The number of new cases per week has halved since mid-December
On the face of it, Sweden’s state epidemiologist Anders Tegnell had only good news to report when he gave his biweekly press conference last Thursday.
"More or less everything is going in the right direction in the various parameters we measure," he said, as he showed charts showing the number of new Covid-19 cases a week more than halving since mid-December, weekly intensive care admissions falling from 240 to around 100, and even deaths falling off sharply.
When Dr Tegnell had similarly positive news to report back in September, he suggested that Sweden might even have put the worst of the pandemic behind it. This time around, he gave a warning.
"There is a big risk of a third wave, and a clear need to continue following the measures that we have in place," he said.
Given that more people have now died of coronavirus in the country since the start of November than in all the months leading up to it, his caution is understandable.
"I think he learned from his experience, and is now highlighting ‘please don’t relax too early," Joakim Dillner, Professor of Infectious Disease Epidemiology at Stockholm’s Karolinska Institute, told The Telegraph.
Sweden has avoided a UK-style lockdown, with all bars, restaurants, and shops still open, albeit with restrictions, people allowed to freely leave their homes, and only teenage schoolchildren shifted to distance learning (with even 13 to 15-year-olds often taught in school).
Professor Dillner nonetheless credits the fall in infections partly to tightened recommendations. "Following the dramatic increase in hospitalizations and deaths, there was a rather strong response from the government," he says.
This included an eight-person limit for gatherings and events, a ban on serving alcohol after 8pm, and the threat of fines for shops and gyms that break the 10-square-metre-per-person limit imposed under a new pandemic law.
As few of Sweden’s recommendations are backed by legal sanctions, the public’s improved behaviour, a reaction to the record daily Covid death rates Sweden suffered in December, has also been important.
"At one point, we could see that there was very limited compliance, but I think it’s different now," Dillner said.
"Now people are truly avoiding gatherings and so on, so I think it is ‘stricter regulations that are actually adhered to’ that has affected the reproductive rate."
Finally, he said that immunity was also starting to play a role.
"In those parts of society in the capital where people live in big families or really do not adhere to avoiding gatherings of people, most people have already had infections," he said.
"In those environments that are susceptible to rapid cluster spreading, I think we already have immunity there." Dr Tegnell on Tuesday argued that greater immunity and better adherence to recommendations amplified one another.
"With an increased share of immune people in the population, better adherence has a bigger and bigger effect," he said. The worry for Dr Tegnell is that the more infectious UK variant, B117 — which a random test of coronavirus samples announced on Tuesday indicates is already the cause of at least 11 percent of coronavirus cases — might start to push in the opposite direction, as it has in the UK.
The public has abided by new limits on gatherings
Credit: AFP
If the UK variant is 50 percent more infectious, the new scenarios the Public Health Agency released on Thursday suggest that it will become dominant in Sweden by the end of March, pushing the number of cases back towards the high levels seen before Christmas, even if the public keeps the level of social distancing it had in the autumn.
The only way to stop this would be for people to limit their social contacts to the same low level as they did over Christmas and New Year, which Tegnell said was "more of a base scenario and not something where there’s any high likelihood of happening".
If the public also then lets go completely, the number of cases could soar as high as 15,000 a day, more than double that seen in the worst days in December. If the UK variant is only 30 percent more infectious, it will not take over before the summer.
Johan Carlson, the director of the Public Health Agency and Dr Tegnell’s boss, warned on Thursday that just as a relatively small change in public behavior over Christmas and New Year had been enough to pull down the rate of transmission, the reverse was also true.
"Even small changes in adherence to restrictions, with increased contacts, can have big consequences," he said. "Together with the spread of the mutated variant it might lead to a third wave during the spring, and in the worst case, a powerful one."
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