a year ago. It's nothing new. Those are old coronaviruses that the T-cells have already reacted against. As we move towards closing statements, let's just talk a little bit about the broader experience in Sweden over the last number of months. So, Jonas, maybe you could talk a little bit more about your feeling of how Sweden's more calibrated response has been beneficial to these other social and economic indicators outside of, you know, core public health metrics.

I mean, the obvious thing to look at first would be the GDP. And Sweden was one of extremely few countries in the EU without contracting economy in the first quarter, we actually had a positive GDP growth. And that sets us apart from Germany, Italy, France, Spain, where the economy contracted by a couple of percent, not much. But looking at the second quarter, our GDP shrank by 8.6 percent compared to the EU average of 11.9. And that was the average. 8.6 percent is still a lot. We had an increase in unemployment as well, that is bad, but I still think that the absence of a general lockdown was beneficial to the economy. I don't think the economy per se is that important, but the economy is what funds

Swedish healthcare. It's what funds social services. Unemployment per se is linked to poor health, suicide, drug abuse, violence. And whenever you can milden the economic downturn, I think that is a positive thing for people's health and the longer term. I also want to point to open schools where I believe that children do have a right to learning. They need a social interaction in school. But also, distance learning is poorer than actual classroom learning. and learning per se is a very strong driver for your future development, your chances of landing a work in the future.

So hopefully Sweden has come out somewhat less scarred than otherwise. Lena, let's have you come back and answer the same question. So what Yunus failed to say was that compared to the EU countries, Yes, we contracted less on average, the average EU countries, but not compared to our Nordic neighbors. Now, with regard to the health of a society overall, of course, a lockdown is difficult to live through and not going to school is difficult. But I just want to say one thing here, and that is that in our neighboring countries, the elderly are no longer. self-isolating. And in Sweden, they are because in Sweden, we have higher case numbers than in our neighboring countries. And so the price that the older people are paying today for the Swedish

freedom is very steep. Great. I think that's an important point. Let's just touch on that, Jonas, before we go to closing statements. What do you think of the argument about how other countries should confront the fall. I mean, if you can extract some general lessons from Sweden for the rest of the world, what are they? I think the top priority of every country should probably be to protect the most vulnerable of its population and to find a way to protect elderly people and risk groups from getting very severe disease and dying. Then, of course, you'll have to find some kind of balance and I'm also aware of the social price that Lena speaks of in the elderly people. It affects my parents every day. At this moment, there is an ongoing discussion in Sweden of

how to lighten up, how to make the social isolation less severe in Sweden. I do not have an answer of how to do that, but I hope that as the number of cases and the number of deaths go down, it will be possible for elderly people to interact more with society and to participate more. That's what I really hope. I really do not have any recommendations for other countries because I think that each country has a very specific situation, which might merit a special approach to COVID-19. So, Lena, what would you say the lessons are that the rest of the world should draw from the experience of Sweden? Not to repeat our experience. I mean, this is a very heartfelt thing that Sweden is not a model to follow,

not only because of our really high death numbers in a very sparsely populated country, but it is not sustainable, which is sort of the argument that they've kept saying. Sweden still is one of the very few countries in the world that doesn't have face masks. You know, people don't dare to put on face masks because no. Nobody else is wearing. You know, we're still not quarantining, isolating contacts of people who are sick. We're telling them to go to work or to go to school. I mean, these are really dangerous recommendations.

In general, what I would say is, please, one thing that we learned with this pandemic in the last number of months that it's been with us is that we can steer the virus. We're not the victims of this virus. In Sweden, we're just letting the virus run the show. And it's not a model for the rest of the world. You're listening to the Monk Debates podcast. If you like this podcast, check out our other episodes, including debates on everything from the U.S. election

to the impact of COVID-on cities, to whether fears of debts and deficits are overblown. All free to download or stream on our website, monkdebates.com. Okay, now it's time to move towards closing statements. Lena, we're going to have you go first. So let's put two minutes on the clock and have you wrap up, make the key points that you want to leave our listening audience with today. I think one of the key lessons to learn from Sweden is that with something as new and as dangerous as COVID-19, the biggest lesson is to be flexible and be, wise. And one of the biggest problems with the Swedish strategy is that it is not flexible. We

have exactly the same recommendations today as we had in February and March. Another lesson is that one has to learn from one's mistakes and not like in Sweden at this point put it on others. The government is putting it now on the fact that so many elderly died is because of the elder care system. is not functioning properly and we have to repair it. No, that's not why so many people died because the system was not in place to take care of this epidemic. And perhaps the most important thing one should say about this pandemic is that we should try to really suppress it. Why? Because the future is with us, in the future, we will have better and better medicines, treatments for this. And we

will hopefully get a vaccine. And for those people who still today say that in the end, at the end of the game, the other Nordic countries will have as many deaths as Sweden has today or then, I will say if that is the case, I will eat my hat. Okay, wow. You've got it here. We'll definitely follow up with you. Let's say sometime in 2021 and see if there's any hat eating to go on.

Jonas, I'm going to put two minutes on the clock. The podium is yours. The COVID-19 pandemic is a catastrophe. I've been to the intensive care unit. I've seen people suffer. My friends have lost their relatives. Looking back, is there nothing we could have done differently? Of course there is.

We could have tested more. We could have tracked COVID-19 transmissions more. Maybe more people should have been put into quarantine. I think Lena Einhorn is right about many things. I don't even rule out that a lockdown at the exact right moment for the exact right time might have been beneficial in some way. And we have to acknowledge that Sweden fail many of its elderly people, as did UK, Belgium, France, Italy and Spain. But these other countries did apply strict lockdowns.

And to me, it does not seem like lockdowns have been the defining feature of success. Overall, I think Swedish strategy was right. So far, my parents and almost all their friends have survived. The boys in my football team have kept going to school. While unemployment rates are up, the situation is better than in many other countries. and that is good because unemployment is also poor health, suicide, drug abuse, violence, etc. Keeping schools in kindergarten's opens also meant that thousands of young nurses, who would otherwise have been forced to stay home and look after the kids,

could keep working in the hotels, could help me in the emergency department, and tend to patients in the intensive care units. Our health care did not collapse. So the main objective of this debate really is, what do we do at the next pandemic? I hope we can agree on a few things. We should protect those who are at risk. risk of severe disease and death. We should stick to a plan that we can maintain for a long time.

This is not about running a mile. This is a marathon. We should avoid a health care collapse, but we should also minimize collateral damage, such as children being deprived of school, as well as massive unemployment, if there are other ways. We should focus on what really makes a difference. These, but not a general lockdown, have been the defining features of the Swedish COVID-19 strategy, and I believe it can serve as a role model for the future. Thank you. Jonas, thank you for that closing statement. And, Lena, thank you for your contributions to.

I mean, COVID-19 is a difficult, difficult subject to discuss. It brings with it a lot of emotion, understandably. And you've approached this debate with civility, with substance, and you've listened to each other and each other's points. So I think that certainly bodes well for the future of Sweden in terms of figuring out what comes next and your collective public policy and health response to this pandemic. So thank you for coming on the Monk Debates podcast today. Thank you very much. Thank you. Well, that wraps up today's debate. Again, thanks to our participants, Dr. Lena Einhorn and Dr.

Jonas LeVigsen, they certainly gave us a lot to think about. While that Monk Debates podcast, as you've just heard, is that place for civil and substantive debate of the big issues of the day. To listen to more debates on everything from climate change to religion, to geopolitics, to the future of human progress, visit our website, monkdebates.com. You'll find their detailed show notes on today's debate. And thank you for helping us bring back the art of public debate one conversation at a time. I'm your moderator, Rudheur Griffiths. The Monk Debates are produced by Antica Productions and supported by the Monk Foundation. Rudyard Griffiths, Maryland, Missouri, and Christina Campbell are the producers.

The Monk Debates podcast is mixed by Kieran Lynch. The president of Antica Productions is Stuart Cox. Be sure to download and subscribe wherever you get your podcasts. And if you like us, feel free to give us a five-star rating. Thanks again for listening.