The Invisible Pandemic

By: John Giesecke — The Lancet, May 5, 2020

Many countries (and members of their press media) have marvelled at Sweden’s relaxed strategy in the face of the coronavirus disease 2019 (COVID-19) pandemic: schools and most workplaces have remained open, and police officers were not checking one’s errands in the street. 

Severe critics have described it as Sweden sacrificing its (elderly) citizens to quickly reach herd immunity.1 The death toll has surpassed our three closest neighbours, Denmark, Norway, and Finland, but the mortality remains lower than in the UK, Spain, and Belgium.2   

It has become clear that a hard lockdown does not protect old and frail people living in care homes—a population the lockdown was designed to protect.3 Neither does it decrease mortality from COVID-19, which is evident when comparing the UK’s experience with that of other European countries.

PCR testing and some straightforward assumptions indicate that, as of April 29, 2020, more than half a million people in Stockholm county, Sweden, which is about 20–25% of the population, have been infected (Hansson D, Swedish Public Health Agency, personal communication). 98–99% of these people are probably unaware or uncertain of having had the infection; they either had symptoms that were severe, but not severe enough for them to go to a hospital and get tested, or no symptoms at all. Serology testing is now supporting these assumptions.4

These facts have led me to the following conclusions. Everyone will be exposed to severe acute respiratory syndrome coronavirus 2, and most people will become infected. COVID-19 is spreading like wildfire in all countries, but we do not see it—it almost always spreads from younger people with no or weak symptoms to other people who will also have mild symptoms. 

This is the real pandemic, but it goes on beneath the surface, and is probably at its peak now in many European countries. There is very little we can do to prevent this spread: a lockdown might delay severe cases for a while, but once restrictions are eased, cases will reappear. I expect that when we count the number of deaths from COVID-19 in each country in 1 year from now, the figures will be similar, regardless of measures taken.

Measures to flatten the curve might have an effect, but a lockdown only pushes the severe cases into the future —it will not prevent them. 

Admittedly, countries have managed to slow down spread so as not to overburden health-care systems, and, yes, effective drugs that save lives might soon be developed, but this pandemic is swift, and those drugs have to be developed, tested, and marketed quickly. Much hope is put in vaccines, but they will take time, and with the unclear protective immunological response to infection, it is not certain that vaccines will be very effective.

In summary, COVID-19 is a disease that is highly infectious and spreads rapidly through society. It is often quite symptomless and might pass unnoticed, but it also causes severe disease, and even death, in a proportion of the population, and our most important task is not to stop spread, which is all but futile, but to concentrate on giving the unfortunate victims optimal care.

I declare no competing interests.

6 thoughts on “The Invisible Pandemic

  1. Great straight to the point, factual, unbiased, non political article.

  2. Sweden is really not so great.

    The Scandinavian countries provided a control group trial of potential responses to the pandemic threat. They are relatively small countries with homogenous populations. They have well established public health systems. Their borders (EU mandated) are open. Denmark, Norway, and Finland elected to utilized extensive testing, contact training, and social lockdown. Anders Tegnell, chief epidemiologist for Sweden’s public health agency proposed a goal of achieving “herd Immunity” to control the epidemic. It was a well thought-out proposal. He encouraged elderly, ill and otherwise vulnerable citizens to self-quarantine while others behave in a relatively normal pattern. Restaurants and bars remained open. Shopping was permitted. Educational institutions continued to function. Large congregations of people were discouraged. Dr Tegnell wanted this population to become infected with benign courses, develop immunity and therefore prevent further spread. Current estimates are at a 15-20% immune level. 70-80% is projected for effective “herd immunity”. He is now not convinced of the wisdom of his approach. Sweden has twice the population of its neighbors. It has 26,000 confirmed cases and 3220 deaths including significant numbers of young adults and children. Denmark has recorded 10,000 cases and 526 deaths. Finland 5880 cases and 265 deaths. Norway 8070 cases and 218 deaths. The Swedish death rate is twice that of the U.S., triple of Finland and Denmark and six times Norway. Sweden is now planning for a second wave and is considering lockdown. Using Sweden as the control group it does appears social distancing and shelter-in-place with extensive testing and contact tracing is the best community approach to reduction of morbidity and mortality in the Covid-19 pandemic. The key to economic revival is control of the underlying pandemic. The Chinese government has announced mistakes in its management of the pandemic. They are examining their response and will be restructuring their public health systems.

  3. Plagiarist. You’re supposed to identify a source when you copy their writing.

  4. From the author:

    First of all, a short recap: It is fine and encouraged, to share these posts, if you find them worthwhile. There is no need to ask permission. I am a retired specialist in Internal Medicine (adult diagnostics). I live in Sun Valley, Idaho with my wife, Patti. I don’t take friend requests from people I don’t know. If we have mutual friends, I make an exception. Back when I let everyone in, I had a malware attack. No good deed goes unpunished.

    I really don’t think it plagiarism if one has permission and the author wishes to remain anonymous.

    Plagiarism or not it’s really the number that are important. Science over politics, please.

  5. Your are a liar and a plagiarist. If you were ever a doctor (from the ignorant postings you have made) I am the Queen of Sheba.

  6. Resident, you really need to lay off the bottle. I have no idea how you came to the idea that I claim to be a doctor.

    I don’t think you are the Queen of Sheba, however I have heard from many fine people that you are the Duchess of Chardon.

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