Excess mortality in Europe has fallen in recent weeks, to the point where fewer deaths are occurring across the continent than you would expect at this time of the year. This doesn’t mean that Covid deaths aren’t occurring or that the problem has disappeared. It does mean it’s in a different phase.
And you could say Europe’s governments are converging on an approach which is looking more and more like that of Sweden’s – that is governments targeting a more limited range of specific public health measures, modifying policy in light of outcomes, and relying more on an informed public to make a sensible trade off between economic (and social) activity and safety-related social distancing.
The main ingredients for reopening policies are:
- cutting back on lockdown policies which restrict commercially valuable activity (ie, restrictions on shopping, restaurants and schooling);
- continuing to limit activities in which particularly intense social mixing is inherent (say nightclubbing) or which experience shows poses particular risks (eg, travel from hotspots);
- encouraging (and in some cases enforcing) social distancing and prophylaxis (hygiene and protection in medical speak); and
- protecting the old and vulnerable.
Hang on, I hear you say. Surely strict lockdown policies reduced the peak death toll? That proposition seems plausible but the data (some of the most useful comes from the European Mortality Monitoring Project) is still stubbornly inconclusive in failing to show a good correlation between the published strictness of lockdown policies and the number and pattern of excess deaths (let alone demonstrate which elements of lockdown policy have been most effective). Yes – the UK has a pronounced mortality peak, but so did Spain. Sure, the UK and Sweden had a slower decline from peak mortality – as did Italy.
Some of the most pronounced variation in mortality is within countries, despite national lockdown policies. The conclusion surely is to look more closely at the reasons for variation at the regional and local level and within institutional settings (such as hospitals and care homes).
Similarly, the variation in age-related mortality data is shocking. Of Europe’s 200,000 excess deaths, less than 20,000 occurred in the under 65 years cohort, while 25,000 occurred in 65-75 years; 60,000 in 75-85 years and 90,000 in the 85+ years. The need for this data to be at the heart of policy is beyond dispute.
But the debate is already moving beyond lockdown sterility, not least because it would be hard for Europe’s governments to renew strict measures on a nationwide basis.
Governments now are edging their way into a less blunt / more sophisticated policy mix. Some may hope to eliminate the disease. But many will simply hope to cap Covid deaths (and/or the excess mortality proxy) at low and stable levels.
This will still leave plenty of space for high profile politically-motivated restrictions (let’s see how many countries ban English – or even Swedish – tourists) but perhaps the most important thing to watch will be the extent to which individual governments think it necessary to micro-regulate activity post-lockdown. Britain’s government has already tied itself up in knots in debates over whether the 2m social distance rule can be relaxed to 1m, and over restrictions on international travel.
So the reason why it is possible to say that policy is converging on Sweden is less to do with the precise effectiveness of specific aspects of lockdown and more to do with realism about what governments can do (particularly in the absence of data) and what people need to do themselves.
Of course, authorities have responsibility for public health coordination: limiting individual actions which pose a high risk to others, helping the afflicted and vulnerable and ensuring reliable information on the reach and implications of a pandemic. But at the heart of disease management, is the need for individuals to understand the risks they face and to decide how much risk he or she can manage in light of possible consequences, bearing in mind that it is people and families who bear the consequences of both their own and their governments’ decisions.
Which brings us back to the basis – moral and pragmatic – for a Swedish-style approach. In public exchanges, there seems some reluctance to acknowledge this conclusion. But as a practical matter, it seems likely to get more recognition in policy decisions.