Thread by @drraghibali

Plan B:
Why Sweden provides a potential model for us to follow - but not for the reasons most people think - and only if we learn from their mistakes.

And why - whichever plan is chosen - we need to build consensus. And how that could be done.

No country has received more attention for its approach to dealing with COVID than Sweden but there continue to be widespread misunderstandings of its strategy - with many thinking they followed the approach outlined in the Great Barrington Declaration.

However, the actual, official Swedish government strategy is ‘to limit the spread of infection in the country and by doing so, to relieve pressure on the health care system and protect people’s lives, health and jobs.’

And as its Chief Epidemiologist, Dr Tegnell has said,

Sweden is not trying to reach herd immunity (and have not achieved it) and they did not encourage the non-vulnerable to return to normal life.

Indeed, they strongly encouraged social distancing; reducing social contacts and the use of public transport; and working from home).

It also introduced many other measures (e.g. closing universities, table-service only in restaurants and limited gatherings to 50 people.)

Tegnell has described the policy as a ‘voluntary lockdown’ – and generally the levels of compliance have been very high.

The Swedish government stressed personal responsibility and trusting the public with simple, consistent, public health messaging - and tried to build public consensus and trust - with the lead being taken by doctors.

The key lesson from Sweden is that it was possible to suppress the virus and get over the first wave without a national lockdown; without reaching herd immunity & without an effective T&T system. And while keeping schools & businesses open – so reducing health and economic harms

Of course, there are many differences between Sweden and the UK, and there is no guarantee that its approach would work here, but the principles are still valid. The Sweden model is also not a cost-free option – and may lead to more Covid-19 deaths in the short term

than would otherwise have been the case – but that is not the key metric, which is whether the strategy will lead to the least overall harm in the long term. We also need to learn from their (and most other countries) mistakes with regard to better protecting the most vulnerable.

Nearly half of Sweden's (and about a third of UK's) deaths were in care homes. But we are in much a better position to prevent this second time around as we now have enough PPE and the capacity to test all care workers regularly and by ensuring workers don't move between homes.

The same also applies to those being cared for in their own homes. We would also need to reintroduce smarter, targeted shielding of the 'community vulnerable' with the individual risk calculators now available. But this should be voluntary to miminise mental health harms.

In summary, I am asking the government to consider this alternative strategy - based on the Swedish approach, but with much better protection of the vulnerable, especially in care homes - which may cause less overall harm.

The key to any successful strategy is sustainable compliance – and it must therefore have public trust and confidence. Open debate is important but ongoing divisions lead to both fear and complacency, undermine public confidence and compliance – and can cost lives and livelihoods

We therefore need doctors, scientists, and politicians to get behind the same overall strategy and I think this will only be possible if we can show which one causes the least overall harm.

The Government should therefore immediately bring together doctors, scientists and economists to conduct a comprehensive cost-benefit analysis of the 4 main options being presented and come to a consensus – which should then be shared with the public and other scientists.

Although I have made my own assessment, I recognise that I neither have access to all the data nor a monopoly on wisdom, and so am happy to accept whichever option comes out best – and hope others will do the same.

Finally, I believe all sides want to protect both lives and livelihoods and to recover from this crisis as quickly as possible and so we must put aside our differences, compromise and come together in the national interest.

‘A house divided against itself cannot stand.’

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