Coronavirus in Sweden: An Update From Sweden's Chief Epidemiologist

andes tegnel who is sweden's state epidemiologist and head of the department of monitoring and surveillance at the swedish public health agency i had the privilege of moderating a conversation with dr tegnall back in april about sweden's response to the covid19 pandemic i am delighted that he's joining us again today as gmf's programming on the transatlantic approach to the coronavirus pandemic continues i'd also like to give a special thank you to the swedish embassy for their excellent partnership in organizing this event i want to invite all of you who are listening to join the conversation by sending in your questions using the q a button at the bottom of your zoom screen and you're also welcome to tweet out about the event the hashtag is gmf tag now and you can also use our twitter handle which is gmfus dr tegnell when you and i spoke in the spring as covid 19 was spreading through europe states across the continent imposed dramatic lockdowns on their citizens there was only one country that stood apart and that was of course sweden unlike france germany the uk italy sweden did not close restaurants bars schools or gyms schools for pupils age 16 and below remained open mask wearing was not mandated and public gatherings of fewer than 50 people were permitted now fast forward six months sweden is still grabbing headlines in terms of how it's approaching the pandemic and over the past week i've been reading lots of articles about what's been happening and here's a sampling of the headlines that we're seeing now sweden's solitary voice in a crisis sweden swims against the tide making sense of sweden sweden's virus plan was called lacks can it be called a success and here's where i want to bring you in from where you sit can sweden's approach be called a success and catch us up on the situation now six months from when we last spoke so dr tegnela warm welcome and over to you and you're still muted about so now um sorry about that thanks a lot for bringing me back here i think we had a very interesting conversation last time and i'm happy to be back let me start with with just a few words on what's happening since last time i mean sweden had a difficult spring i think we should realize that um it worked out reasonably well as our calculation shows that the epidemic pandemic peaked in sweden the first part of april sometime and then we had a slow decline of cases until we really hit very low levels from you in and onwards and during the summer we had very low levels of spread in sweden uh probably one of the lowest in europe um and during that time the swedish healthcare system continued to function very well of course it meant that there was a lot of transition being made a lot of anything that could be delayed was delayed and there was a huge focus on on treating kovi 19 patients i think 70 80 percent of the patients in icus were kovy 19 patient for a while uh on the other hand there was always free bets in icus never less than 20 of the beds were free at any given time of course there were regional variations and a few patients needed to move from one region to the other but on the on the whole the health system coped extremely well and now when you talk to them afterwards and they compare their figures with other countries they also produced a lot of high quality health care because the results from the swedish icus and swedish healthcare in general are at least as good as any other european country uh so that that worked out really well we had a big problem with our nursing homes for a while and that produced very high mortality and that's the background to be that we still have high levels of mortality but since i would say middle of june uh and even earlier and so that was fairly quickly rectified and cases in nursing homes fell dramatically and our mortality rates have been on very low levels all through the summer and is still on very low levels so is this a success or not i think we all need to be humble when it comes to this pandemic who has come back with such a vengeance in in many european countries so we should not feel safe and we do see increasing numbers in sweden too not dramatically so and cases in hospitals and icu's are still on very low levels our mortality rates are still on low levels but it's definitely a concern and we are instituting more recommendations in in on the regional level right now and we are following the situation very closely to try to to break this trend as quickly as possible i want to dig a little bit deeper on this one of the elements of sweden's approach that's gotten a lot of attention has been this issue of lockdowns and for many who oppose lockdowns who are advocates of small government who feel that lockdowns are an infringement of individual freedom they have held sweden up as a poster child for a different policy i've heard you say that look be careful here i mean maybe sweden did not lock down the way other countries did but you said sweden had a virtual lockdown can you help us better understand what you mean by that now what's happening is that we sort of asked people to to minimize their social contacts and people did that to a very high degree we can measure it in some ways we have asked people to what extent they have actually diminished a social context and follow our advice and continuously 80 to 90 percent of the population says yes we have really changed our our lifestyle a lot and there's even been surveys in other european countries and sweden comes out as one of the countries where the population say they changed most which i think is is a sign that this advice we gave really sort of in practice gave a virtual lockdown we can also see that on travel i mean domestic flights in sweden stopped basically and they have started a bit again trains went down to i think about 30 or 40 percent of normal capacity uh we can look at mobile phone traffic and see that people traveled or moved around 20 percent less than they normally do which is a higher change than in you know than in our neighboring countries and we still travel less compared to normal travel patterns than in any other country around us so i think yes we had a virtual lockdown we managed to achieve it mainly by getting the population to change the habits voluntarily but also by having some strict measures in some aspects like for restaurants example for example we know that restaurants are places where there can be a lot of spread if you don't control them well and so we gave a lot of regulations to restaurants the local authorities are continuously inspecting restaurants to see that they they follow those rules when we now look into our contact tracing data we can see that people very seldom are infected in restaurants so that worked out uh we also as you said cut down on big events another place where we know internationally it's quite often that you get big spread and that has also been followed because in legally we can only restrict certain events um very quite few events but in practice this level of 50 were instituted on all events voluntarily so in in practice i would say that we had is just as much as overlocked on as many other countries but in doing it with slightly different tools than many other countries did it's fascinating your comment that 80 percent of swedes have said they have changed their behavior as a result of these recommendations and it underscores a point i've heard you make before about sweden being a high trust society and you know in your role as an epidemiologist what is your advice for countries like the united states that maybe don't have that high level of trust as we see in the u.s this has become a deeply partisan issue so if the key is to stop transmission and the way it's transmitted is people being together and people aren't self-policing how does a public health agency or a government try to stop that transmission it's very difficult because i think each country is is different and the context is different but but i think what we have learned not only from this time but also from ebay and west africa and a number of other incidents that you need to be able to have a dialogue with your population you need to get your population to understand that we have a common goal in this and and get them to understand what really is important not just telling people to put on masks or doing this or that but really communicate that the main issue now is to try to meet as few people as possible close by and then giving them the opportunity to sort of choose how they are do need to do it to be able to achieve that i know this is difficult because it also builds on that there is a kind of trust between the agencies and the population and that's something you you don't change from one day to the next that comes from a long time of sort of being together and i mean i think that's the lucky thing that we have in sweden that that trust has been built up over years and it's very stable we usually quote our childhood vaccination program a completely voluntary program and we reach 98 percent of all children 98 of all parents voluntarily go to their well baby clinic and get their children vaccinated no creation knowing no money exchanged there is no nothing happens if you don't go there but people go there because they trust them and they trust the nurses there and everybody sort of trusts that we all want what's best for their children so given that backdrop i am struck that you have adjusted your approach with the second wave of coven 19 and i'd like to draw you out on this you know seeing the recent rise in cases i did note and you referenced that you've issued some localized guidelines there was one in the university town of uppsala and i know you were born there so i thought i'd take that example where you saw spiking cases as students returned for the fall sessions people have been told to avoid public transportation and in-person contact outside their households until november third i also noted that in mid-september the public health agency recommended for the first time that individuals who have a household member testing positive for covet that they should quarantine tell us a little more about some of these local measures that you're putting in place and how you're thinking about that yep first of all we are in a different situation and we i mean in the spring we had a huge increase of cases with the imputation from all over the world and then we sort of needed to adjust our advice or measures to that level of cases now after the summer we have a much lower level of cases we have a healthcare with much more resources to be spared for more preventive work and that's why we we went for measures that we could not really do before because there was not just no resources to do it and one of them is to to tell people in the same household to stay home if someone in the household has tested positive um because that would make a bit more of a difference and that would also make our contact racing more effective and now when we have resources to do contact tracing so that's and we hope by that to sort of break the transmission a little bit more than with other measures in place then we have also and that was true also in the spring but not as much that the this epidemic pandemic is very much a regional there's huge regional differences both in a number of cases but also where the transmission takes place and that's why we now have a dialogue with our regions uh when they get an increase to try to understand okay what's your problem like what's the problem in uppsala oh yeah the problems start to beat a lot of students coming back to upsell is a huge student town and we needed to um and there was a lot of transmission in those not so much in the university as in all of these social events that comes with being a student town so we all realized okay this is not a good spring for a lot of student events we need to come together and tell the students you need to cut on this so we managed to get the student unions to come along and the university to come along and now we hope that this is going to have a big impact we noticed the retail business told us that after one week in uppsala retail fell by 40 so obviously people are listening and people are staying home meeting other people a lot less already and that will most definitely have an impact on the spread of the disease in epsilon the other thing we're noticing about this second wave is it seems as though fewer people are dying than we saw in the spring is that just because it's early days still is it because the folks being infected are younger what are your expectations of this next wave of covet 19 i think what we're seeing now in sweden in america and many other european countries is that the new wave a new peak of cases is very much about younger people probably because the mixing patterns are are more intense among younger peoples and the possibilities to spread there is much bigger they also get much less symptoms they very rarely get severely ill and soon and i think especially after a severe lockdown there is also a huge craving for more social contacts maybe more in those groups than in other groups so that's how it starts in many european countries it has then moved to a more generalized spread in all parts of the population and unfortunately we even see some increase in the mortality in some of the european countries the development in sweden is a little bit slower than in many other european countries we hope we can keep it like that we do see your spread also in other age groups in sweden but so far not in the age group above 70. um and so it's mainly in the sort of adult part of the not the elderly part maybe and we do not see any increase in sorry we don't see any increase in mortality in sweden we have seen a little bit of an increase in icu intake and that's why we are now working quite hard with mainly with testing and contact tracing to to try to contain this new development as quickly as possible so are the building blocks blocks of your six of a successful covet 19 strategy essentially what they were in the spring that it's testing that it's tracing and then isolating those who are sick yeah i mean basically we're working with the same thing with sort of the main goal really to try to cut down on on social contacts as much as possible and to convince people to stay at home when they are have any kind of symptoms now we can also say stay home when you have been tested positive because now we have the testing capacity to test everybody with symptoms but those are still the main main blocks that we are working with even if we are tweaking a little bit on them now and then and just right to this point one of our listeners wanted to throw in a question saying that you recently recommended that the recommendations or regulations in sweden for people aged 70 and over you you changed that why do this now when the numbers are increasing isn't this a big risk yeah i mean it's something we discussed for some time because the back top of this is really that the elderly people in sweden has felt and have been very isolated and that has really impacted on their mental health in many ways and we have a number of discussions a lot of dialogue with different groups among those and we realized that since this is going to go on for some time more we cannot really ask them to isolate them as much anymore and then we were in a situation yes the spread is bigger than it used to be but it's not near as much as it was this spring and we have the hospital the healthcare capacity to deal with cases now in a completely different manner we also believe that this group is a very responsible group and yes they will change their behavior slightly but not that much so our expectations is really that this will not really change the epidemic very much and we also need to understand that the driving part of this epidemic pandemic is not the elderly all the young people it's the it's the working age people that's where the real drive of the pandemic is so um letting the elderly people have a little bit more of a social context leave it leading a little bit more of a normal life which will improve their mental health immensely is the way we consider it a fairly low risk with huge benefits i'm sure it's a huge difference for elderly folks living in nursing homes to be able to have visitors at this point you said you know you're now able to treat this in a very different way maybe say a little bit more about that and i know one of the factors driving the high death rate in sweden in the spring were in fact those deaths in nursing homes so just help us understand what's different now no especially with the nursing homes they've been through a huge transition i would say they were not very well prepared for this kind of onslaught that the pandemic was this spring and many of them far from all but many of them had a lot of spread in their facilities and of course the people living there are the people that are most likely to die from this disease because they're both old and many of them have other chronic diseases there was a huge effort being made a lot of people being trained a lot of equipment being put in place procedures updated testing being done in those places and now the procedures are in place and we have actually seen very very little transmission in those places during the last two or three months and that's another reason why we do believe that opening up the society a bit for elderly people would not really carry any risk and yes now you can go and visit your elderly relatives in those places but you do have to follow the rules and regulations of the place you you need to be healthy of course uh you need to have a good hand hygiene you will meet in special rooms uh keeping distance so there's a number of things in place to save god that we don't introduce the disease into these places again and i also have to ask you about face masks because that is something that across much of europe and in the us citizens are encouraged to wear face masks this has not been a policy that you've encouraged in sweden why is that i think that the face mask issue is not completely easy i mean face masks in health care and social care and so of course has a long tradition everybody knows how to do it they are very very important both to keep staff healthy but also to avoid the spread from staff to to the patients so that's of course used in sweden all over the place no question about that face mask out in society is a different kind of thing i mean it's there's a long tradition about that in asia but in sweden and europe it's never been like that when you look at the evidence behind using face masks in society they are not that great very few studies have been done i saw one from cdc lately that showed that this face mask might not make that much of a difference to other studies and and also modeling and so on showing that yes they might make a big difference but we don't really know it's definitely our feeling or our belief that keeping distance is much more important and fortunately we are in a place in sweden where we do can keep distance we are not a very crowded country most of our cities with a slight exception stockholm are not very crowded we also rich country which means that we don't have to fill our buses to 120 um so we we can keep distance and as long as that works our strategy is not to use face masks if that doesn't work anymore of course we'll we'll look at face mask and maybe use them for a short period in in some places you also have to realize that the experiences in europe are not that great i mean many of the countries that now are looking at huge increase of cases have had legal obligations to wear face most for quite some time and which does not say it could have been even worse without the face muscle wash we don't know that but it's also quite clear that face mask is not gonna be the silver bullet it's not gonna make that huge difference and then i think it's a bit dangerous to believe that you can change so much by by using face mask but of course there are places and times when they might make a difference and then we will of course use them so far we've been able to cope quite well without them and and then i think it's it works better in sweden without i get mails from many swedes coming back from other countries and saying oh happy they are back to be back and being without the face masks it's face mask is problematic i would say i've worked in infectious diseases for a long time it's something you use but it's not not something that you would like to use if you didn't have to yeah interesting um we have one of our listeners who wanted to jump in on the conversation that we were just having about nursing homes and her question is you mentioned that there were free intensive care beds at all times in the spring and she's saying but many old people in sweden were not brought to the hospital why was that decision made i think that's an ongoing discussion in sweden and there are investigations going into that so i'm not going to say that this this did not happen but you also need to realize that swedish intensive care has a long tradition around looking very carefully about the patient that they admit into icus i mean going into icu you need to be reasonably healthy to be able to to benefit from the treatment there and i think that the clinicians in icus in sweden are very good at choosing the patients that will benefit from their care and not accepting patients that this will only mean that they will get isolated and going having a kind of treatment they will not help them and the end will anyway be mortality just with a few more days in an icu bed which is not really needed or ethical or morally way to take care of your patients and when i talk to my ceo colleagues they are quite convinced that they made the same choices during this time that they made at other times and that the patients the people that did not receive treatment they were better off staying in their normal homes and it would not have changed the outcome if they were admitted to hospitals of course there might be exceptions i'm well aware that and or in inspectorate are looking into that to see if there was another kind of selection of patients at this time or not and we'll see what the outcome of that but i think we need to realize that that many many of these people who very old very sick would not have benefited from hospital care or definitely not from icu care and that's a choice that needs to be to be made i now want to turn to the topic of immunity and as you know you know both supporters of sweden's approach and detractors have often described sweden's approach as one of herd immunity you have said that is not what sweden is doing um you know help us understand the role that immunity does play in this and you know could we possibly be seeing lower numbers in stockholm today because there is greater immunity i know you were optimistic in the spring that the large numbers in stockholm might have led to immunity in that population help us understand the debate around immunity i mean immunity is important of course i mean we know that from infectious epidemiology that immunity of population will very much affect the way that it disease is spread we know that from from the yearly flu the normal yearly flu where many people have immunity around it uh really slows down the spread and diminishes spread quite a lot i mean a normal flu season might result in some four or five percent of the population getting ill or something when we have a disease a flu that we are not immune to we reach level 40 50 percent maybe so of course immunity does have a role with any kind of infectious disease almost there's a few exceptions but not not many the immunity of kobe 19 how that works we don't really know very well yet but we do know that people do get immune because six months or more into the pandemic we see very very few cases of people who have been infected twice so logic tells us yes people do get immune and in some way immunity will slow down the spread of disease at what levels that will happen and how it will happen we are still learning i think part of the problem is that the immunity in the population is not homogeneous it differs enormously between different groups of in the population we know that certain parts of stockholm the immunity might be up to 25 30 percent in other parts of stockholm is only maybe five percent and that of course means that they're still part of stockholm they're very likely to have quite a lot of spread while other parts of stockholm maybe the immunity will break to spread at least to a certain extent so immunity is important but of course i mean what's implied in saying that sweden goes for herd immunities that we're sort of sacrificing people to reach that and and that is something i would like to deny very much once again uh we are have never even thought about sacrificing anybody uh around this we are really trying to get the spread of the disease to be as slow as possible uh using means that are not hurting the population more than it's helping them but in the long term of course even kovid 19 and immunity coven 19 will definitely affect the spread of the disease very much and if we get a good vaccine that will help us reach those levels quicker than the disease in itself will do it will not eradicate the disease i would be very very surprised if we ever eradicate this disease but it will help us to handle it in a much more effective way than we do today so several of the folks who've tuned in for this session are deeply interested in this debate around immunity and a couple of the folks are citing a study from imperial college in london and according to these um listeners researchers there concluded that the proportion of people in britain with antibodies that protect against covid19 declined over the summer and so the question is the study results indicated that immunity to covid19 may be short-lived and suggest skepticism about this idea that we'll see greater immunity developing in the population can you speak to that yeah i mean we we need to realize that when we live when we measure the level of antibodies then we're only looking into one small part of the immune system and we don't know what is a protective level of antibodies for kobe 19 yet because there is no date on that so yes there are several studies not only imperial college that shows that at least for some people the antibody levels falls rather quickly which is of course interesting but the the real thing is of course how many people do get sick a second time i mean that's that shows the real immunity and not just the the level of antibodies and i think that's the most important thing to follow and let's follow very very carefully all over the world and i think last count i saw a week ago something like that if that so far we have found 20 people in the world who has had the disease twice and of course considering that hundreds or millions of people have had the disease the risk so far is not very great on the other hand in the long term yeah most likely this is not the disease that gives you lifelong immunity i don't think that and then other coronaviruses don't do that but it will definitely be with us for six months for sure we can tell already and it will probably also stay for the majority of the population uh for quite a lot longer than that and it will definitely make an impact on the spread of the disease i believe and it will not fall as quickly as the data from imperial college shows because then we would have a lot of more cases of people coming back with a second second infection interesting so another topic that a lot of our listeners are interested in is schools and they're very interested in the swedish experience with keeping schools open how do you manage it is it the health authority that is making those decisions together with a school board are you seeing teachers and staff getting sick just what's the experience been over these past six months we had a lot of discussion with the school authorities on the national level in the beginning of this and based on the data from china showing that children very very rarely got severely ill and also that a lot of the early report from china also said that children very rarely are infecting other people even if that's often difficult to to measure in any reasonable way and that coupled to that we know that having children in school are very important for their health short term and long term and we can also now see from other countries so close to schools that children are really suffering i mean that's a big concern i think that children are really suffering all over the world from not being able to go to school abuse in home increases malnutrition increases so many things happen when children are not able to go to school so you really need to think carefully about closing schools especially if you do it for any longer time periods and that's why we decided to to keep them open and follow it carefully and i would say that during the spring we saw almost no outbreaks in schools we saw a few outbreaks but then among teachers obviously teachers infecting each other because there were no children involved and it was very clear that it was a teacher coming back and infecting colleagues in most cases we have afterwards looked at the rate of teachers being hospitalized with kobe 19 and it does not differ from other professions it looks like it's lower than quite a lot of professions though other professions that are have a higher risk of ending up in hospitals of course this is complicated matter also connected to socio-economic issues and so on but we do at least we do not see that teachers are more affected than anybody else if anything they are affected less than but most other people what we see now after the spring because in the spring the high schools were closed as you said we do see that high school students are different i mean in in those 15 plus children there is some spread they don't get severely ill teachers don't seem to be very much affected even if they are affected a little bit more than teachers of younger children but but there we do see some space so of course it's not an on and off button but the younger the children are the less sick they get and the less they spread the disease and and i always say that our general experience with keeping the schools open are very very positive and we do also get a lot of feedback from parents from many places in society that they are very happy about that we kept the schools open and i would say that most countries in europe now are going that way the risk of keeping schools so open are not very great and the benefits are very very big and just so i'm clear did the high schools and universities open in the fall yep they open in the fall high schools completely they are now back to normal teaching universities do a bit of mixed teaching which some of them did already before something some of the distance uh some of them physically in place interesting i mean that's going to be a fascinating model for the rest of us i mean i live in washington dc and nothing's open i mean none of the primary schools which also has a knock on effect i mean it has a very clear effect on the children but also the parents exactly especially if you ask parents to work from home working from home is okay but working from home if you also have to take care of your children who are at home that's not a very easy combination to to deal with so i now want to open another topic on which we've got a lot of comments and it has to do with the development of a vaccine and i want to read it's a slightly longer comment but it's quite poignant from one of our listeners who's living in belgium and she writes the understanding here in many european countries seems to be that the only thing that works is a lockdown and the belgian government will likely announce a second lockdown this coming friday the damage from the second lockdown is likely to be even bigger than from the first one and yet this is the only approach that can work so we are told they tell us that we have to wait for a vaccine reportedly to be available in march 2021 and this will bring the end of the pandemic at the same time some experts argue that a vaccine may not end the pandemic due to possible issues related to the vaccine itself availability etc what is your take on this argument that if we want to resume normal lives we will have to wait for this vaccine and for all to be vaccinated i think it we need to realize that we are now waiting for vaccines that we don't know very much about so far i mean the the trials what we know from trials have been reasonably successful but we are also looking at vaccines that are of a different kind than any of the vaccines that we're using today i'm not saying that that's a bad idea it's it's the kind of vaccines that have been worked on for a long time but they have never been mass produced have never been used on a massive scale before so that's that's a little bit of a concern uh i think that this safety issues can be handled but we need to realize that the efficacy and the long-term efficacy of those kind of vaccines we don't know too much about we don't know if how well they will work on the elderly and so on but i think the main issue is that yes deliveries will start somewhere reasonably early next year but they will be spread over a year or two which means that we will not have a vaccine that will affect the spread in the population for at least i mean early as next fall if we are lucky because we do really need to vaccinate probably around 40 50 percent of the population to see any kind of reasonable effect on the spread of the disease so yes a vaccine will definitely help us but it will not let us come back to normal life for for quite some time yet um it will hopefully help us to protect the elderly and the risk groups i think that's the most important thing we can think about to start with that will make a difference and help us also protect healthcare workers and so on that will be important but for society at the large it will take much longer before it will have an effect and and we also need to realize that we need to convince the population of that they need to get vaccinated if we go back to the swine flu pandemic 10 years ago or so that was not an easy thing to do i noticed that in france they managed to reach surfing three or four percent of the population in spite of that there was plenty of vaccine available and they did a lot of effort to try to convince people and of course if we end up in the same situation this time that large parts of the population are not interested in being vaccinated which is maybe there are some polls saying that 50 60 percent of the population might get vaccinated in europe it might be more but i mean for great parts of the population um they might look at it that they are not going to get severely ill and i think that's part of the reason why we see so much overspread in the younger parts of the population in europe right now many of them the risk calculation is that the risk for me to to get corona is not that great and to convince them to get vaccinated for the good of society that will maybe not be that easy so i i'm highly skeptical skeptical about saying that yes once we get the vaccine we can forget about lockdowns and everything else and just go on living like we always did it's going to take quite some time before we reach that level that's sobering but important for all of us to to think through the implications of that we have another listener who is very interested in your opinion on why china is doing so well fighting this virus and of course china is also vaccinating people as we talk right now so what about the chinese example and can we learn from that yeah i mean i think that's difficult we don't know too much about china we the the i mean we know some things i mean they've used extremely drastic measures and i'm not too sure about the acceptability of those level of measures in europe at least and probably in many other countries too it's obvious that those kind of drastic isolation measures do have an impact and quite a big impact and if you can get an acceptance in the population for doing those obviously like in china you will have a very good effect if that will work in the long term it still remains to be seen i mean there has been some new outbreaks in china they have managed to contain them very quickly of course by using the same jurassic measures again now when we're going back in europe to the same domestic measures that we use this spring there's quite a lot of opposition to it so i think we need to realize that these are different cultures different political systems and there are limited things we can learn from china unfortunately because i think that many of the things used there would not be acceptable in sweden and probably not in most european countries you mean in terms of the surveillance they're doing of in terms of surveillance they're doing the terms of sort of drastic measures against individuals if they don't follow exactly the the rules in terms of the self-isolation that are imposed on on huge groups of the population for extensive times and would you if you have the opportunity to be vaccinated with the chinese vaccine would you take that since we don't know how that much about how it's actually been tested and so on i would prefer to to use a vaccine that's gone through by our european medical agency where there's a lot of transparency about the tests and so on that's been done on it so that we can feel very safe about that we're using as safe as a vaccine that's possible to make yeah well and to your point that there are a lot of there's a lot of skepticism in some of our countries about vaccines in general it's probably quite important that whatever go to market not have immediate negative side effects for lots of people one thing that's really striking about your approach to covet 19 is the holistic view you have of public health and it came through very clearly when you talked about the regulations being lifted on visiting nursing homes because you want to think about the psychological well-being of the elderly in sweden it comes through when you talk about schools and the impact that not going to school has on children and we have a couple questions that are asking about the impact of some of the covet 19 policies on business in the retail sector and you talked a bit earlier about the impact on the retail sector of some of the new regulations and there's interest in hearing from you what kind of dialogue or coordination there is between the health authority and business and inter industry as you think about what approach to put into place um i think in different ways when it comes to sort of the economic consequences and so on i mean then that kind of dialogue is done by the government it's not the public health agencies we are not involved in any kind of subsidies or anything like that to companies that are not running that well on the other hand we have a lot of dialogue with different actors on how they can participate in making it easier for people to not being crowded just this morning we had a conversation with the reta with the union of the retailers in sweden uh who really wants to get our advice on how do they arrange the stores and the selling and the big shopping malls and so on how do they arrange things to minimize the risk of spreading those so this is really i think an area of collaboration of course they are very open with they need to keep on selling things but on the other hand they're also quite open to getting any kind of advice on keep on doing that with as little risk as possible and i think they're also quite prepared to take some losses rather than having the risk of being sort of closed down completely so i think this has been quite a good dialogue and i would say that many of the stores in sweden have done a very good job on that there are a lot of markings in the floors on how to keep a distance many stores have a system for not letting too many people in at the same time many stores have employed special people that go around telling people to keep distance and stuff like that so um i think they've really done their share in the sort of community thing around making it possible to keep a distance in different places in sweden so i'm personally very interested in what you have learned over the past six months about this disease and when this began we were very focused on the damage that coveted 19 does to our lungs it now seems that covet 19 affects a lot of other of our major organs including our heart and what what have we learned about this disease and how it attacks us over these past six months yeah clinically i think quite a lot and as you say is probably one of the infectious diseases that affects most different parts of our body in many different ways in surprising ways i mean taste for example one of the fairly common and maybe one of the most common uh symptoms of kobe 19 some people even say that this should maybe be the best way of measuring how many people actually have been having had coffee 19 and it's asking me if they lost taste at any given time because that's very common and can keep on for extensive period of time so it's really giving a lot of odd symptoms even for infectious disease clinician i would say and also the way it spreads because it spreads in such unusual patterns it does not spread if we say that individuals seems to spread the disease so differently there are studies saying that maybe 80 percent of everybody getting it or not spreading the disease to anybody while they lost twenty percent are spreading it to a lot of people and and that makes for a kind of spread that's unlike most other diseases that we know about and that's i think what's behind this kind of cluster so super spreading events of uh that we see a fair amount of and that's also has made that we need to do our supervision and it needs to do our measures tailor them slightly differently than we do for many other diseases because these big outbreaks and so on are much more driving in this disease than in any other disease with so it is it's it's a very different disease than from i would say any other infectious disease we have had to deal with in the last decades or so well this your comment just now engendered a couple of questions so let me just ask you those right now one is that isn't losing taste connected to not having enough zinc in your body and the other is what do you think about the use of sniffer dogs to detect people with active infections this has been used in finland and elsewhere is this a viable alternative to pcr testing back to you uh no i think the taste is more about that this virus seems to be affecting our nerve system in different ways because there's also quite a lot of people describing other nerve i mean losing sensibility on your skin there's a number of ways that this virus seems to affect our nerve system so i think it's more connected to that than anything else the sniffer talks are very interesting um and i'm sure there are places and and times when they're going to be useful i mean it but it's a question of how many sniffer dogs can you actually um produce in the short term i think there is a good complement but they will not really replace normal testing and so on but it's going to be quite interesting to see how the finns are using them in airports and so on and how much of an impact that has interesting and i want to ask you also about are we getting better at treating covet 19 i think the human condition is such that we always want there to be a silver bullet and you've made very clear there are no silver bullets when it comes to coping 19 and it's a vaccine won't be a silver bullet which then leads to the question of okay if we can get better at treating this then that's another avenue a path forward to normality and you know it does seem that we've learned some things about when to use blood thinner and when to use ventilators but talk about the treatment side yeah it's not something we follow that closely to public health but i would say in general that's been while the vaccines seem to be quite successful i mean we have a lot of vaccines coming up a few of them five to ten are very close to to being starting to be used so that's really been a success story in many ways even if it's not gonna be the complete silver bullet uh while the treatment has proven much more difficult to get something that actually sort of stops the viral disease that affects the viruses none of the treatments tried have been really all that good on the other hand technically i would say icu doctors and clinicians have become much better at handling the patients which means that they are much better choosing which ones to put on ventilators how to ventilate them the best way and so on so i think that the survival rate in hospitals has probably increased quite a lot and and also that the needed treatment periods and so on has been shorter but and of course that's good but it does not really it's not a big change and it will not really i think affect our way of of looking at this as a severe disease that you really need to be careful about so we're getting near the end of our time and i want to ask you when you think about all the things you've learned over these past several months around covet and you think about the swedish experience which necessarily is unique because each of our countries has has different societal norms and different senses of individual responsibility and what you've talked about and trust in government what are the lessons you have learned that you would say are transferable to other countries that you want to make sure we who are not swedish keep in our heads as we sounds like have another at least year to try to manage this i think many of them we have learnt in many countries i mean one of them is how careful we need to be about nursing home and or the elderly part of our population because how vulnerable they are and how this disease would affect them so severely and that we need to be really careful in the institutions that treat our elderly people i think that's something we have learned and paid dearly for so i think that's very important the other part is also to have supplies in place for our hospitals and for our hospital staff because there's been a fight all over the world to be able to keep everything needed in place all the time and i think this just in time delivery methods that are very apparent in sweden and in many parts of the world these days we need to adjust them i think to a certain extent to be able to to supply or help staff with reasonable ways of working and also maybe in the end that our society needs to understand that crowding is something that can be dangerous and we maybe need to think about how we're building our cities our societies in a way that we don't don't assume that crowding is going to be okay um that we build it in a way that's easier to to move back and forth between working and home without having to use public transport all the time and things like that so maybe those kind of things will also be apparent to us that crowding is in itself um a dangerous thing and that us humans there's a need to have a little bit of space around us to be a bit safer well dr tagnell i think you and your colleagues across europe and here in the united states have made clear to all of us the importance of public health officials and the importance of facts guiding the policies we put in place and one thing that really sticks with me from the comments you've made is the importance of whatever approach we put in place being sustainable over time and that we need both government action we need public health officials giving us their best guidance but there's also a critical role for individual responsibility and all of us then following through on that guidance and i just thank you for being such a clear messenger on that point as well and it sounds like that's going to be a key part of us getting through the next year with as few people as possible getting sick but an even smaller number dying um is you know if there's any message along those lines you want to close this out with please let me hand it back to you oh but i think you're very right i mean we need to find a way to live with this disease that are not hurting our societies more than absolutely necessary i think that's very clear and those ways would be different in different countries i think that's also quite clear but we need to think about this in in the long term and to do that we all need to take responsibility this cannot be handled by any one individual or any one institution or any one politician and it's not either a way we can buy our way out of we really need to to work together to make life bearable for the next 12 months well dr tegnell i want to let you know that everything in the q and answer box right now is saying thank you very much dr tegnal for a fascinating conversation for those of you who have tuned in wonderful to have you terrific questions this session has been recorded it'll be posted to gms youtube channel you're welcome to watch it encourage others to watch it i think the more knowledgeable we are about this disease the better poise will be to manage it and dr tegnal i will look forward to inviting you back in six months and doing another stock taking but in the meantime i wish you well and thank you so much for making us smarter about covet 19. thank you so much for having us having me bye-bye

Channel: The German Marshall Fund of the United States

Views: 161,667

Keywords: German, Marshall, Fund, Sweden, Coronavirus, Pandemic, COVID19

Id: 0IgbuUD5MjQ

Length: 59min 10sec (3550 seconds)

Published: Wed Oct 28 2020