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Advisor to the Swedish government: "you can't stay in quarantine forever."
Material posted: Publication date: 08-05-2020
Sweden is one of the few countries that refused the strict measures of isolation in response to the pandemic coronavirus. About the features of the approach chosen, told RBC a scientific Advisor to the Swedish government and who Johan Giesecke.

"People are not stupid"

In contrast to the vast number of countries, Sweden did not impose a stringent regime of quarantine. If I'm not mistaken, almost the only valid in the country the prohibition applies to meetings in one place more than 50 people. Why it was decided not to impose tougher measures?

Already at the initial stage of the epidemic, we have decided to limit implementation to only those measures that have a scientific justification. And, in our opinion, such measures only two. First, you need to wash your hands, as we knew already 150 years. Secondly, you should respect the social distance-not too close to other people. These are the two main rules.

As for the other restrictions, the closure of the borders is useless. The closure of schools, probably, does not entail any consequences. To forbid people to go out? This is nonsense, have no such prohibition there is a scientific justification.

In Sweden on may 4, 317 were 22 diagnosed cases of the novel coronavirus and 2679 deaths (according to the European centre for prevention and disease control). The number of deaths from the coronavirus in 1 million people in Sweden is more than 260 more than in neighbouring Finland (42), Denmark (83) or Norway (38), but less than in Italy (477), France (381) or the UK (419).

The Swedish population is 10.2 million people.

— The fact that such measures are useless, is your findings? Conclusions from the scientific advisors of the government of Sweden?

— Yes, it's our decision. But I think that to give some evidence in favor of their position needs those who impose rigid restrictions. They need to justify why it's (limitations) effectively. We ask: where is the evidence that your actions are correct? But we have no hard constraints are not taken. Let the justification given by those who such restrictions were introduced, but they have not done so.

— What factors you took into account when determining the strategy for the country's fight against the virus? What were you looking at: the ability of the health system to cope with the current load, rate of virus spread, percentage of cases?

— The ability of the health system to cope with the flood of cases is a very important factor. We should not overload our system. In addition, the Swedes and so themselves disciplinary. Of course, if they did not, the rate of new infections in the country would be much higher. So in a sense we can say that in our country also has some semblance of quarantine. But we don't need laws that require people to stay home. This is an important principle of Sweden's strategy — people are not stupid. If you explain to them that any rules will do them good, to help others, they will listen to you. They understand. Don't need the police, you don't need the fines. I think that such a principle would act in any country, not only in Sweden.

— So you do not consider the possibility of introducing additional measures in the near future?

— No, quite the contrary. It is interesting to observe how countries are looking for ways to get out of their quarantine. Nobody, no politician in Europe is not talked about how to mitigate the quarantine. They entered it, but I have not heard any discussions on how to take it off. Here they closed the schools. And when they should be open? What criteria should be applied? Kept saying, quarantine, quarantine, quarantine, but none said how to get out of it.

— To what extent are you worried about not to bring in patients from other countries? Are you going to introduce more rigorous measures to check those coming into the country from abroad?

— No, why would we do that? Everyone in Europe, including Russia, have been infected. Every country has growing pockets of the virus within its borders, so nothing to worry about importing diseases from abroad make much sense anymore.

— How to cope with the crisis, Sweden's healthcare system?

— We are experiencing a difficult period, the healthcare system is subjected to severe strain, however, we still have free beds in intensive care units.

— What percentage of beds remained vacant?

— About 10%.

— How important is the role of testing? Sweden is behind many other European countries on this indicator.

Testing and identify contacts of the sick person is of special importance, or at the very early stage of the epidemic, or when their peak has passed. In other words, when the rate of infections is not very high and you have the opportunity to bring the epidemic under control. But now, when the virus spreads like fire, testing does not play a role.

The Swedish approach and its criticism

Sweden has demonstrated an unusual approach to combat the coronavirus, refusing to impose a hard limit. There are open public spaces, cafes, primary schools, kindergartens, public transport. A moratorium is imposed only on the collection of more than 50 people in one place, and high school students and institutions of higher education are translated into online learning. The government encourages the citizens to observe social distance, it is possible to work from home and avoid contact with elderly citizens. "This is an important rule: if you woke up in the morning and you have any symptoms of the disease, you need to stay home," said RBC Giesecke, stressing that the authorities follow the advice of how ordinary citizens and employers. The who noted the ability of the Swedes to respect the social distance with no hard bans, calling it an example for other countries.

Chief epidemiologist of the country Anders Tegnell believes that the current restrictions are sufficient. Strengths of the Swedish approach Tegnell believes the emphasis on the personal responsibility of citizens and their willingness to comply with social distance. Tegnell recognizes that the mortality rate from coronavirus in Sweden is higher than in neighboring countries, but it explains the infection in nursing homes, which negatively affected the overall statistics of deaths.

More than half of Swedes (51%) support the actions of the authorities, to the public opinion poll conducted in April by Swedish scientists. 31% believe that the authorities should tighten the rules of quarantine, 18% are neutral to the situation. According to a survey by the newspaper Svenska Dagbladet, the policy of the authorities is supported by 52% of respondents, the tightening measures are 14%.

However, the approach of Agnella there are critics. More than 2 thousand Swedish physicians, scientists and professors, including the Chairman of the Board of the Nobel Foundation Carl-Henrik Heldin, in March, signed a petition calling for tougher quarantine in the country.

"You can't stay in quarantine forever."

— How do you explain the fact that in neighbouring Finland and Norway, have adopted more stringent quarantine measures, the morbidity and mortality considerably lower than in Sweden?

— The problem with Denmark, Norway and Finland that adopted there are limitations ever have to remove. You can't stay in quarantine forever. When this happens, the rate of infection will jump. Everything that makes a rigid quarantine is delaying the solution to the problem that stands before you. But this problem is still relevant in a few months.

That is, in your opinion as to suppress the disease in the Bud failed, the only way to overcome it is to develop herd immunity, that is, to give more than 60% of the population to contract the virus?

— Right.

— By this logic, maybe it should speed up the spread of the disease, if the health system to cope with the flow of patients.

— Probably, it would be possible to accelerate the spread of the disease among young people who are not experiencing severe symptoms and die from COVID-19, is that like a couple of days with a cough.

— Many Swedes already had the virus?

— We have information only on Stockholm, home to about 2.5 million people (10 million across the country). And according to our calculations, about half a million already infected with a virus. The debate about how long does the immunity continue. You will not be immune to the disease all his life, and only about a year, but this is enough (for epidemic).

Swedish epidemiologists said that the population can develop herd immunity in a few weeks. Is it realistic?

— If we talk about Stockholm, Yes, but maybe for the whole country it will take a bit more time. Probably a few months.

— That is the real number of infections exceeds a multiple of the official statistics according to which in Sweden became ill about 20 thousand people?

— Of course. It is very easily spread disease, and spreads it very quickly. The majority of carriers of this disease — people who have not observed serious symptoms, such order of 98.5 percent. They won't go to the doctor for help, and they have mild symptoms: fever, sore throat, headache, fever, maybe diarrhea. Of course, there are those who face severe symptoms, and those for whom the disease will turn fatal, but it is 0.1% of the population.

— How soon, in your opinion, can be developed the vaccine?

— I think, at least next year.

— If she will put an end to the pandemic?

— Let's hope. However, it is believed that the immunity is valid for a limited time and not lifetime. In this case, we will probably be faced with the need to vaccinate people around the world every year, and it is extremely difficult. So I'm not entirely sure that even the vaccine will solve all the problems. The best option — every country needs to develop herd immunity.

— You are the Advisor to the world health organization, which has been criticized by the United States for lack of transparency and slowness. Do you agree with this criticism?

— I don't think they were slow with the announcement of alarms, it was done quite quickly. They could sound the alarm a week or two earlier, but it wouldn't have mattered.

— The United States also advocated that the reform of who. Is there such a need?

— I believe that the who is a useful organization. Work there are a lot of good people, but sometimes they face difficulties. They were criticized during the Ebola epidemic in West Africa five years ago. Then, too, talked about the need to rebuild who. Yes, the organization is not running fully optimally, but it works well. A big problem who is that many donor countries such as the USA, give her money — or gave money, while the President trump had not yet forbidden to do so, but said that you should use the money for research of a particular disease. So make sure to plan something that was very difficult, considering that the money allocated to the organization, already reserved for specific tasks.

Johan Giesecke was born in 1949 in Sweden, a graduate of Carolina University. Engaged in the treatment of infectious diseases. In 1992 he received a master's degree in epidemiology at the London school of hygiene and tropical medicine. From 1995 to 2005 he was the chief epidemiologist of Sweden. Giesecke took on the job of the current chief virologist of the country Anders Tegnell.

In 1999-2000 Giesecke headed the working group on the revision of the international health regulations of who. From 2005 to 2014, he headed the office of the head of research of the European center for the prevention and control of diseases (the structure of the European Union). Is an Advisor to the government of Sweden and Advisor to the who Director-General.

Yevgeny Pudovkin


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