COVID-19—a very visible pandemic
Authors: Andrew Ewing
Journal: The Lancet (2020)

Johan Giesecke's1Giesecke J The invisible pandemic.Lancet. 2020; 395: e98Summary Full Text Full Text PDF PubMed Scopus (61) Google Scholar many claims lead to two concepts. First, that lockdowns were bad, with the Swedish way being the best approach to the pandemic; and second, that everyone in the world would get COVID-19 in a thinly veiled argument that herd immunity was the only way that the virus would be controlled. During April and May, 2020, Giesecke became somewhat of a celebrity in the UK and elsewhere, giving interviews that promoted these arguments. Giesecke's letter specifically stated that PCR tests and assumptions had shown that 20–25% of Stockholm was infected already, that serology tests were already supporting this conclusion, and that 98–99% of people infected did not know it. These ideas, espoused by Giesecke and his colleagues at the Public Health Agency of Sweden have sparked protests around the world where many raise signs calling for an approach like Sweden's and no lock-ins. In fact, when representative testing was published in Stockholm, the results indicated only a 7·3% infection rate,2FolkhalsomyndighetenFörsta resultaten från pågående undersökning av antikroppar för COVID-19-virus.https://www.folkhalsomyndigheten.se/nyheter-och-press/nyhetsarkiv/2020/maj/forsta-resultaten-fran-pagaende-undersokning-av-antikroppar-for-covid-19-virus/Date: May 20, 2020Date accessed: June 2, 2020Google Scholar although the health authority continues to debate this. This number is, however, consistent with infection rates of about 5% reported across Spain at the time,3de Castro NR España, lejos de la inmunidad de grupo con solo dos millones de positivos en coronavirus.https://www.abc.es/sociedad/abci-millones-espanoles-estado-contacto-nuevo-coronavirus-202005131942_noticia.html?ref=https:%2F%2Fen.wikipedia.orgDate: May 13, 2020Date accessed: June 2, 2020Google Scholar and those reported in the news for France and Belgium. Importantly, despite the low infection rate, the death rates in Sweden are considerably higher than those of its neighbouring countries and approximately 30 countries around the world that enforced lockdown rapidly and now are making use of testing, tracing, isolation, and masks to control the disease. The Swedish experiment has failed, but what is the cost? The death rate is much higher in countries (1) that delayed lockdown, (2) where posters calling for an approach like Sweden's arguably led to people in these countries (eg, Brazil and the USA) attempting to follow the Swedish approach to the pandemic, and (3) that were released from lockdown early by their government. It is indeed difficult to calculate, but the increased death toll from following advice from Giesecke and the Public Health Agency of Sweden is going to be substantial around the world. The attempt to reach herd immunity, and the public promotion of herd immunity to others, has cost many lives. Giesecke1Giesecke J The invisible pandemic.Lancet. 2020; 395: e98Summary Full Text Full Text PDF PubMed Scopus (61) Google Scholar stated that "our most important task is not to stop spread, which is all but futile, but to concentrate on giving the unfortunate victims optimal care". He also declared no competing interests. Is it important that he has some serious conflicts of interest that might or might not drive his ideas? Although he reports his affiliation as a professor at the Karolinska Institute, he was (and still is) a paid consultant of the Swedish health agency supporting the COVID-19 response.4Ronge J Folkhälsomyndigheten kan betala Giesecke en miljon.https://www.expressen.se/nyheter/folkhalsomyndigheten-kan-betala-giesecke-en-miljon/?fbclid=IwAR2o-kSvuCgqPMctYxb4s2q2K7SfdvXkjixYQ97liAFgfs0eDate: May 26, 2020Date accessed: June 2, 2020Google Scholar This online publication has been corrected. The corrected version first appeared at thelancet.com on August 10, 2020 This online publication has been corrected. The corrected version first appeared at thelancet.com on August 10, 2020 I declare no competing interests. COVID-19—a very visible pandemicWe read the Correspondence by Johan Giesecke,1 a senior consultant to the Swedish Public Health Agency, with considerable concern. Full-Text PDF COVID-19—a very visible pandemic – Author's replyLet me express thanks to the many colleagues who have provided valuable feedback. I will not address each of these responses individually, but give a collective answer. Full-Text PDF COVID-19—a very visible pandemicMany predictions have been made regarding the slowing spread of COVID-19; it is not my intention to refute the epidemiological position of Johan Giesecke in his Correspondence.1 However, I will respond as a student doctor concerned about the broader implications. Full-Text PDF COVID-19—a very visible pandemicI read with interest the Correspondence by Johan Giesecke.1 Applauding the Swedish model, Giesecke1 posits a "relaxed strategy" or the development of a herd immunity as the way forward in dealing with the COVID-19 pandemic. He recommends that the crucial task is not to stop the spread, "which is all but futile, but to concentrate on giving the unfortunate victims optimal care". Given the drastic adverse economic consequences of the lockdown globally, the advocacy of herd immunity as a way out appears attractive. Full-Text PDF COVID-19—a very visible pandemicJohan Giesecke1 referred to the COVID-19 pandemic as an invisible pandemic, estimating that 25% of the Stockholm population was infected by the end of April, 2020, of which 98–99% are unaware of being infected. On April 1, 2020, the media reported that half of the Swedish population might be infected by the end of April, 2020.2 More conservative estimates suggested that at least one-third of the Stockholm population may be seropositive by mid-May, and later that Stockholm might reach herd immunity by mid-June. Full-Text PDF COVID-19—a very visible pandemicThe COVID-19 pandemic is exacting a confronting and extraordinarily visible toll in lives and livelihoods globally. The last occasion where humanity fought a similar calamitous infectious disease threat was the 1918–19 influenza pandemic. There are many lessons from that pandemic that are still relevant. The first pandemic wave did not grant adequate herd immunity and was followed by one or more subsequent waves, with those waves being more deadly than the initial wave.1 Additionally, stringent public health measures flattened the epidemic curve, preserving hospital capacity and saving many lives. Full-Text PDF The invisible pandemicMany 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. Full-Text PDF Department of ErrorEwing A. COVID-19—a very visible pandemic. Lancet 2020; 396: e18—In this Correspondence, the third and final sentences of the fourth paragraph should have said, "The death rate is much higher in countries (1) that delayed lockdown, (2) where posters calling for an approach like Sweden's arguably led to people in these countries (eg, Brazil and the USA) attempting to follow the Swedish approach to the pandemic, and (3) that were released from lockdown early by their government", and "The attempt to reach herd immunity, and the public promotion of herd immunity to others, has cost many lives", respectively. Full-Text PDF