He contended that the difference in infection and death rates between countries would come out in the wash, regardless of their lockdown policies and promised to return in a year’s time to review the evidence.

But he makes no bones about his mistakes. When I remind him of his prediction that countries would end up with similar results after a year, he readily concedes he was mistaken. “One of the things I got wrong a year ago is the rate of spread of this disease. I thought it would spread quicker. And I also thought it would be more similar in different countries. We can see now that there are big differences in the rates of spread in between countries. It may have to do with lockdown, it may have to do with cultural things in these countries. But there is a big difference between countries.”

The difference that is most commonly cited in the ‘case for the prosecution’ against the Swedish strategy is the following chart showing Sweden’s deaths per million dramatically exceeding its neighbouring Scandinavian countries. This is generally considered solid proof that the Swedish strategy failed.

Johan Giesecke disagrees: “The differences between Sweden and its neighbours are much bigger than people realise from the outside — different systems, different cultural traditions…If you compare Sweden to other European countries [such as the UK, France, Spain, Italy, Belgium] it’s the other way round. On the ranking of excess mortality, Sweden is somewhere in the middle or below the middle of European countries. So I think it’s really Norway and Finland that are the outliers more than Sweden.”

Explaining what he means by cultural differences, he mentions among other factors that “they’re more sparsely populated. There are less people per square kilometre in these two countries. There are also much fewer people who  were born outside Europe living in these two countries.”

So, crucially, if Sweden had instituted a hard lockdown and shut the border earlier, would its death rate have been closer to its Nordic neighbours? “Maybe not,” he says, “I think we would still have more deaths than they have.”

He is also fairly dismissive of charts currently showing that Sweden has the highest level of infection in Europe:

“I don’t think you should compare countries now, while we are still in the pandemic. You should wait until the pandemic has receded before we start comparing countries. If you did that chart a month ago it would be very different. And a month from now? I don’t know but it would be very different. These snapshots may not show the whole truth.”

Compared to the UK, Sweden ranks 23 in the world in terms of Covid deaths per million, and the UK ranks 11 —so on the most important measure of all, Sweden has had a better result. In fact, as the above chart shows there are strikingly similar patterns of deaths over the past 12 months in the two countries.

“They’re very similar,” says Gieseke, “And yet one of the countries has had three severe lockdowns and the other has only had voluntary or mostly voluntary measures. That tells us something I think.”

What does it tell us?

“That lockdowns may not be a very useful tool in the long run.”

Watch the original interview

Did Sweden get Covid wrong?

By UnHerd

In our first interview, the Professor speculated that the Infection Fatality Rate (IFR) could be as low as 0.1% and that over 50% of people would shortly be revealed to have already had the virus once antibody testing became widespread.

We now know that the IFR for countries like the UK and Sweden is between 0.5% and 0.9% and that antibody testing has persistently revealed disappointingly small prevalence. Even now, after tens of millions of people have had Covid in the UK and a further 32 million have been vaccinated, antibodies are only estimated to be present in 55% of people.

“Two things I really got wrong (there are probably more things, but two big things). One is that the vaccine came so fast. I had no idea that we would have a vaccine within a year… The other thing is the rate of spread — I overestimated it, I thought it would spread much faster than it did.”

Giesecke was critical, last year, of Prof Neil Ferguson’s forecasts of up to 510,000 deaths in the UK from an unmitigated epidemic, 250,000 from a mitigated epidemic and as few as 20,000 with a suppression strategy. But with over 130,000 deaths in the UK, I ask, Ferguson’s numbers don’t look so wrong any more, do they?

“You may be right,” he concedes. “There is quite a difference between half a million and 130,000 — but, yep.” Put together, I suggest, these errors — a wrong estimate of the fatalities, the wrong percentage of people infected and an overly pessimistic expectation of the vaccine roll out — add up to getting the overall picture very wrong. So does that mean that his rejection of lockdowns at that stage was wrong, too?

“No. Sweden has had rather severe restrictions, but we based them on voluntary participation by the inhabitants instead of using laws and police. A lot of people in the world seem to think that Sweden did nothing about the Covid pandemic. That’s wrong. The entire population changed their way of living and it had profound effects on daily life for millions of Swedes, even though you weren’t fined if you were in the wrong place at the wrong time. So I would still advocate the Swedish model, even knowing all that.”

Although he concedes that some lives may have been saved, he believes that the successes of the Swedish approach over the past year should be considered in the balance:

“Look at the good things with the Swedish system…. One is the schools: we are not destroying the future for classes of children. Another is that Sweden kept to its international agreements — for example in the EU you are not supposed to close your borders with other countries, but that has happened in several countries in Europe. We have made it possible for small businesses like cafes or bicycle shops to survive the pandemic. We have kept democracy. We have trusted people. I think there are a number of benefits from not having a severe lockdown and more of them will come as we do research on this in the future.”

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A year ago, Giesecke predicted that inhabitants of a democracy would swiftly tire of lockdown, and that long-term house arrest was not a viable option. But as it turned out, the policy remained highly popular among the majority across Europe for most of the period.

“People were willing to give up more freedom than I thought they would. It worries me — there are many democratic rules and freedoms that have been curtailed. I think that may be one of the dangerous results of this pandemic.”

He regrets the recent legislation in Sweden that makes lockdowns constitutionally possible for the future. “There is a new law — a pandemic law — which gives the Government more power than it had before, and curtails part of the freedom of the Swedish population… It’s shifted power away from parliament to some extent, which is a new thing in Sweden at least in peacetime.”

Looking to the future, Giesecke can see various scenarios playing out:

“The virus may mutate so it becomes less pathogenic than it is now. It may be that it comes back in a new shape every autumn. And it may be that we’ll all have to take a new coronavaccine every year, tailored for that strain. But it is here to stay — we won’t get rid of it.”

Which is not to say the pandemic heralds the beginning of a “new normal”, or is part of a “great reset”. In fact, he is confident that the old normal will return. Once vaccinated, he believes people should return to normal:

“If you are vaccinated with two doses and wait the right number of weeks, then… you should be able to live like you did before the pandemic. This disease is sometimes seen as something supernatural, mystical, mythical — but it’s a viral disease like all other diseases. More dangerous than some of them, but it’s not unique, Covid. So a proper vaccine used correctly protects you and means that you don’t infect other people as well…. No vaccine is 100% effective, but we don’t have this discussion about any other vaccine.”

He has been vaccinated with the AstraZeneca jab, and would be happy for  everyone to take it: “If we really want to get down to small numbers — we won’t eradicate it, but to small numbers — then I think even children should be vaccinated… I can’t see why not.”

Giesecke had a long and prestigious career at the top of international medicine. Does he regret joining the debate so publicly, and becoming such a controversial figure?

“I hope I have done some useful things for the Swedish population. If it has been useful for me or not… the discussion in Sweden has been very politicised and very divisive.”

He believes that history will judge him kindly.

“I think I got most of the things right, actually.”

After all these months, does he now think that his strategy is a failure or a success? A bit of both, he says quickly, but emphasises more of the latter:

“I think to a great extent it’s been a success. We are now seeing rapidly falling cases, we have continuously had healthcare that has been working, there have been free beds at any given time, never any crowding in the hospitals, we have been able to keep schools open which we think is extremely important, and society fairly open — while still having social distancing in place in a way that means that the spread of the disease has been limited.

The failure has of course been the death toll … that has been very much related to the long-term care facilities in Sweden. Now that has improved, we see a lot less cases in those facilities.”

Mortality is hardly an afterthought — so why is Sweden’s mortality rate so high? At around 550 per million of population, it sits just under the UK and Italy but far above neighbouring Norway and Denmark. Dr Tegnell offers a collection of reasons: with its larger migrant populations and dense urban areas, Sweden is actually more similar to the Netherlands and the UK than it is to other Scandinavian countries; he believes the Swedish counting system for deaths has been more stringent than elsewhere; also, countries are at different points in the epidemic cycle so it is too early to compare totals.

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The one thing he doesn’t mention in this list is that Sweden, uniquely in Europe, did not impose a mandatory lockdown at any point. Is he really claiming that this is not even a factor?

“I am not sure that it is easy to say that lockdown would make the difference … in many ways we have had a very stringent lockdown in Sweden. We have cut down on movement in society quite a lot: we have compared how much we travel in Scandinavian countries, and the decrease in travel is the same in Sweden as in neighbouring countries … In many ways the voluntary measures we put in place in Sweden have been just as effective as complete lockdowns in other countries. So I don’t think complete lockdown is the way to go for all countries … the rapidly declining cases we see in Sweden right now is another indication that you can get the number of cases down quite a lot in a country without having a complete lockdown.”

I ask again: is he claiming that lockdowns make no difference?

“We don’t know. It would have made maybe some difference, we don’t know. But on the other hand we know that lockdowns also have big other effects on public health. We know that closing schools has a great effect on children’s health in the short and the long term. We know that people being out of work also produces a lot of problems in the public health area. So we also have to look at what are the negative effect of lockdowns, and that has not been done very much so far.”

Tegnell points out the huge differences between different areas in Sweden — parts of the South that have had much lower Covid-19 than Copenhagen just over the water while Stockholm has had it much worse, despite the same lockdown policy nationwide. This he puts down to the volume of original introduction of the disease due to international travel:

“There seems to be a close connection to how many people introduced the disease at the same time… The spring holidays in Sweden are spread over four different weeks depending on different geographical regions. Unfortunately Stockholm happened to have its spring holiday just when there was an enormous spread of Covid-19 in Europe … so a lot of Swedes living in the Stockholm area came back with the disease. And that started an epidemic on a level that was much higher than the start of the epidemic in the South of Sweden, or in Finland or in Norway. Currently that’s to me the most likely theory – that if you have a massive introduction, it’s going to be a disease that is very, very hard to control.” Stockholm, in other words, was more like London or New York than Oslo or Helsinki in terms of introduction of the virus.

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He believes strongly that eradication — the zero-tolerance approach that is increasingly winning the day in the UK and US — is not a viable option.

“I don’t think that this is a disease that we can eradicate – not with the methods that we have right now. It might be a disease that in the long term we can eradicate with a vaccine, but I’m not even sure about that. If you look at comparable diseases like the flu and other respiratory viruses we are not even close to eradicating them despite the fact that we have a vaccine. I personally believe that this is a disease we are going to have to learn to live with.”

Many people feel that Anders Tegnell’s approach has been overly laissez-faire and that even now, he should be introducing more draconian measures. A model this week from his Health Agency suggested as many as 3000 additional deaths may be seen in Sweden in the next year — shouldn’t he do more to stop that happening?

He insists that those projections are only models, and that he hopes and expects to achieve a much better result. But he is also mindful of whether these draconian measures may do more harm than good:

“Of course we are trying to keep the mortality rates as low as possible, but at the same time we have to look at the draconian measures you are talking about. Are they going to produce even more deaths by other means than the disease itself? Somehow we need to have the discussion of what we are actually trying to achieve. Is it better for public health as a whole? Or is it trying to suppress Covid-19 as much as possible? Because getting rid of it I don’t think is going to happen: it happened for a short time in New Zealand and maybe Iceland and those kind of countries might be able to keep it away, but with the global world we have today, keeping a disease like this away has never been possible in the past and it would be even more surprising if it were possible in the future.”

One type of intervention that does not appear to have adverse effects is encouraging, or mandating, the use of masks. This has become an intensely political issue in the US and more recently in the UK. In Sweden mask use is minimal in almost all settings. Why is he not even recommending use of masks?

“One reason is that the evidence base for using masks in society is still very weak. Even if more and more countries are now enforcing them in different ways … we haven’t seen any new evidence coming up, which is a little bit surprising. The other reason is that everything tells us that keeping social distance is a much better way of controlling this disease than putting masks on people. We are worried (and we get at least tales from other countries) that people put on masks and then they believe they can go around in society being close to each other, even going around in society being sick. And that, in our view, would definitely produce higher spread than we have right now.”

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The emphasis on spread of the virus to the exclusion of everything else Dr Tegnell believes is misguided, as the number of cases is less and less correlated to the number of deaths.

“Deaths are not so closely connected to the amount of cases you have in a country. There are so many other things that influence the amount of deaths you have. What part of the population gets hit? Is it the elderly people? How well can you protect people in your long-term facilities? How well does your healthcare system continue to function? How can we improve the treatment in ICUs? All of these things have been changing a lot in the past few months… Those things will influence mortality a lot more, I think, than the actual spread of the disease.”

His belief is that, in the final account, the Infection Fatality Rate will be similar to the flu: “somewhere between 0.1% and 0.5% of people getting infected, maybe … And that is not radically different to what we see with the yearly flu.”

On the controversial question of immunity, he suggests that a larger percentage of the population in Sweden is already immune than antibody studies suggest.

“There are a number of small studies already that show that of people who had been diagnosed with Covid-19 with PCR, not all of them develop antibodies. On the other hand we have quite a lot of evidence that falling ill with Covid-19 twice seems to be extremely rare… Obviously there is also quite a big part of the population that has other kinds of immunity and T Cell immunity is the one that is most likely.

“What we see right now is a rapid fall in the number of cases, and of course some kind of immunity has to be involved in that as nothing else has changed. That means that immunity affects the R value quite a lot in Sweden today.”

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Why we aren't wearing masks in Sweden

By Freddie Sayers

Does that mean that Sweden will be better placed to limit second waves and future flare ups than countries that have had minimal infection levels so far?

“I think it’s likely that those kinds of outbreaks will be easier to limit in Sweden because there is immunity in the population. All our experience with measles and other diseases shows that … we know that with large immunity in the population it is much easier to control the outbreaks than if you don’t have immunity in the population.

“There is now a number of countries in Europe that have a fairly low level of spread for a very long time, which is very unusual with a disease that seems to be so contagious, and where there is so little immunity in the population. If that is really a sustainable way for the disease to exist we will wait and see — I think the fall will show if it is possible or not.”

The eyes of the world have been on him for the past few months. How would he like to be judged, and when?

“It is better to have a more complete discussion around this in say 12 months, after next summer, then I think we can more fairly judge what has been good in some countries and bad in other countries.”

He has promised to talk to us again at that time. 23^rd July 2021 – it’s in the diary.