Sweden's response to COVID-19 pandemic Dr Anders Tegnell in conversation with Prof. Martina Cormican

and there's a there's a term called presentism which is we judge the past by what we know now and I think it's worthwhile us all going back to the moment we heard a pandemic was coming what was happening in Northern Italy the sense of uncertainty the sense of panic um I do epidemiological research and stroke um and we frequently you know we do analysis to predict patterns of disease but we have data so we're predicting patterns of disease knowing what the key contributors to disease are knowing what's patterns are out there and we still get it wrong so having armed with information so certainly when this happened and there was a sense of you know asking people like Martin and Anders like tell us what's going to happen here I would have certainly had a overwhelming sense of sympathy because one of the rules in epidemiological research is don't model to where you don't have data you then Champion people with saying okay we don't have data but can you please tell us what's going to happen and I remember reading articles New York Times Jama where researchers not in this space were criticizing infectious disease and epidemiological research saying you know you really should know how to predict this how the disease is going to unfold you also should have good interventions that are evidence-based which again at the time was a sense of that's crazy how are you going to develop interventions when we haven't had a pandemic in 100 years but that self-same defense and a sense of you know it's not fair to expect the research and Public Health Community to know won't apply next time because we should know better we should have learned from this one and there is a sense and I had a two and more I mentioned it yesterday of this kind of collective sense of it's over let's forget about us let's drop the masks let's have a few drinks so you know for certainly Martin cormican who's a a very dear colleague to put his head over the purpose and challenge open up conversations Anders throughout the pandemic questioning things challenging things I think it's something that we're very grateful for them and it's Brave it's Brave to make predictions where there's no data but it's also Brave to raise questions about I you you can say it right and wrong right because you can't get it right it's about what aspects of this do we get least wrong so it's that context I think within this presentation and then you know by recalled attending a lecture with Richard dog who was you know one of the founders of modern day epidemiology along with Bradford Hill did a series of epidemiological studies thus Illustrated smoking cause lung cancer and he gave a lecture to be honest I hadn't realized he was still alive in 2005 he was 95 at the time he gave this cracking lecture like just so insightful and bright and gave the full story of his experience and then after the lecture somebody asked him a question you know can you predict what the next contributor is the cardiovascular disease burden will be and like you could hear a pin drop like this kind of Yoda of epidemiology and he said no and then they went but surely you have ideas like us too what it might be or where it might come from and he said oh I've got ideas he said I can guess I just can't predict so when you take somebody with that expanse of experience defines the field I think one of the key things here is that we expect certainty and reasonable prediction in a place where getting at least wrong um is where we're asked so I congratulate the research you're doing also the fact that the research extends beyond the direct contribution of the virus to disease and disability it's a holistic perspective it's its impact on prevention and treatment of other diseases and certainly as a working geriatrician we're seeing the legacy of the covert pandemic day in Day Out the lockdown the residual accelerated cognitive and functional decline they didn't get covered but we're seeing that Legacy I was reading some literature on the great Irish famine how you could measure the consequences right up to the 1980s because of the Legacy effect they were modest but they were multi-generational so I think this is the correct setting for it it's an academic institution it's academic freedom we Embrace bold ideas we Embrace challenges even if we don't agree with them so it gives me distinct pleasure to welcome Professor Martin cormican and again one of our own and took a leadership role within this and then there's techno they will both present for approximately five to ten minutes each and then they will host questions and discussions there is an advisory this is live streamed so your questions will be streamed across an audience and will be recorded but that should not deter people from asking the questions you want to ask and the more challenging the better which is easy for me to say because I don't have to answer the questions um exits are to the rear that's for fire hazard rather than requesting that you leave and thank you for attending so with that I'll hand over to our two August disgusting some presenters and on behalf of our University and college thank you for attending thank you see how this works thanks a lot for inviting me here [Music] look so you might have to I'll do it on this one might have to do it now okay I think so oh wow that works good thanks and thanks a lot for inviting me here this gives me flashbacks to my medical student days which is kind of strange Arrangements which does not really give interactive audiences very easily but I hope we can get it going anywhere today I will rush through a number of different aspects on the Kobe pandemic and what we experienced in Sweden so that we have a little bit of different things that we can come back to and discuss further on that does not mean that you're perfectly allowed to to stop and ask questions along around if I get if you're not sure what I'm trying to tell you so what have we learned from from pandemics from this pandemic and what can we learn I mean we all know that pandemics has been with us in history probably forever and ever at least since we started building cities and started crowding our shops together so we should have learned something for a few thousand years one might think but then I found this poster from the Spanish flu and I'm not going to go through but just quickly reading it you can see that advice they gave to the public in those days were exactly the same advice that we try to give today so this is for more than 100 years this is a far we got in the non-pharmaceutical interventions so that I think gives us some perspectives and then they didn't really know what they were doing and we probably didn't know what we were doing this time either uh we need to realize I think this is one thing we really learned context how important personally I get more and more to think that the difference between countries is not about what we did it's about the context where the pandemic struck Sweden is a federal country we're dividing in different ways so the the mandate to do things comes down to many many different actors and one of our main tasks at the National Arena was really to coordinate and try to get people to do reasonably the same kind of things but it's it's really and I know and everybody who is here from a federal country knows that this really adds a lot of complexity to to things like this and especially the healthcare system is is run by 21 different regions in size from 60 000 to 2 million so that's also another challenge in Sweden two words became very very often used by different actors and I don't know if it was like that here but the precautionary principle was used all the time and for many people it was that then we should do everything because that's the precautionary principle but of course you can also look at the other way you should not do things that you at least expect to more harm than it does good I mean that's also one of the basics of medicine I mean it's one of the ethical parts of the medical training don't hurt people more than you actually need to and that was missed you so many times the other thing which is very much ingrained in in Swedish law especially in the communicable disease sect is proportionality you're not really allowed to do things in Sweden where you cannot see that they do more good than bad and and the the burden of proof is really on the person that decides to do things and these things we discussed a lot and that's very much a background to to many things how we acted so what measures Sweden like some countries I'm not quite sure it was an island but we had a fantastic introduction of the deceased at in a very short time one million Suites travel away from Sweden during or winter holidays for three weeks four weeks and it's quite interesting because some people travel during a good time that's the ones in the very self that was before the outbreaks in Europe some people travel during a bad time two weeks later and came back with enormous amounts of cases so very very quickly the the whole system in Sweden was overloaded and we needed to go from from stopping the disease to mitigating disease and here again this is a lot of discussions around us this really the correct decision to take but we didn't really have any choice but we try to do this which is sort of classical pandemic um ways to handle a pandemic I fought until this pandemic because in this pandemic there was suddenly forces saying that we can stop it it has never happened in history that we stopped the pandemic but this time there was a lot of belief in stopping it completely while we really tried to to keep it at a reasonable level so that the health system could take care of it and what we did is really try and we talked about independent project and I think it's good we need to tailor measures we can't sort of close everything down we need to find well most of the diseases spreads and it's not easy to know from the beginning I mean there were some things we learned from Italy from China so and we wanted to of course reduce contact intensity in different ways and we follow the the Spanish Flu rules we did testing and contact racing that's also another myth after that we didn't do Tyrone in Sweden which is not at all true we did frequent Communications 198 press conferences I'm still asking Henrik but within two more so we could then we I I'm sure we could have sent it to the Guinness book of records and and another thing we learned is this so and we talked about independent project too I think very nicely that this is the whole of society problem a pandemic cannot be handled by by Health Care Services or even by communal Disease Control and so on so these are just a number of different actors that we work with anything from the scouts to the Swedish Church to the children's Ombudsman and so many different actors that were involved in this and that took us some time to to get those things into place so I think that's the learning thing for the Future these are different actors that public health needs to have contact with constantly and of course then claim the vaccinations and I think we don't really want to think about what will happen during this pandemic if the vaccines didn't come even if Omicron seems to be nicer I'm not quite sure how much nicer it is if you don't have a vaccine in the background and you can see here up how the wave soft to the vaccinations start looked completely different so that was the big game change and I think what we spent a lot of time and effort trying to implement in a good way um we vaccinated everybody about 12. we did a very structured vaccination starting with the elderly people's home where we know most of the people got really serious ill and then worked all the way down during the different age groups so what were the challenges I mean in the beginning we talked a lot about this the super spreader and that really made a lot of predictions we talked about predictions very very difficult to to understand because many you could run like 50 big events and nothing happened on the 51st you happen to get a super spreader in place and a scenario like in South Korea with hundreds of people getting infected came into place and that makes measures very very difficult to validate and I think it also made a lot of the research we tried to do afterwards very very difficult to interpret so there was one thing the other thing was the elderly people song and I'm quite happy to come back to that discussion because these are really the areas we need to learn because these were I think in most countries were really severely hurt and so many people died in these places and this is from the US so but you can probably name any country in the world and you have the same kind of problem and then we had the children what should we do with the children and I'm also I think now we are happy to come back and talk more about in Sweden we took the very conscious decision not to close schools for children under 15. and I think if it's one decision I'm happy that we took this is the one because I think that's going to make a lot of difference for all the children in Sweden and then we had the hard to reach the vulnerable groups you can call them many different things in public health we all know about them they have more of probably any kind of disease you can say that are more prevalent in these groups and they have higher risks they smoke more their worst diet everything and they also got much more hurt during this pandemic than in other groups and I think once here that's something we've seen and here we did we looked at the the risk to end to have to spend time in intensive care in the if you have a background in different countries and as you can see if you come if you have a background in Africa and live in Sweden your risk is 67 almost six times higher than for a person living in Sweden and of course this is not genetics or anything like that this is social economy in different with different ways they work in places where they meet more people they live in more crowded conditions yeah many many different things and another learning experience I think that we really need to take and it's I mean you conduct different course this is intensive care mortality on the same child but basically showing the same thing and also that the gradient the further away from Sweden or basically the higher risk so really high risk for the Middle East and Africa and then coming lower and lower and of course many of the things we do during a pandemic depends on trust and adherence to measures and we try to measure that in different ways and I think something we could maybe discuss more in the pandemic how can you measure adherence how do you know what the public response is to and how do you get the good public response we had already from the beginning very high level of trust in the public health agency and actually yeah it jumped up and down a little bit but on the whole it stayed very very high during the whole pandemic in spite of high levels of spreadable disease and high levels of mortality and we could see that people actually also listened to us because we can we mobile phone data we can see how people move move around this way and we can compare it to other Nordic countries and the Lilac whole line is Sweden so you can see that swedes actually decrease their travel even more than I think in other countries where they had a much more stringent measures around travel so you can get very far with recommendations and soft measures if you have the trust in your population and another thing we look at is other kinds of diseases but in a similar way to covid-19 like whopping cough which in Sweden like in many other countries basically disappeared during the first four which I think is a good indicator that people actually do keep distances better than they do in their work from home more than other things so what do we now measure to return then we had a discussion about that just now when excess mortality you can do it in many different ways of course in Sweden we like the ones where we see Sweden something coming very very low down in one of the countries that has among its lowest excess mortality island is even lower but if we use another method we can get Sweden to become the lowest laughs so this is statistics you know all about statistics and Mark Twain there's lies damn lies and then no statistics you can prove basically anything but still I mean whatever method you use Sweden will come out quite low compared to many other countries of course it differs over time and this is what critics then raise up during the first wave the first year it was comparatively high in Sweden but then it fell considered during this second and third year so what did we learn I found a slide I made of the source spread in 2003 2-3 something that and if you read through and what we can take them later but if you read through this I mean we could make the same slide today this is what we don't have to recovery so I think once again and it's one of the major reasons I still do these kind of talks is that we should not forget we need to take the lessons on board that we learned now so that we can hopefully become a bit better next time but what's going to happen next time and you talked about that what kind of predictions can we make and I actually got this from Angus Nichols one of my real heroes during the swine flu pandemic and we cannot make any predictions we can guess and then we can use this kind interesting and enough as you might notice is that it ended up in monkeypox so sometimes even guessing can prove you right yeah so thank you very much [Applause] thanks very much Anders I'm going to be very brief I've been reliably told that many people in Ireland have heard quite enough of me already and uh I I wish you hadn't all left so much of that but yeah as as I am as I was listening to uh Martin and Andrew's talking I was remembering that my my boss when I worked in the United States in the 90s used to quote uh I believe he was a baseball player called Yogi Berra who said making predictions is hard especially about the future so very briefly I suppose I if we ever look at doing something like this again if we ever have to and I hope it's not in my lifetime then I think as was articulated by others it's really important to State what it is we we are trying to do if there is another pandemic and and that is about managing the short and the long term harmed health and well-being of the whole population with the lowest practical impact on individual free freedom and on the environment because I think the environmental impact of the pandemic management is is something that we need to be very conscious of and it's about the health and well-being of the whole of the population and although some of the metrics that we can look at like how many people are getting and and how many people are dying of the actual disease is the broad picture of what's happening to the entire population health is is what is easy to lose sight of when you're focused on a short-term metric and so that's not the same thing if the lowest possible number of infections this week or this month it's it's a bigger thing it's much harder to measure um but at least if you state what you're trying to do as you keep your eye on the ball then there's better chance you're going to be heading in that direction and of course it was very easy to forget that having an infection is not having a disease how many of you in this room have an infection today well the rest of you have but you do not know about it everybody in this room is infected all the time with lots of things it's just that's just life and most of you are infected with at least one heart based virus probably with several and I know I am and with other things so so infection is not disease and what matters for us what matters for people what matters for society is disease and suffering and hardship that infection is is related to that but they're not the same thing so how do we get there if that's our objective I think key things would be that the decisions need to be based on values informed by science and it's not a scientocracy we don't live in a scientocracy we live in a democracy and and that means that people don't always do what scientists suggest our medic suggest and sometimes you see that covered in the media as the government are ignoring the scientists actually they're not ignoring the scientists they may be listening to the scientists and deciding to do something else and and if you live in a democracy that's how it's supposed to work and and for us as scientists who are doing the advising is really important that we have a little bit of humility or at least we Fane a little humility and try to remember that that's how it's supposed to to work and what we shouldn't do though and what does tend to happen is we shouldn't reshape the evidence to prop up a decision that is not evidence-based and so we should be honest about it and say that actually there isn't evidence to support this but we're going to do it anyway because we think it's appropriate because of our values and because of the Democratic Society are because there's a public demand for it or for other reasons it may be appropriate but it doesn't mean that it's evidence-based in terms of Health and Social care the biggest challenge for everybody and I count myself in this was the challenge of caring in the face of fear uh fear of infection and fear of blame which was a huge thing and a lot of people knew what the kind thing to do was and didn't do the kind thing because they were afraid somebody would blame them for not following the guideline and one of the things we have to emphasize so much not just during pandemics but forever for all time is that guidelines are not a rule book and they're not a law they're a guideline and and I often said to people who used to do weekly webinars at one stage during the thing and one of my lines at the end of the webinar was if you have to choose between the guideline and kindness you should almost always go with kindness and but people were often afraid because if something bad happened and they were blamed is it so so I can stop here now because if anybody wants to know what I have to say about the pandemic they can find it on this link and nobody's going to be able to remember the link so what I did is I checked on Google and if you put in researchgate cormican and dashwood into Google it will take you directly to that's one of the advantages of using a weird literary reference in the title of your papers makes it easier to find so it's there on Research gate if anyone is interested um and I'm going to stop at that and ask Anders to join me here and we'll uh [Applause] so I I teach the um I teach the medical students in this room quite a bit um and so this is the scary bit where you say has anybody got any questions so you're not a medical student so it's obviously going to be a bit better normally when you say to the medical students has anybody got any questions they start heading for the door so any questions our comments our observations I'm not going to know your name so excuse me for pointing at you but yeah please as I'm just I worry that sometimes we're going back to business as usual going back to business as usual are not integrating the lessons that we've learned during the pandemic and my question is how do we capitalize on the Leisure speak in the public policy making Institute decision makers on evidence um opinion is the evidence called tree of different evidence types and values and transparency and how do we make sure that we bring that forward again don't forget thank you and I I'm I think that observation rather than the question so thank you for that I'm going to let go to the next question here I'm from the School of Psychology of the University of Galway I'm very interested in getting decision to keep the schools open in Sweden and whether that was an evidence-based decision or whether that was based on some socio-cultural values that's something closed for so long I'd be interested to hear what Anders has to say about what drove that decision in Sweden you mentioned that it's something you're particularly proud of and would you perhaps say a bit more about what led to that decision I I think two parts I mean from our port to the epidemiology part and the Infectious Disease part was that we we had all the indications that children were very very seldom sick I mean Chinese Italian all the data told us that so we were not really worried about the children and we also the data told us that were very seldom spreading the disease even so that was also quite and then we had advantage of that we actually had we had people in our agency who who work with school and school health and those kind of things and there is plenty of evidence how bad it is especially for disadvantaged children not to be able to go to school for many different reasons not only because of education but also because school lunches social contacts and all of these kinds of which I'm sure you're quite aware about so I would say not complete evidence of course because we didn't know exactly but we tend to forget I think sometimes that sure it was a new virus but it was not completely new it was a respiratory virus we know a lot about respiratory worries we not a lot of contexts we know a lot of what's good and I think the other part was that we had an intensive discussion about school closures during the swine pandemic in many different contexts and I was myself involved in in networks and somewhere we discussed that and at that time we tried to collect evidence and it was very little evidence even with flu that it makes much of a difference to closed schools so we really we felt quite safe both because we know that the possible side effects children were going to get very well very very slow but also we even worse so we knew that if we closed the schools we we might really have a big problem for them and I think the third part of it which I think different between different countries we really had a long-term Vision the whole time we said this is not going to go away we're going to have to work with it for longer we didn't I don't think anybody was would would have liked to think about three years but we realized it's going to take a long time so we're not talking about closing school for a week or two [Music] thanks Andrew any any other comments or questions um um can I just ask the social media this pandemic was um unusual in that social media had a large role how would you evaluate um if social media that was a nice benefit for um did it just applicate misinformation um we managed to keep people connected if people saying perhaps during lockdowns but um class have been responsible for um this information so thanks Jared I think it was it was you first of all I I agree with your perspective that managing social media was it was a new part of managing a pandemic I don't think any of us had been through that before there are a couple of Parts about it the first I have today is just a person of observation is that one of the best decisions I made was that I um stopped looking at Twitter about two months into the pandemic and because I found that a on Tuesday it was adulation and on Wednesday it was abuse and and and both were equally toxic in different ways so I I stopped looking at it I mean I think it has a value for it social media was really valuable and was very heavily used to communicate to people and I think that was really valuable because it wasn't safe to leave that space unoccupied by people who knew what they have what they were talking about so so the HSE and the organizations and the department had had very good systems for and very sophisticated systems for community getting through social media but at a personal level I would actually think it's really important for people who are involved in public facing in this not to be personally engaged with it because I think there's one of the other problems with it is that I I my sense would be I don't know if it's the same in other countries was that people who are making decisions were sometimes excessively influenced by them by noise on social media because it looks like everybody wants something because there's a bunch of people on about it on Twitter but actually not a regular people aren't saying anything and so you can be I think it can influence decision making in ways that can be destructive if you're too engaged with it so it was um it was and as you said the misinformation was huge but I think the only way that you can practically deal with that is to keep communicating and you know there's a great line that somebody told me once about communication is that there's nothing so hard to to fake as uh as as being genuine so the the way to if you are genuinely being transparent if you're actually trying to be honest including admitting admitting your uncertainties and so on I think that's probably the best way to deal with misinformation I don't know how it was managed in in Sweden no I think a person I have a very similar experience I did not go out on social media and from what I learned from friends and family was that was a really good choice because it was not a nice place to be and there are other people who dealt with it in a similar Manner and we care what's one of them in a similar manner that really try to feel fill it with good information to try to somehow to counteract I think what made me being able to handle this was also that as you said this is only a very small part of your population that is actually out there and even smaller part where all these really toxic people and and we did this regular surveys where sort of 75 80 of the Swedish population continuously said that their trust had a high level of trust in us and they really believed in what we were doing and when I was out in the street and recognized people quite often came up and told me we are so happy with what you're doing and so on and I think those kind of things can counteract but I completely agree getting engaged in social media as an individual in this kind of positions a bad choice to make I might just add that the the HSC also was managing public confidence and as was the Department of Health in Ireland and actually similar to what you described in Sweden people's confidence in the Health Care System went generally went up to the pandemic rather than rather than down and that was in spite of all that you know that there could be a whole bunch of a storm on social media but actually overall people were actually um I think overall I think people trusted not that we were getting everything right but that people were actually doing their best which was which was probably because we weren't getting everything right but I think most people were doing their best the microphone is coming and how here at the University and I'm interested in kind of the there's a lot of talk about pandemic preparedness now and I know there's you know there's grants and money and all of that going that way I am interested in how we can invent in accountability and checks and balances for decisions that are made during potential future pandemics in what we're doing now for pandemic preparing us so I would feel that you know the human rights principles of proportionality legality necessity can be proven by or can be matched with things that we do in evidence synthesis you know and and all like we have Frameworks for you know evidence to decision making and we have Frameworks and ways of proving proportionality necessity in health economics for example and I think they're those are their standards they're already there so how can we incorporate them in pandemic preparednesses while I I have read The Who and Drug treaty and there is you know they talk about evidence evidence and they talk about human rights but I actually don't see a whole lot in terms of um pandemic preparedness that's specifically got to do with accountability and checks and balances using what we already have that's a very difficult question I I would say that one way of handling it is what we use in Sweden is that anybody who is involved in the management of a crisis should also be should be the same entity Persians whatever who handles things in peace time because then you have these kind of procedures in place I mean we talk about proportionality we talk about human rights and so on of course every time we discuss Public Health measures in general and if you have that sort of in your system and have the people who are used to thinking about that I think at least it makes it easier what you are talking about which I think is incredibly important but difficult so I think that's one way of getting into a systematic thinking around that uh one of the things that I think is really a useful model to think about how how how that might be handled and I don't mean just in pandemics because I guess the issue of stigma associated with infection is is not just for pandemics uh in the last week for example you know I've heard of account of a person who was colonized with antibiotic resistant organism who is having difficulty accessing services so it's not just for pandemics the rights of people who who have infection or who are feared to have infection doesn't go away because you know it's there all the time but I think one of the ideas that is very helpful is in in relation to mental health there is often a need to act urgently to if somebody is a risk themselves or others and and the legislation allows for that but it then also allows or requires that that is reviewed within a defined period of time and that actually the the constraints placed on the person's rights is upheld or removed by an independent from your body and I think that one of the things that we have to keep the ability if we ever face something like this to make quick decisions but I think having a defined time frame during which it's reviewed during which the expected benefits are outlined the expected harms are outlined and the decision is made and it's made publicly available within a defined time frame would be a really good way of being transparent of engaging others in in and there is a model there that that my understanding is that model works very well because I think you do need to be able to make a decision at five o'clock on a Friday evening um but that and having that reviewed a month later and having a change doesn't mean you were wrong at five o'clock on a Friday evening it just but so I think that sort of approach is one of the ways of making that work better for the future um it's kind of follow-on question you mentioned context and then decisions and I guess my question relates to have we learned lessons from who makes the best decisions so for example your perspective on closing schools was a part of California which was a trade-off consequence of Public Health and politicians for example may make decisions on differing perspectives and pressure groups so do you think we've learned lessons from what's the best structure of decision making public Representatives I think that at least we're getting close to the world when we do like I said before that we keep on doing this taking decisions within the Mandate where we're normally comfortable and when we have experience and know what we're doing because that's what happened in Sweden the public health agency has comparatively wide mandate but it's very clear it's illegally established and we took the decisions that we were comfortable we take within taking within that mandate and when we for different reasons saw that that was not enough we need more then we went to the government to the political level and and sort of told them okay we need more and what can we then do and then they took decisions on for example big gatherings where we did not have the Mandate and the knowledge and understanding how to do it so I think that's does not always mean that we take the right decisions but I think it's a at least it's better changing because I think that's one of the more dangerous things you can do is suddenly change people who who sit in decision making positions during a crisis and putting into some special kind of body and think that that's going to get better because normally it doesn't because then they start taking decisions without really understanding the background of what they're doing I mean as I understand it here at Martin the answer is that we don't have that structure but um and so in in relation to how things are perceived and addressed people were often I found this was very interesting to hear some people discussion about who is making decisions because actually a lot of what we're described as decision-making buddies were actually groups that were making recommendations because it ultimately under the Constitution under our constitution it is the government who makes the decisions and and it goes back I think one of the points I made at the beginning is that it you know the government the government has to decide who it takes advice from and it has to decide what to do with the advice and so who makes the best decisions I suppose if we live in a democracy in under our constitution the government makes the decisions whether we like them or not that's our constitution um and I don't think you want to change this in a crisis because it undermines the fabric of democracy and inevitably it means that sometimes decisions are made that are not based on science or public health advice I'm not sure that that makes them wrong decisions because a large part I think what a government has to do with this kind of situation is it has to maintain uh social integrity and it has to maintain public support it it does so so sometimes they may choose to do things that objectively don't make a whole lot of sense as a public health measure but actually might make political sense and and and the country is a political you know so so I guess it's it's you have to look at what what the law and the Constitution and and here ultimately even though lots of people said oh for example neth had made a decision actually never I said in another form Netflix didn't have the authority to make you put a lamp on your bicycle and nefert was an Advisory Group and and if somebody took chores if the government took that advice as a decision that was the government's responsibility ultimately because that's the Constitution yes um but what you're articulating and I'm not challenging democracy is that you can within a democracy have different approaches where the decision aligns with the expertise more so than with politicians and I guess it surrounds moving forward if there's something we should consider in restructuring how that happened and maybe not I would love to see it at an Institute for public health in Ireland with similar type of structures as you say we don't have that now but yes I agree I think that would be not just for pandemics for all sorts of things to take that and I mean of course it's also part of democracy because this is what Parliament has decided how they want to have the division of mandate between the agencies and the government and actually this is something started like 400 years ago with the famous sweet collection who started this a little bit different divisional mandate between agencies and and the political bodies and it served us well during 400 years and we're definitely not going to change it just because we have a crisis even if there's been a number of even commit even official committees and so on saying that this was not the right thing a way to do things we should have changed but I think when after some time when we sort of can sit back and think a bit more clear about it I think everybody still agrees that this is a nice way to write and I think the politicians are at least as happy with it as we are because they they are they can for some of these minute details where they don't really feel very comfortable about taking decisions they have another body who can take care of it so I'm going to take three questions or comments together maybe Enders and then we'll come back so there's three people there I think there's yeah and then there's two people I think three walls back thanks thanks for the talk I was wondering if you could comment a bit on if we have learned to open our science to improve our future science and um or data and if you've seen important increase in open openness in the same in the scientific community over at least two years of government Texas we only read admittedly this is a little bit left to feel but it's taking off on Jared's comment about a language and toxic and the toxic use of language and then coming on to Human Rights because I found at some in some ways public discourse was also toxic and particularly the use of militaristic metaphors to describe um our response and that in some ways you know it it shuts down discourse and there's an assumption there that one would give up civil liberties and so forth in the case of an emergency and human rights and so on so I'm wondering is there any learning from that is there another way that we can frame these sort of discussions that isn't and you know based on militaristic metaphors that are highly and toxic and masculinist and um that really it's treasonous if you ask the question and even in an academic Institution this question uh Pat McGarry from biomedical engineering uh this question kind of relates to your comment Martin that you can be infected but not not because not well you can be infected but not uh transmission disease oh sorry the comment was that you couldn't be infected but not sick essentially so in I think May 2020 a study from the La Jolla Institute showed that blood samples taken from 2017 uh per 50 of the population uh they contain cross-reactive T cells to the covid-19 showing us the population was an entirely naive to the to the disease that was quite a bit of uh background immunity and when you incorporate this kind of detail into the addictive models it changes to calculus so it makes things a little bit less scary um I'm just wondering would it be a good strategy if there's a future potentially scary situation with another disease to do population wide monitoring all cross-reactive T cells antibodies Etc and then try to work on the two predictive modeling so you can get a better handle on what you're really facing science the militaristic uh mindset and and T cells so we're really wow so let's start in about 30 seconds yes our immunity is a very complicated system I did my medical training some service five years ago and what we learned what I learned and is completely useless today and I think it's a medical students here but you will only today is probably going to be completely useless in another five or six years there is so much we don't know about it I don't there is no reason to believe that there was any major part of immunity the population to this Kobe there is the way we try to measure it in different ways no no background immunity it's been discussed if kids started back on immunity because they do a lot more Corona that that nobody has really been able to prove that in in a reasonable manner I think and I think we cannot predict what the level of immunity we have today how that could affect the future pandemic I think we are not that foreign next generation of medical students will learn things where you can do it uh and the question about data is interesting uh openness I mean from a public agency we have always been open about our data we are always I mean whatever data we collect is always also possible to access for researchers so how to as long as they follow the rules and things that are surrounded around that so that personal Integrity will not be in some are compromised uh I think what was interesting there's at least in Sweden I don't know what it was like here if there's something we've got to access to data we couldn't dream of we had data from so many different sources that we never sort of seen before at least at least I said the summer and we didn't even know that exists I mean data like how many people go into shops every day how many people eating restaurants and how many would travel with the subway and stuff like this so I think that there's been a lot more openness about data sometimes also to giving us a problem and we talked about that that media asked for all the data we had the raw data and then they did their own calculations and Analysis of that data and suddenly came up with completely different outcomes than we did with the same data so it's also I mean it's yeah this openness and excess of data has also produced an enormous amount of what we call a the amateur epidemiologists I have a small collection of interesting ways of analyzing epidemiological data that I got sent to me during this three years might publish it sometimes and your question I'm not sure what it is about my masculinity by the way but I I agree with you uh that they think that the way of constructing these things is the battle against this set and the other and not it's much wider than pandemics the battle against cancer the battle against covet whereas the real business of healthcare is care and constructing it in those kind of terms of of survival and metrics it often becomes about a the you know the virus really didn't matter at all it was the people who mattered um it's the cancer doesn't matter at all it's the people who matter so I think constructing it in terms of a battle against a disease is dehumanizing in in many respects and there's a very nice important movement I think that has recently started internationally and there's been some discussion about the bmj and others recently about the fact that if we are going to make Healthcare better it's not about tweaking some of this it's actually much more radical than that it's about actually going back to what our business is which is caring for people I suppose it's a very wider thing but I I know Martin would and others here would agree is one of the Expressions that I've come to to hate for example and people don't use it much anymore you still is if somebody has an advanced disease you're sometimes hear this expression of withdrawing care well you should never withdraw care you may you may stop intrusive interventions but that's not you know so I think it is an issue and I think it's a much wider issue than pandemics and I think it does construct this kind of thing of forgetting that actually you know it's it's about the overall well-being and health of the entire population and having the lowest possible number of cases I've covered this week is not a Triumph if if we're looking at 10 years of kids who whose educational and and life opportunities have been reduced by the fact that they lust out so much so but it's a really hard thing I think to give you a big picture I think you said Martin is it cheese Thanks Martin Andres that's really interesting and my question um really to building capacity within the Health Service and your learnings from this pandemic what advice or what thoughts do you have in terms of making sure there is sufficient capacity within a functioning Health Service to absorb crises like this because while we may not get a full-blown pandemic you know in the next five to ten years you know there'll be different things that were right through and what are the learnings I suppose in in terms of making sure that there is that capacity to absorb these kind of challenges thank you I mean I I worked as a clinician for a couple of decades so I have some understanding of the health systems and they are incredibly complex organizations my sister is is an economist and she works with sort of private companies and stuff like that and she usually when I try to sort of tell her about the problems in healthcare she usually says it's never going to work that's kind of organization is doomed to die because the steering mechanism and so on are just not fit for purpose so it's very difficult and I think healthcare is quite impressive because it it has a capacity to adapt for short terms very very quickly and very efficiently and I'm always quite impressed with it where there's a big accident and so in the whole has Hospital Cancer completely change very quickly I think the Big Challenge this time was that the big big pressure over a long period of time and Healthcare is not very good at that because it works at maximum capacity constantly and I had that discussions with a number of leaders in healthcare quite some time and say okay maybe it's like this that Healthcare should not work at 100 capacity maybe it should work at like 80 85. because then people will feel much better they will have a more healthier life and you could take this kind of sort of big challenges much easier but but it's so difficult because Healthcare there is always a need for more Health Care this is this is like a black hole one of the the heads of the Swedish Society for Regions one said that I have been through I've been through three decades of new interventions and everything and every time they said okay now we know how to take care of stomach ulcers we give them medicines we don't have to operate anymore it's gonna we're gonna have so many free beds and he said during 30 years I've never seen a free bed it's always going to be filled by something else so in that way it's very very difficult to say what what exactly you're going to do but but I think you you need to have this conversation going and you need to keep the experience they have done right now and I think the experience is not so much to have a much redundancy but much more experience on how do you actually change and adapt and be flexible how can you I mean in Sweden we're impressive and I mean we in just a few weeks time we we increased our intensive care capacity by 100 percent and those kind of I think how you do that and how you can do that again without hurting the system too much is and then on the other hand we had a problem with so many people that didn't get the cat I needed I don't know what it was like here but in college already and many other places people did not come for checkups and so on and not so much because I was in capacity to do it but because they were afraid not to come so yeah no good answer but it's just to say that it's trying to find new models on how to run Health Services yeah good luck I think I think Martinez is the larger question there as well that's what we call HealthCARE is actually not Healthcare at all it's disease care and and one of the one of the things that I think societies and we keep I think creating the illusion that if we spend enough and Healthcare that we can fix all of these things and actually we can't and there'll never be enough there will never be enough you could double the budget of the National Health Care System it wouldn't be enough you know and we actually there is a there's a lack of honesty about actually having the conversation with people that there will never be enough not in my lifetime not in your lifetime and so we need to start talking about what are our expectations and how do we reach those expectations and how do we make sure that there's a balance between what people expect the system can provide and what we're prepared as a society to fund and that requires us being honest about saying actually we can't fund everything and and the danger of keep putting money into what you know so I'm American practitioner and I like my job and I try to do as well as I can but the danger about hiring more of me is that actually we know that the most important things for health are not more of me the most important things for health there are nutrition and education and space and exercise and how we organize our society so life expectancy for most people expectancy of life and well-being for most people would not materially changed if you doubled the number of beds and Consultants it would make very little but if you actually got better care for the kids who are living in poverty including better education and all that so so I think we have to be careful about becoming the Trap that's always sucking in more resources and delivering diminishing returns which we do we are diminishing returns you know Health Care Systems throughout European Union are in a situation of diminishing returns you double the budget and it will make very little real impact I think I'm going to have to wrap up soon because I think we're on our time but I see a question [Music] but how do you see any any change or any in the future if you see that working conditions of you know stuff is going to improve so they can be covered from the extensive work if it is on budget what they need what is what it is it's a common number they are just going to be forgot for a while until something else happens uh I suppose for me I think one of the things about helping healthcare workers recover is actually managing the expectations and again it probably varies from country to country but my sense would be that a lot of healthcare workers one of the things that's having a big impact on their ability is is that they're expected to deliver what this what what the capacity system can't deliver one of the things that makes their life so difficult is we've created an expectation of service that the healthcare worker can't deliver and then they often are the subject of the hostility and the upset and the outrage of somebody who's whose expectations have been pitched at one level and the service got delivered so I think there's two parts to it there's one is increasing capacity and helping healthcare workers recover but I think the other part of it is is getting thought that aligned with expectations I mean a lot of the colleagues that I know who who some of them are relatively early in the career who who are feeling burnt out and and stressed it's it's about dealing with people expecting things out them that they can't do and but I think the other thing I suppose I suppose I'm graduating for finishing up soon is just to say is I suppose we didn't say is actually a lot of healthcare workers of course made two sacrifices through the last years it's fair to say that sorted a lot of other people in other emergency services and so on but but it is really important if we're coming to an end I think to recognize that and to thank all the people who did all of that work and I was certainly in early stages in the pandemic and some of the larger um Residential Care settings which we're dealing with outbreaks where there was a skeleton staff because lots of people were sick and and I was deeply impressed by you know the commitment of certain individual of many individuals who who did extraordinary things and it is important I think to remember that and to recognize it yeah and there's it no I agree it's it's this discrepancy because between what people actually think that Health Services can deliver and what they actually can and that's a structural problem in our society to a certain extent that Health Services has also become the grandmother of everybody so it's not only you don't only go there with things that Health Services can handle but also with so many other things and it makes it very difficult for the staff to to deliver on that and it comes back to organization I think because there is not enough there is not enough strong enough organization to really make it clear both to to the staff and to the to the world around it what health services reasonably can be expected to deliver and what they can't and and they can't make us live forever it is one of the things I think last question I think from and then I think we need to wrap up I think but yeah I work in Communications in the University here and I worked in government as an advisor at the start of the pandemic so I appreciate your Insight but two things 100 different questions for you specifically do you think that um access to vaccines in Sweden had a particular borrowing on the decisions that you were able to take at the time and the second question I have is whether or not um you would have any advice in relation to how to manage the Divergence between the public health advice or the decisions that the public health advisors would wish government to th and the political opposition that there would be to that Martin kind of touched on in terms of the structure as to how decisions are made but if we're in a scenario like this again what advice would you give in order to allow you the correct decisions to be made or the the preferred decisions doing it um on the first part no I wouldn't say that we didn't I mean you know sometimes people have said that we should have known that the vaccines was going to come so quickly but um I'm pretty sure that at least nine out of 10 of vaccine experts when the pandemic strike would have said we were talking about two or three years as a minimum before we have a reasonable good vaccine on the market and that it went so quickly quick was due to a number of happy circumstances I would say we were really lucky this was not something that was planned we were lucky that that there were new technology that has had been used for decades but never really proved to be very good that suddenly worked in this sin and also that the disease was possible to make a vaccine from so that's that's clear what you I mean what you're asking is really very much contextual and I think and I think Martin also said that we need to realize that many of the decisions that are going to be taken are going to be a combination of evidence medical expertise and political expertise and I think that's what's really worked very well in the Swedish system that there was a constant dialogue between the agency with the medical and Technical and evidence-based expertise and the government who understood the sort of political context what is possible to do and what what kind of things you need to weigh together to to make reasonable decisions for for a whole of society approach and I think that to Foster those kind of dialogues and and build a trust between those those different parts of society I think that's quite important and that's the other part of Sweden having this system in place for stress for a long time there is not only a high level of trust between the population and government and politics but there is also a high level of trust between at least most of the politicians and the agencies and that makes it I think comfortable for the politicians to sort of have this kind of dialogue and that we jointly can arrive at decisions that sort of reasonably good for all of society so thank you Anders I'm going to thank Martin for uh introducing us to Nev and Ed for all of the work that we're getting is here Mara Conley especially because we're all a lot of us are here because Mars brought us together in relation to the pandem project and and this is at the end of two days of pretty intensive work and pandem so thank you for that and especially thanks to all of you for coming for participating um and I think it's actually a great success that we were able to have something like this which was open to anybody who wanted to come and that we were able to have a conversation and I'm sure that we many of us disagree on many of the things we've talked about we've all done in a civilized fashion which is great um so so thank you very much for making this success thank you [Applause]

Channel: University of Galway

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Id: C3awcMX_hqE

Length: 68min 31sec (4111 seconds)

Published: Thu Apr 27 2023