I’m a New York City resident and a lifelong New Yorker. My partner is Swedish. We have considered moving from NYC to Sweden to carefully help my elderly Mom-in-law.
Governments, media, epidemiologists and other commentators globally, and across the political spectrum, have been fairly unified in their criticism of Sweden’s approach to the COVID-19 pandemic and its leaders, Chief Epidemiologist, Anders Tegnell, and Prime Minister, Stefan Löfven.
I am not going to (too) vigorously take a side here. I am not an epidemiologist nor an economist. But I will ask all of us, especially those in the United States two questions:
1 — Are we not dangerously perpetrating Groupthink here? Are we not shouting down all ideas that are not our own or the conventional wisdom before we fully consider the full ramifications of all strategies?
2 — Is the conventional wisdom approach that has emerged in the Corona virus debate an indication of the liability culture in the U.S., another epidemic that has been globally exported for years now? Specifically, our inability, in recent decades, to allow our citizens to be victims of their own decision making and personal responsibility?
My understanding of the official COVID-19 approach in Sweden is that it goes something like this: If you are under the age of 65 and you do not have an underlying health risk factor (or you do not think you have one), then please take precautions (avoid large gatherings, stay home if you’re feeling sick, etc.). If you do not fit into that group, then please try to stay home and away from others, except under extreme circumstances.
If all Swedish citizens strictly adhere to these guidelines, then Sweden should mitigate their economic crisis, avoid overwhelming their healthcare system and steepening the morbidity curve. Meanwhile, perhaps it will strengthen the healthy population’s immunity, in six months, prior to a vaccine, and in twelve to eighteen months, even post-vaccine.
(Please note: If any of us Googles “CDC Coronavirus death rate demographics,” several CDC website links provide a wealth of demographic morbidity and Intensive Care Unit data. It also outlines the known underlying health risk factors. This data is supportive of significantly lower death rates and ICU-necessary complications, among those under the age of 55, or even 65, and without underlying health risk factors. We will assume for now that that data is accurate.)
The counter-arguments to Sweden’s current official policy are well known, at this point (and very astutely laid out by Tomas Pueyo’s Medium articles, among others): We must totally shut down society for one to three months to flatten the curve and avoid overwhelming our healthcare system and an exponential spike in death rate.
Most commentators I’ve seen have laid out three options:
Option A: Total shut-down of the economy and society. Most agree we would successfully flatten the curve and stave off epidemiological disaster. However, there is disagreement on how realistic it is in some countries, for example, in the U.S., how long it would take and what the full impact on the economy will be (and the residual impact on the health crisis of that economic impact).
In Option A, what happens if it drags on for longer than three months, with unprecedented unemployment, leading to widespread debt defaults, at a time that we are historically over-leveraged? What happens if Option A becomes the greatest depression we have ever faced? Does the U.S. Treasury have enough fire power left, after its initial unprecedented stimulus runs out (in maybe two months)?
Option B: A relaxed approach to Corona virus. This is the control and we don’t need to spend a lot of time on it now. We know, with high confidence, that we would see overwhelmed healthcare systems, Intensive Care Units and an exponential increase in case death rate among those most at-risk.
Option C: Mitigation. One could argue that most U.S. states and counties and many countries are evolving or have evolved somewhere on the spectrum between total shutdown and mitigation. Mitigation, I guess, can be broadly defined as looser but significant controls. There seems to be some consensus that mitigation may lead to a slightly flatter or slower curve but also overwhelmed ICUs and an intolerable death rate, among those most at-risk.
But no one seems to be considering a fourth Option: Option D.
Let’s call Option D. Sweden Plus.
From my experience of Sweden, it is a country with characteristics and circumstances that may lead it to greater personal responsibility among at-risk populations. I think an enhanced Sweden strategy could make up for a more pronounced liability culture in the U.S. and elsewhere.
Option D: Follow a mitigation strategy among the under 60 population, with no diagnosed underlying health risk factors. Social distancing, avoid large gatherings, work from home where possible, etc. Essentially Sweden’s policy. But we add to it:
-A strictly “enforced” quarantine of anyone who is age 60 or older or has a diagnosed health risk factor.
-This quarantine is enforced by the U.S. National Guard, all branches of the U.S military and local police. All citizens must carry ID and submit to a check.
-If an at-risk person is “discovered” they are gently guided back home, or to a quarantine center (their choice). This solution sounds Draconian but is it compared to the total shut-down alternative? Perhaps, an at-risk person, who decides not to cooperate, is allowed to freely go on their way, perhaps they must sign an ICU priority waiver? These are issues that we’d have to decide as a society.
-What is a quarantine center? Here’s an idea… If a company like Hilton takes a bailout check, they must provide the CDC with exclusive quarantine centers. Or any number of other possible types of sites could be used.
-If a family lives with an at-risk person, then they must quarantine as a family, or the at-risk person must go to a quarantine center. So, if I have high blood pressure, my family can decide to go into quarantine or I can go to “the quarantine Hilton”. Families could decide to change their quarantine strategy as often as they like.
-Any citizen is welcome to get free testing for underlying health risk factors, at a quarantine center, or to choose to self quarantine without testing.
-Anyone who is under quarantine receives aggressive and overwhelming financial, logistical and quality of life support. For example, they receive groceries and supplies (delivered, for free, by companies like Amazon, CVS or others that have made a large profit on the pandemic); they receive special assistance with rent and bills; they are given access to nature walks as often and as safely as possible.
Does all that sound expensive? More than two trillion dollars?
So, assuming Option D is feasible, here are some questions:
If the CDC ICU and morbidity demographic data is accurate, does Option D, not mean, by definition, that ICUs are not overwhelmed and the morbidity curve flattens? Or does it not mean, at least, that those at-risk people that are dying are those who have chosen to flout a militarily enforced quarantine, so in essence, have chosen death? Of course, there are tragic exceptions but those exceptions will occur in Option A also, to some degree.
Does Option D, given that the majority of healthy people, under age 60, can return to some level of normalcy and employment, not mean, by definition, that we mitigate a prolonged economic disaster?
If the answers to these above two questions are yes, then is that not preferable to an Option A, lasting three or more months and, potentially, to a Phase 2 Option A in 6 to 12 months, which we would have to face with few economic stimulus tools to bailout our economy? How badly does the health crisis spin out of control, shut down or not, if we have to face it with an economy that has already spiraled out of control?
I guess the answer to the third question is dependent on how long Option A needs to last: Two months? Three? Three and then another three (in six months)? 12? 18 (as the Imperial College study seemed to suggest)?
I do not know the answer, for the U.S., for Europe or for Sweden. Maybe the answers will be different for each. But I do hope that we, policy makers, the media, the scientific and financial community consider all strategies and all ramifications. This is not a time to align by nationality, or politics. This is not a time to consider only Epidemiology or Economics. This is a time for Epidemiologists and Economists to be talking and educating each other. This is not a time for Groupthink. Let us rise above to overcome.
