The State Epidemiologist who inspires tattoos

Is Sweden’s approach to Covid-19 a cautionary tale, or a realistic response in the absence of a vaccine?

I doubt that even the most ardent fan of our Chief Medical Officer (CMO), Dr Tony Holohan, has his image tattooed on their arm. But given the chasm between his approach to Covid-19 and that of Swedish State Epidemiologist Anders Tegnell, the absence of a CMO tattoo-wielding Irish citizen is but one example of the difference between Ireland and Sweden when it comes to the coronavirus.

Following a period of leave to be with his terminally ill wife, Dr Holohan returned to his post with a bang in early October. Clearly concerned about rising infection numbers, he called an unexpected meeting of the national public health emergency team (NPHET) on a Sunday, at the end of which the emergency team recommended an immediate move nationally from level 2 to level 5, the most severe response in the State’s established virus response plan.

In the end, the Government chose to move to level 3 rather than level 5 amid mounting public anxiety about NPHET’s severe advice

In the end, the Government chose to move to level 3 rather than level 5 amid mounting public anxiety about NPHET’s severe advice. And there was some overt political reaction to the modus operandi of the emergency team, culminating in an extraordinary attack by Tanaiste Leo Varadkar, live on the Today with Claire Byrne show on RTÉ.

Contrast this scenario with that in Sweden. Under the guidance of Tegnell, the country eschewed a broad lockdown approach. It meant that as the rest of Europe saw a summer reduction in Covid-19 cases, Sweden had its highest number of new cases recorded on June 24, 2020, when the number reached 1,698. The numbers subsequently dropped, albeit with an uptick in recent days.

As a result of his singular approach, Tegnell has become one of the best known and most controversial figures of the global coronavirus crisis. His approach to Covid-19 – to keep schools, restaurants, fitness centres, and borders open – has placed Sweden on a unique coronavirus trajectory. A majority of Swedes have largely supported his approach. As a result, there are stories (and photographic evidence) of his bespectacled face tattooed on citizens’ bodies.

But there have also been calls for him to resign after thousands of older people in nursing homes died. Sweden recorded the fifth highest death rate from coronavirus per capita in Europe – about 10 times higher than neighbours Norway and Finland. Globally his stubbornness has been criticised, with The New York Times calling Sweden a “pariah state” and “the world’s cautionary tale”.

In a recent interview with the Financial Times (FT), Tegnell argues against quick fixes and a short-term approach based on some future magic bullet solution. “We see a disease that we’re going to have to handle for a long time into the future and we need to build up systems for doing that,” he says.

He reckons other countries will be more vulnerable to spikes of infection, without the level of immunity he believes now exists in Sweden. But he rejects accusations the country has followed a herd immunity approach. Tegnell is not a fan of national lockdowns. Instead, his approach has been about having a strategy that can work for years if needs be, rather than the constant chopping and changing seen in the rest of Europe. “We don’t see it as viable to have this kind of drastic closing down, opening and closing. You can’t open and close schools. That is going to be a disaster.

And you probably can’t open and close restaurants and stuff like that either too many times. Once or twice, yes, but then people will get very tired and businesses will probably suffer more than if you close them down completely,” he says.

He takes a broad view of public health. As a result, children’s sports carried on, as did drinking and eating out with friends, and shopping. Life did not carry on entirely as normal. Universities and schools for children over 16 switched to online learning, gatherings of more than 50 were banned, and people were asked to work from home. Those over-70 were asked to self-isolate.

Tegnell does not see the future availability of a coronavirus vaccine as a silver bullet. “I’m not very fond of easy solutions to complex problems and to believe that once the vaccine is here we can go back and live as we always have done. I think that’s a dangerous message to send because it’s not going to be that easy,” he tells the FT.

Sweden’s constitution means the governance of public health is different to that in Ireland and most other countries. Politicians do not make the big decisions – Sweden’s public health agency does. Which probably means fans of the Republic’s CMO are unlikely to sport adulatory tattoos anytime soon.