Sweden’s lessons for the UK’s third wave

By Jay Bhattacharya, Martin Kulldorff and Sunetra Gupta.

"The UK has successfully achieved the ultimate goal in tackling the pandemic: protecting the vulnerable. 

In the first week of May, the UK recorded the lowest number of new cases since last August. This was met with excitement after such a devastating winter. The government therefore prepared for ‘freedom day’ on 21 June, when lockdown restrictions would finally be lifted. However, they reversed course as cases rose again, postponing it to 19 July. Over the last two months, infections have surged, with no real way of stopping them.

Throughout the pandemic, a rise in cases has been followed by a rise in deaths two to three weeks later, but that did not happen this time. Cases increased at a similar rate to the autumn of 2020, but deaths have been flat and near-zero since April. The UK is sufficiently protected.

What is the scientific basis for this success? While anyone can get infected by Covid, there is more than a thousand-fold gulf in the risk of death between older and younger people. It is the elderly and vulnerable who disproportionately die from the disease.

In its first two waves, the UK did not succeed in following a focused protection approach. The elderly, whether in care homes or elsewhere, were exposed and suffered the predictable consequences of a blanket lockdown approach to the virus. Lockdowns protected the 'non-essential' laptop class from the virus, while exposing the 'essential' working class and poor, regardless of medical vulnerability. On top of all this, the population at large experienced the devastating collateral damage of lockdown.

The third wave has been different for one reason: the UK rapidly rolled out its vaccine programme with a strategy of prioritising the vulnerable and those who care for them. By May, over 90 per cent of the over-70s had been fully vaccinated.

To see where the UK has been successful, it is instructive to look at Sweden. As an EU member state, its vaccine deliveries were slower than in the UK, but it was strict about providing its few available doses to care home residents, older adults, and front-line health workers. A government employee was fired for skipping the vaccine queue.

Like the UK, Sweden had a sizeable second wave (although it experienced far fewer deaths per capita). Its third wave began in February, and has only recently subsided. However, because it focused on getting vaccines to the elderly and the vulnerable, it had relatively few hospitalisations and deaths.

The outcomes during the Swedish third wave provide a reliable guide to what the UK should expect in the coming months. As the UK lifts restrictions on 19 July, hospitalisations and deaths will not hit their previously high levels, despite a large wave of cases.

As Theresa May, Sajid Javid and Boris Johnson have pointed out, we must learn to live with Covid. As Covid becomes endemic, it will no longer pose the same danger to people that it once did. In its endemic state, there is no point in testing asymptomatic or mildly symptomatic people and obsessing over case numbers (unless the objective is endless panic). We do not test and count every case of flu or the common cold. Epidemiologists should continue to track Covid’s progress, but within reason.

In England, we can now celebrate the achievement of protecting the elderly and vulnerable (though older people who are not yet vaccinated should of course get the jab). We can enjoy the return of family and friends, social gatherings, religious services, cultural events, sports, holidays, restaurants and pubs. These should never again be limited by lockdowns. Welcome back to the old normal."