Herd immunity and trust: Tackling the pandemic the Swedish way

Sweden has gone against the norm by not imposing a lockdown. Image credit: By Kabelleger / David Gubler - Own work: Also available at http://www.bahnbilder.ch/picture/16065, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=36256992

In January, this year, a friend shifted to Sweden with her husband, who works with an IT major. Then, the pandemic was still remote, localised in China. A couple of months later, India went into lockdown. As my friend kept getting updates about her friends and family members back home during what is being called the world’s most stringent lockdown, she realised how things were different in Sweden. While she, and some of the other Indian families she knows there, have been self-quarantining at home, on the streets of Stockholm and other parts of the country, it has been business as usual, albeit with some restrictions.   

For, Sweden is one of the only countries in the world to not impose an official lockdown. In Sweden, as opposed to its neighbouring countries, and most of Europe, there is no ban on moving outdoors, nor are bars, restaurants, offices or even primary schools shut. While some offices have adopted work from home policies, many people still travel to work. Rather, the country has been relying on trust, common sense and recommendations of social distancing, led by the state epidemiologist, Anders Tegnell, who has said that locking people at home will not work in the long term.

It is not that life is completely normal. Sweden has imposed four rules to counter the pandemic – no visiting elderly care homes or retirement homes, no public gatherings of over 50 people, restaurants and bars need to make sure they are not crowded, and all guests need to be seated. It has also closed high schools and universities; though primary schools are still open.

So, why is Sweden not following the rest of the world in locking down completely? For one, the country considers personal freedom a top priority, by locking down the society, people’s freedom of movement would be curtailed. It is also amongst the most egalitarian countries in the world - by shutting down schools, the younger children would have to stay at home, which would be difficult for working parents, especially if they are single/low earning. Further, the trust factor between the Swedish government and its people is high, and, according to data, many people have been voluntarily self-quarantining, while public transport usage has dropped significantly.

Further, more than half of homes in Sweden are single individual households, while most of the elderly live in care homes. Surveys have also found that three-fourths of Swedes maintain the recommended minimum one-metre distance from each other – something that is pretty common in a country that takes personal space seriously. Even before the pandemic, the Swedes have maintained a minimum of an arm’s length from each other.

A gamble

However, another, approach that Sweden is relying on, though it has not confirmed the same officially, is that of getting herd immunity – a highly debated term. This happens when a large proportion (around 80 per cent) of the population develops immunity to a virus. This could either be through mass immunisation or by having people infected with the virus, recovering from it and developing immunity to it.

In Sweden’s case, Tegnell has estimated that 40 per cent of the population will develop immunity to the virus by May end, and, as opposed to its neighbours such as Finland, in case a second wave happens in autumn, most Swedes would already be immune to it. 

This move has caused much controversy - some have called it reckless and dangerous – the country has a total of 25,265 cases and 3,175 deaths - others, especially many Swedes, believe that this is the right move. Sweden’s death rate is nearly six times that of its neighbouring countries, Norway and Finland. A large number of deaths are among the older population. Sweden also recently had to crack down on a few bars and restaurants in Stockholm where social distancing rules were being flouted.

Sweden is not the only country to try this approach - in early March, there were reports that the United Kingdom was hoping to reduce the impact of the virus by allowing more people to get infected and develop immunity to the virus.  However, projections showed that the country’s health services would not be able keep up with the rapidly rising number of infected people, deaths were also increasing. By end-March, the country ordered all schools, pubs, restaurants shut and banned large gathering. The country’s Chief Scientific Advisor, Patrick Vallance, later clarified that herd immunity was never the goal, rather it was to try and suppress the peak and keep it at a level at which the country’s medical services could cope.       

The herd immunity debate and India

With cases rising, and the severe economic fallout of the pandemic and lockdown, some commentators are debating whether herd immunity would be a better approach for a developing country like India. According to experts in favour of such an approach, India’s young population, which require less intense hospitalisation and could have a lower fatality rate, could make the country an option for trying out the herd immunity way.  However, this would have to be reached in a way that it does not affect the most vulnerable – the elderly population and those with co-morbidities.

As per a team of researchers from Princeton University and Washington, New Delhi based public health advocacy group, Centre for Center for Disease Dynamics, Economics and Policy, by controlling the way the virus is released in the next seven months, 60 per cent of the population could get immune to it by November. The experts believe that the approach adopted could be to allow most of India’s under-60 population to get back to normal life while restricting large gatherings encouraging social distancing and making masks compulsory.

However, critics of the policy maintain that allowing more people to get infected would mean stretching the country’s already-strained healthcare system in order to be able to accommodate the critically ill who need hospitalisation. India also has a high proportion of people with diabetes, cardiac illnesses and other comorbidities, hence increasing the risk factor. Many Indians also live in multi-generational families, hence, protecting the elderly from the virus may be difficult if people are allowed to mingle freely.

Further, considering the COVID-19, which emerged late last year, is still understudied, it would be difficult to predict how protective the antibody response would be and for how long. In the absence of a vaccine, herd immunity may be a risky experiment, which could prove dangerous if things go wrong in a country like India. As the health ministry said on Friday, with no early tapering off in sight, Indians would have to learn to live with the virus and adjust to new social distancing norms.