Sweden Shouldn't Be America's Pandemic Model
The Swedes aren't close to reaching herd immunity. We need to continue to contain the virus spread.
The Trump administration's Covid response seems increasingly to reflect a policy preference among some conservatives: Protect the elderly and let others try to get on with their lives. This thinking assumes that herd immunity will slow the pandemic if more younger people are infected. Many features of federal policy seem to be following this philosophy.
It's important to protect the old and the vulnerable, who are at the highest risk of severe illness and bad outcomes. But like most issues of medicine, it isn't a binary choice. Given the uncertainties of how this virus spreads and its high risk of infirmities, it would be unwise to abandon efforts to limit Covid spread wherever possible. That means continued universal masking, social distancing, and diagnosing and tracing of individual cases.
While age appears to be the strongest predictor of death and severe disease, other risks like diabetes and obesity correlate with bad outcomes. About 10% of Americans have diabetes, and 40% are considered obese. Young people can fall seriously ill. About 40% of hospitalizations in Sunbelt states in the last week of June were in people ages 18 to 49. Then there are those who survive but don't fully recover. There's growing evidence that the virus can damage the heart and cause dangerous autoimmune and inflammatory conditions, including in children.
Covid spreads too easily to think it can be confined to the young. The summer epidemics in Sunbelt states initially affected mainly a younger cohort and then seeped into an older population. A wedding in Maine caused an outbreak that spread to a rehabilitation center and a jail. It is neither possible nor desirable to lock away the elderly and people with underlying health conditions.
Yet this week proponents of the let-it-rip policy hailed a
rewrite of Centers for Disease Control and Prevention guidelines that appears to discourage testing asymptomatic people who have been exposed to the virus. The new guidance, whatever its intent, will discourage communities from testing the young and the healthy. This will make it more difficult to track and trace cases.
Proponents point to Sweden as a successful model of this approach. Swedish government officials initially sought to let the virus run largely unchallenged in the general population while taking steps to protect the elderly. The Swedish view was that the country could reach herd immunity without jeopardizing the economy. But holding up Sweden as an enlightened model misreads important parts of its experience.
Many Swedes pulled back from normal activities to shelter themselves from infection anyway, even younger and middle-aged people. The country experienced 5,821 Covid deaths in a population the size of North Carolina. And Sweden is far short of herd immunity, even as the country's economic recovery ranks among the worst in its region. A May survey of Swedish exposure to coronavirus found that 6.7% of those aged 20 to 64 had evidence of past infection, along with 4.7% of those younger than 19 and 2.7% of those 65 and older. Stockholm, the country's single large population center, also has a much lower density than most American cities. That reduces Sweden's risk of continued epidemic spread.
Yet embrace of the "Swedish model" is based on assumptions that sidestep some of these facts. The biggest misconception is a belief that there's a large reservoir of Americans who are already immune to Covid. This view is based on the fact that as many as 50% of people have immune cells, called T-cells, that develop in response to other seasonal coronaviruses and which have been shown to counter the Covid virus in petri-dish tests. Yet the science here is preliminary, and this lab finding may not have any bearing on the pandemic's dynamics.
Confronting a dangerous pandemic requires containing spread wherever it is reasonably possible. Sensible measures such as universal masking, testing and widespread and rapid contact tracing can help. The best way to protect the vulnerable is to try to protect everyone.
Dr. Gottlieb is a resident fellow at the American Enterprise Institute and was commissioner of the Food and Drug Administration, 2017-19. He serves on the boards of health-care companies involved in the Covid-19 response and is a partner at the venture-capital firm New Enterprise Associates.
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