An article on the Nature magazine Web site reports that 22 scientists last month wrote to the daily Dagens Nyheter criticizing Sweden’s no-lockdown response to COVID-19. However, evidence-based analysis shows that a lockdown is not a one-size-fits-all strategy and Sweden is showing the world a sustainable way for everybody to fearlessly live with the virus, which is an inevitable situation that everyone must face and accept for a while.
The biggest myth about lockdowns is that they are the only solution when an epidemic worsens. A lockdown is a measure to cordon off a seriously affected area so that people in surrounding areas are protected.
When SARS hit Taiwan in 2003, local health authorities locked down a hospital with a nosocomial infection to protect the community.
When Wuhan became the epicenter of China’s COVID-19 outbreak in January, authorities issued a lockdown order to prevent the virus from spreading to other cities and provinces.
Italy misunderstood the lockdown measure. Italy was the first country in Europe to enforce a lockdown, starting in the north and then spreading nationwide, but on March 19, it also became the first country to have a death toll that surpassed China’s.
The lockdown measure was also misunderstood in New York state. While California and Washington, on the West Coast, were piling up confirmed cases in February, New Yorkers seemed to think that they had nothing to do with the virus.
The Wall Street Journal reported that New York hospitals did not coordinate their coronavirus response until the death toll topped 1,200. New York Governor Andrew Cuomo on March 20 issued a “stay home” order and enforced strict measures, but New York became the US state with the greatest number of confirmed cases.
Belgium rushed into a lockdown, but forgot to take care of at-risk older people. The BBC on May 2 reported that 53 percent of Belgium’s 7,703 deaths occurred in care homes. It quoted Belgium officials as saying that because of poor preparation, care home staff lacked personal protective equipment, which allowed the virus to spread quickly.
An analysis by Israeli scientist Isaac Ben-Israel shows that the COVID-19 pandemic would run its course despite lockdowns or similar measures.
One price of chaotic restrictions — which the whole world must pay for — is the collapse of supply chains. This has led to many frontline medical personnel having to fight the coronavirus without personal protective equipment.
A “flu-like epidemic control” better describes Sweden’s response to the pandemic — COVID-19 is highly contagious and has a transmission pattern similar to a flu-like epidemic, with so many nations worldwide reporting confirmed cases. The most beneficial and sustainable measures for most nations are flu control protocols.
Germany’s first two infected people contracted COVID-19 at the end of January from a colleague who flew in from Shanghai to join a company workshop. Soon after, two other colleagues, who had not had contact with the Chinese visitor, tested positive for the coronavirus.
The cluster showed how the coronavirus is transmitted from human to human — very similar to an influenza virus — and showed that COVID-19 can present as mild flu-like symptoms.
Singapore and Japan in February offered evidence on a larger scale. As of Feb. 29, Singapore had reported 93 cases, including five clusters and quite a few patients whose source of infection could not be traced. This showed that the coronavirus could spread easily within a community, just like an influenza virus.
By February, Japan had confirmed more than 250 cases — excluding the cruise ship cases. Most of those infected only had flu-like symptoms only, while six older patients died of pneumonia. So, in Japan, the coronavirus also looked like a flu-like epidemic, with elderly people more likely to have a severe illness and to die.
The frighteningly high death tolls in China and Italy could have resulted from collapsing healthcare systems, where too many people were rushing to hospitals for treatment, a scenario seen in flu-like epidemics.
However, most people appeared too nervous to notice the “flu-like epidemic” pattern of COVID-19, as they rushed into lockdowns and criticized nations without restrictions for risking people’s lives.
Taiwan’s COVID-19 success story offers a control protocol that combines an existing surveillance system for flu-like disease symptoms, experience with SARS controls and no strict lockdowns.
The surveillance system asks clinics and hospitals to cooperate by reporting patients with flu-like symptoms for virus testing and early treatment.
While infected people and their contacts must undergo a home or facility quarantine, and healthy people are reminded to practice good hygiene at all times to flatten the epidemic curve, COVID-19 has not seriously disrupted people’s daily lives in Taiwan. For example, many people in Taipei still commute by train every day.
As of May 12, Taiwan’s population of 24 million had reported six deaths from COVID-19 and fewer than 500 confirmed cases, while New York State had 19 million residents under lockdown and more than 27,000 deaths.
In the middle of January, people in Taiwan began to wear masks, even though experts at the time could not agree on whether it helped, and the government coordinated with mask manufacturers to increase production to meet demand. By contrast, most Western countries did not add wearing masks to their control guidelines until last month.
The only thing that Sweden needs to worry about is the high number of deaths from COVID-19 in nursing homes. If nearby hospitals have spare capacity, it would be better to move care home residents to hospitals, and thoroughly clean and sanitize affected nursing homes.
Taiwan’s experience has proved that wearing a mask can be an effective extra precaution, especially for nations trying to avoid stricter measures. People do not need a surgical mask, cloth masks work well, too.
The more Swedes wear masks, the more effective Sweden’s COVID-19 control measures will appear to the world.
Edward Pingyuan Lu is director of HSVG Mission’s Public Health Office.
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