Skeptical experts in Sweden say its decision to have no lockdown is a terrible mistake that no other nation should copy

• More than 2,000 experts across Sweden in April urged the country to change its unusual decision not to have an enforced coronavirus lockdown.
• Its death toll is now among the highest in the world, and some of those experts told Business Insider they remain convinced the plan is a historic mistake.
• "This is not an example to follow. I don't want thousands of people around the globe to start dying," one science professor said.
• They say much of Sweden's advice is out of step with other countries: on masks, on the risks to children, and on who should self-isolate.
• They are urging Sweden to test more so it can better understand its outbreak and give information to the rest of the world.

Sweden's strategy for dealing with the coronavirus means it has never had a lockdown.

Instead it allows people to go to parks, restaurants, and keeping working, while encouraging but not enforcing social distancing.

It's a strategy that most in the country appear to support.

But it has sparked alarm among some experts who point to the country's high death toll, the effects on vulnerable groups, and what they say is an approach that ignores much of the best research on COVID-19.

Two open letters signed in April by more than 2,000 experts across the country to adopt tougher measures with compulsory elements.

But the letters did not change government policy. Sweden's death toll is now among the highest in the world, and its average death toll from May 13 to May 20 was the highest in the world on a per capita basis.

Business Insider spoke to some of those experts, who said Swedish health officials are not looking closely enough at new research.

They said they hope no other countries try to imitate Sweden, which anti-lockdown protesters and some US politicians have held up as an example of a better approach.

Olle Kämpe, a professor and senior consultant in endocrinology at the Karolinska Institutet in Stockholm, said: "We are sacrificing old people and people with diseases."

"So I don't that it's something that anyone should copy."

Is Sweden gambling on herd immunity?

Sweden claims that its strategy is not based on achieving "herd immunity" — the point at which so many people are immune to a virus through infection or vaccination that it cannot take hold in a population.

But Anders Tegnell, Sweden's state epidemiologist and the main figure behind Sweden's plan, has highlighted Sweden's progress towards such a state. He said in late April that up to 20% of people in Stockholm were immune, and that this could help guard against a second wave.

Many understood this as a quiet admission that herd immunity is the strategy. But scientists around the world have warned that there is no guarantee that catching the virus gives permanent immunity — and even if it did, the human cost of reaching that state would be huge.

Marcus Carlsson, a mathematician at Lund University, said: "They are denying it in practice but if you look at their actions they're clearly going for herd immunity — that's why they are keeping schools and everything open."

Kämpe said that Sweden is trying to "reach herd immunity by killing people."

"It's saying that people who are old, or have a disease like obesity like diabetes, are worth less than the rest of us, so we can just let them die and we get herd immunity."

Kämpe said that Sweden's radically different approach means it has a special responsibility to justify itself. "The burden of proof is very strong," he said.

Experts say Sweden's plan ignores science

Kämpe said much of Sweden's approach is "not based on facts."

"If you have a virus that's totally new, you know very little about it, why don't you take a step back and say you are trying to infect as few people as possible until we know more?"

"Sweden's strategy is the opposite: infect as many people, reach herd immunity."

He pointed to new things discovered about the virus, including young people experiencing blood clots and strokes and a new inflammatory syndrome that has killed least four children.

He noted how Sweden does not consider children to be an at-risk group. They must go to school, even if they have preexisting conditions known to increase adults' risk.

Christopher Plumberg, a theoretical physics researcher at Lund University, noted that the stance on children "stands in stark contrast to the United States and the United Kingdom."

Carlsson said that the differences show that Sweden's Public Health Agency has "a strange view on how to do science and research."

"They claim to be more logical while the rest of the world is panicking, claiming to be the voice of rationality."

He described the authority as being "picky about evidence" — insisting on unusually strong levels of proof before taking steps to mitigate the virus, as the rest of the world goes further.

He pointed to how the Public Health Agency has only urged people to stay at home when they show symptoms.

Swedish officials say it is "still too early to say" how much the virus is spread by those without symptoms.

It is a stark contrast to other public health bodies, which mostly say that everyone should stay home to mitigate the risk of asymptomatic transmission.

Carlsson said that waiting for definitive proof in this case means waiting too long and risking lives.

"Evidence-based is good science over time, but in emergency response to an unknown virus, you cannot sit and wait for a peer review process. Science is very slow."

Sweden's renegade advice

Sweden diverges from the consensus in more ways than its advice on staying who should stay home.

Even after people have been ill, Sweden recommends isolation for only two days after recovery. Other countries advise seven days, and the World Health Organization recommends a full two weeks.

Plumberg said Sweden has not "adequately adhered to the European Union precautionary principle," which says lawmakers should act to prevent harm even if they are not yet totally sure it will work.

"More succinctly, the principle cautions: 'Better safe than sorry.'"

Plumberg said he agreed with Tegnell's own statement that Sweden's death toll has been "horrifying."

But he said that Sweden should have looked closer at what was happening in other countries.

He said: "To make no decision on condition of 'too little evidence' is already to make a decision. The virus itself has forced a rapid policy response, and Sweden seems philosophically opposed to making such changes."

Tegnell, the state epidemiologist, responded to the open letters in April by defending the scientific basis for Sweden's policy, and calling the figures they cited "inaccurate."

He also said that Sweden's death toll was inflated because the virus had spread in nursing homes to a greater extent than in other countries, causing more people to die.

The signatories say Sweden needs to collect more data about its outbreak, and to allow an open debate between the Public Health Agency and other scientists.

Flying blind on testing

Sweden is prioritizing its coronavirus tests for healthcare workers who show symptoms, and patients already in hospital.

It then gives priority to police and emergency responders. The health agency says that people who have cold or flu symptoms "will not be prioritized for testing," but should stay home.

weden has only just expanded its testing to include those with mild symptoms.

Lena Hallengren, Sweden's health minister, said at the end of March that targeted testing, rather than mass testing of the population, was the right way to go for Sweden.

TheLocal.se, an English-language news service for Sweden, reported that as of May 8, around 1,000 people were being tested in Stockholm a day.

It said the country was hitting around a third of its goal of 100,000 a week.

Sweden's testing rate is at 17.6 per 1,000 people, according to tracking by the website Statista. Norway, its close neighbor, has a rate of 37.9.

Kämpe, the science professor, said more testing is necessary to assess how successful Sweden's strategy was: "To evaluate this afterwards we have to have data."

"We still don't have data to calculate the projections people are making. It still doesn't exist," he said.

Carlsson said testing was especially important as Sweden's strategy is so different. "Because we chose a different path, we are in a unique position to provide valuable information for the rest of the world."

"If we test a lot, we could provide so much information for the world. And save individual lives."

'Sacrificing' the old and weak

Sweden says its plan is meant to protect the most vulnerable: People over 70 are urged to stay at home and visitors to the nursing homes have been banned.

But around half of Sweden' deaths have taken place in nursing homes, and around 88% of its deaths are people over 70, a figure similar to some of Europe's worst-hit countries like the UK and France.

Nursing home workers have reported having to work without access to personal protective equipment.

Some staff have complained that they do not have permission to give oxygen treatment to patients with the virus, and say they have been told not take the patients to hospitals.

People with conditions who make them more vulnerable have also told Business Insider that Sweden's plan has left them frightened as they choose to isolate themselves.

Kämpe said "We are sacrificing old people and people with diseases."

Tegnell denies that Sweden's plan involved sacrificing certain groups. Instead, he said, the high deaths were an unforeseen event, not part of the plan at all. Health Minister Hallengren has publicly admitted that "we failed to protect our elderly."

The Public Health Agency said it has started enforcing greater hygiene measures, which have begun to reduce nursing home deaths.

But Sweden's death toll — at 3,698 on Tuesday — has soared above its Nordic neighbours that locked down early.

Per capita, its deaths are around four times those in Denmark and eight times those in Norway — countries with similar healthcare systems, political systems, and population density.

Sweden is also reporting more than 400 new cases a day, compared to around 20 a day in Norway and around 60 a day in Denmark.

'Don't copy us'

Kämpe said Sweden too had the ingredients for a low death toll: It is not very densely populated, has a high degree of education, and has low rates of diseases like diabetes and obesity.

Be, he said, "and still there are so many deaths. As a physician you don't accept any unnecessary deaths. But we have thousands. If this continues, we will have tens of thousands."

"I don't think that it's something that anyone should copy."

Carlsson said Sweden is at "a very dangerous point in time" as its plan receives international attention: "People want a way through without a lockdown."

But the strategy would "jeopardize the Swedish population and thousands of lives on a European and worldwide level."

"We are not testing. We are totally in the dark. This is not an example to follow."

Sweden has implied it will change it strategy if it finds evidence another one would work better.

But so far it has not indicated that any change is coming.

Read the original article on Business Insider