The coronavirus data debate

Two months into California’s shelter-in-place order, locals are restless. As spring fever takes hold, people are pouring onto the beaches in large numbers and protesting Gov. Gavin Newsom’s continued restrictions. Grocery stores once full of mask-covered shoppers scanning for toilet paper and pasta now have a more relaxed vibe: In early May, less than half of the shoppers in a San Clemente grocery store were wearing masks, even as an employee announced over the intercom that face coverings were required.

Shutdowns are taking their toll, creating economic hardship, lost educational hours, and mental health problems. Increasingly, people are searching for another way and pointing to a country roughly the same size as California taking a radically different approach to the virus: Sweden. The Scandinavian country has boldly condemned lockdowns since day one, and images of joyful Swedes gathering in restaurants and appearing to live as usual taunt those across the Atlantic feeling the brunt of the economic shutdown.

Multiple theories have emerged, each staking claims on the million (or multi-trillion) dollar question: How do we open struggling businesses while preventing new outbreaks that could cripple healthcare systems? Some medical professionals say the data support the Swedish model, while others urge caution, claiming Sweden’s numbers are alarming. Other countries have implemented measures which probably won’t work in the U.S. But the debate isn’t just about achieving the optimal level of social distancing. What scientists believe about fatality rates and immunity affects their views on Sweden’s approach and the policies they embrace for jumpstarting the U.S. economy.

SWEDEN’S CHIEF EPIDEMIOLOGIST, Anders Tegnell, believes lockdowns don’t prevent deaths—they just change the timing of the deaths. Proponents of this theory claim quarantine measures increase a country’s chance of mortalities spiking during a second wave of infections as economies begin to open.

Herd immunity was never Sweden’s stated goal, but researchers are testing it as a possible alternative to freezing movement and waiting for a vaccine. Sweden’s health officials believe a quarter of Stockholm’s population may already be infected with the virus, putting it on a path toward the 50-60 percent some claim is necessary to achieve herd immunity.

Sweden banned gatherings of more than 50 people and recommended social distancing measures to protect the elderly and vulnerable. The government encouraged working from home when possible. Because most Swedes tend to trust their government, many people followed those guidelines. Local officials temporarily shuttered five Stockholm restaurants in late April for not following guidelines, but most have been cooperative. Bars, gyms, and restaurants have stayed open.

Sweden also decided to keep K-8 schools open, and some say that’s allowed the virus to circulate among the low-risk population. Joel Hay, a professor of pharmaceutical and health economics at the University of Southern California, applauded Sweden’s decision: “Sweden is the only place in the world that’s doing everything right,” Hay said. “Their ICU cases keep dropping just as fast as Norway’s, and they have zero pediatric deaths even though they’ve been in school the whole time.”

But with this theory comes the assumption that the coronavirus is not as deadly as most epidemiologists claim, and that’s more difficult to prove. Sweden’s former chief epidemiologist, Johan Giesecke, predicts a death toll similar to that of a bad flu season or double the deaths at most. But the United States and many other countries are well on their way to surpassing their worst influenza pandemics since the Spanish Flu of 1918.

Many promoting the Sweden model claim COVID-19 has a mortality rate between 0.1 to 0.3 percent, citing studies they say prove a far greater number of asymptomatic cases among the population than we realize.

Other medical researchers draw much different conclusions, pointing out testing problems with some of the antibody surveys concluding a death rate similar to that of the flu. Faulty tests and sample pools are among the criticisms.

Andrew Noymer, an epidemiologist at the University of California in Irvine, says the mortality rate based on confirmed infections in the United States is around 6 percent. But it may be as low as 0.6 percent when you consider the possible number of asymptomatic cases in the population. That’s still six times deadlier than the flu, with a much higher infection rate. Three months after its first coronavirus outbreak, the U.S. is close to surpassing the 100,000 deaths attributed to the 1968 Hong Kong flu pandemic.

Noymer also believes Sweden has sacrificed its elderly citizens for a policy of more freedom. The virus ran rampant throughout nursing homes—about 90 percent of the country’s coronavirus deaths are among those ages 70 and over—and the country reached 343 coronavirus deaths per million in mid-May: six to eight times higher than its Scandinavian neighbors and surpassing the United States in deaths per capita. That’s telling, given the United States’ handicaps: poorer average health and higher population density. Nearly half of all Swedes live alone, and Sweden’s land mass is roughly the same size as California with a quarter of the residents.

Despite claims that Sweden’s policy has saved its economy, early projections suggest it may be on par with the United States and Germany. Swedish authorities predict a 7 percent drop in economic output by the end of the year.

Further, Noymer says the Swedish approach assumes no vaccine will come anytime soon. That may prove true, but he places high confidence in treatments that will decrease the death-to-case ratio over time: “At that point it will be too late for Sweden to take back its policy because all those people will be dead and buried.”

ANOTHER POSSIBLE PATH FORWARD is the “test and trace” model that a handful of countries in Asia and the South Pacific implemented. New Zealand imposed a “go hard, go early” strategy that included a halt to international and domestic travel in mid-March.

If deaths per capita is the measurement for success, New Zealand is among the winners with only four deaths per million as of mid-May. Singapore, Taiwan, and South Korea achieved similar results through massive testing and aggressive contact tracing: testing large quantities of people, identifying and isolating those who test positive, and tracking down those with whom they came into contact. Many New Zealand businesses are using contact tracing apps as the economy begins to open.

Hay is skeptical of New Zealand’s alleged success and claims sufficient testing would reveal the same endemic rate as other countries. Others in his camp point out the challenges these countries will face as they open their economies. New Zealand depends on tourism and trade, but an isolationist approach will make it difficult to jumpstart those sectors. And extensive contact tracing opens the door for Big Brother policies that could stay indefinitely.

Noymer says contact tracing is helpful, but it won’t save the day in the United States. New Zealand, Singapore, and Taiwan have smaller populations and are surrounded by water. South Korea is a peninsula with a closed land border. The United States has a population of 330 million people, and interactions will spike as businesses open once again. Plus, populations accustomed to uncertainty and threats are more likely to trust government policies that curtail individual freedoms.

BOTH NOYMER AND HAY believe the path forward includes reopening the economy. But because they disagree about the virus itself, they disagree about how to do that.

“We should chill out and get back to normal as quickly as possible because the lockdown will kill 10 times to a thousand times as many people as [COVID-19],” Hay said. “If there’s anything that is a travesty of this whole ridiculous nonsense [it] is taking kids out of school.” Sweden kept schools open, yet no children under 14 died from the coronavirus, he points out. Ten or fewer children have died in the United States.

His beliefs about the virus shape his own actions as he walks out his front door in Los Angeles County: He hasn’t worn a mask or gloves during the pandemic and doesn’t plan to: “I’ll be happy to inject myself with [the coronavirus] on live TV if it would make a difference.”

Some proponents of this plan claim deaths have already peaked in many parts of the country, and the U.S. should encourage transmission among the young and healthy while protecting the elderly and the vulnerable. The country should also reopen parks and schools and embrace the warm days of summer with the exception of large gatherings.

Others push for a more cautious approach. “We need to reopen very slowly, very deliberately, and very smartly and with the strategy to start closing things if things don’t go as planned,” Noymer said. Proponents of this theory are worried about a second wave that could increase deaths and overwhelm healthcare systems, generating more fear and economic hardship. He says it’s too early to decide whether to open schools in the fall and is against a “one size fits all” approach to the virus.

Noymer wears a mask and sometimes gloves when he leaves home. Although he’s in favor of beach reopenings, he will not be joining the crowds: “I want to delay getting this for as long as I can, because I think the virus is going to evolve away from virulent toward being milder.”

Noymer says the goal in the U.S. has been to prevent a situation similar to Italy’s Lombardy region where coronavirus cases inundated hospitals and physicians triaged patients: “We’ve promised that as long as we can do that, we’ll start to reopen the economy, and that promise has to be kept.”