One has to wonder if parts of Europe are a harbinger of what is to come for the United States in the COVID-19 pandemic. If it is, what is coming out of the Nordic countries is all good news. Revised testing guidelines, slower rates of infection and expedited opening are all indicated in the experience in Sweden, Norway, and Switzerland might be better than expected. It won’t make the “lockdown until November, we need 5 million tests a day” crowd happy at all.
Sweden has chosen a different path to public health from the beginning of the pandemic. Seeking to protect their hospital system and increase immunity in the population, they put light recommendations in place and allowed shops and primary schools to stay open.
Despite the hands-off, high-trust approach, Sweden falls in about the middle of the pack for deaths per million in Europe. Yet their disease penetration in Stockholm, a metro area of about 2.6 million people, is only 7.3% as of the end of April according to antibody testing.
This is far below expectations given the original R0, or measure of how contagious a virus is. Original estimates said this rate could be as high as one infected person infecting 5-6 others on average. Sweden’s approach suggests this might be much lower, which would be good news.
In Norway, they have abandoned their plans for broad-based testing:
Instead, tests will be reserved for those who have symptoms of coronavirus, those who work in healthcare or elderly care homes, and those in risk groups.
If 12,000 random people were tested in Norway today, the Norwegian Institute of Public Health estimated in a press release issued on Monday, 15 would test positive, of which only one would have a real coronavirus infection.
Based on the low forecasted infection rates and an even lower symptomatic disease forecast, the Norwegian Institute of Public Health issued new testing guidelines that mirror the kind of sentinel surveillance Dr. Deborah Birx has been describing for months. It suggests testing asymptomatic individuals in specific circumstances, not broadly:
- After an outbreak of infection in elderly care homes, all employees and residents of the affected units should be tested
- When diagnosing infection in health institutions, it may be appropriate to test asymptomatic close contacts.
- When new residents move into nursing homes, testing may be appropriate.
- Prior to certain hospital stays or procedures (although this is up to each hospital).
- In some cases, foreign universities or employers might require testing. This can be done on a private basis.
- Research: In some research studies, all participants will be tested regardless of symptoms.
They also set COVID-19 testing priorities that focus on symptomatic individuals, screening specific populations and contact tracing.
In addition, Switzerland is accelerating its reopening efforts:
The Federal Council thereby indicates that it wants to end the extraordinary situation again after three months and get out of the situation thanks to which it ruled in many areas by emergency law.
The Health Minister proposed changes and as of June 6, 2020, the only significant restrictions that will remain in place are bans on gatherings of more than 300 people. All schools, indoor and outdoor entertainment including sporting events, will be allowed. Their phased reopening approach has been progressing quickly since beginning on April 27th.
Additional information on vaccine testing tells us the United Kingdom is also seeing declining infection rates. They have declined to the point researchers are concerned about successfully completing the trial.
All of this is good news as America contemplates how to proceed with reopening on a regional level even a few weeks behind.
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