Emma Ross
Welcome and welcome back to the Chatham House weekly COVID-19 webinar with Chatham House Distinguished Fellow David Heymann. Today we have a very special guest with us, Professor Johan Giesecke, who is not only advising the Swedish Government on their response, and among a group of high-level Advisors to WHO, but he is also a globally-respected Elder Statesman Epidemiologist, kind of like David, actually. Just some housekeeping, briefly at first. This briefing is on the record. So please tweet away, using the #CHEvents. Questions can be submitted, throughout the session, using the Q&A function on Zoom. Please do upvote questions you like the look of or are similar to one that you want to ask, ‘cause the popular ones tend to get prioritised.
So, it’s a great pleasure to have you both on the webinar this week. I know you know each other extremely well, so I’m hoping you’ll feel free to spar off each other a bit as we go through. Why don’t we start with Johan? I was hoping you could just do a little brief introduction on how you would characterise the approach that Sweden is taking, why it was chosen, and what’s been your experience with it?
Professor Johan Giesecke, MD, PhD
I would characterise it as a voluntarily – voluntary, rather soft lockdown because there are many things that have changed in people’s behaviour in Sweden, but it’s not so much from laws or ordinance, but rather from explaining to people why they should do this and why they shouldn’t do that, and most people are following. I find that people are not stupid. If you tell them what’s good for them and what’s good for their fellows, they understand and they usually do as you ask them to do.
Emma Ross
But why do you think it’s been so controversial, internally as well as externally, it looks like?
Professor Johan Giesecke, MD, PhD
Mainly for political reasons because I think most of the lockdowns installed or setup in Europe are because of politic – Politicians need to show strength, decisiveness, action, and they jump on when they have an occasion. Sweden decided early that we should only introduce restrictions that had some kind of scientific basis, and as far as I know, there’s only two of them. One is, we should wash your hands, our hands and we’ve known that for 176 years, and the other’s keep your social distance. The other restrictions that countries have setup are – have very little scientific background. Closing a border, uh-uh, doesn’t do very much. Closing schools, there has been some studies on that, but the jury is still out on that one. Well, that’s a few examples.
Emma Ross
So are you saying that there’s really no evidence-base for these lockdowns?
Professor Johan Giesecke, MD, PhD
That’s what I’m saying.
Emma Ross
Do you think they were a bad idea, or necessary, given different contexts and different countries, do you see that in any country it might have been a good idea or do you think that there’s never any reason for them?
Professor Johan Giesecke, MD, PhD
I think some things, some actions, some behaviour in society should be addressed by some kind of lockdown. But the way it’s been taking on in most European countries is far too much. I think a voluntary one, like we’ve had in Sweden, would work in most countries. People are not stupid in those countries either.
Emma Ross
Why do you think you’re such a loner in this and why do you think more countries didn’t follow the route you did?
Professor Johan Giesecke, MD, PhD
Because Politicians want to show action, decisiveness and do something. I think my main favourite useless intervention is spraying the sidewalks in Asia with chloride. That doesn’t help anyone. It’s an environmental problem, but not a contagious disease problem. But that shows that the authorities are doing something.
Emma Ross
And do the Politicians in Sweden not want to look like they’re taking action? Are they different to Politicians everywhere else?
Professor Johan Giesecke, MD, PhD
I think they’ve listened a bit more to public health people than in many. I know two of our neighbours at the Public Health Institutes said – what’s the word for it? Didn’t want the Politicians to install a lockdown, but they were overruled by the governments in these two countries.
Emma Ross
Okay. Well, in the UK, for instance, the government has always said we are being guided by the science, and you have previously said that you thought that the UK was going in the right direction…
Professor Johan Giesecke, MD, PhD
You were.
Emma Ross
…earlier.
Professor Johan Giesecke, MD, PhD
It’s too late, and that…
Emma Ross
But what happened?
Professor Johan Giesecke, MD, PhD
The paper from Imperial College happened, which, as far as I know, isn’t even published yet. It’s never peer reviewed, as far as I know. But that should be interesting to write a book about: how a not very scientific paper changed the policy in entire country.
Emma Ross
So, are you saying that perhaps the prediction that the Health Service would be overwhelmed may not have been correct and maybe we could have got away without a lockdown, without being overwhelmed in our Health Service? Or…
Professor Johan Giesecke, MD, PhD
I think…
Emma Ross
…that we should have done something else?
Professor Johan Giesecke, MD, PhD
No, you’re touching something there, I think, and that’s true for Sweden also, the spread of disease was slowed down a little by the mild lockdown that we had, and it was slowed down in other countries. So, it has helped to keep healthcare capacity enough. But as far as I know, you have an empty hospital standing somewhere in England, for COVID patients, and Sweden is certainly – we have had empty ICU beds all along and still have, and case numbers are going down now.
Emma Ross
Okay. Could I just move to David just for a bit before I come back to you, Johan? David, I wanted to ask why you think there’s so much interest in the approach that Sweden’s taking, and what strikes you as most noteworthy about what they’re doing? Does anything impress you, concern you?
Professor David Heymann CBE
Well, I think the most noteworthy accomplishment in Sweden, and in other countries, hopefully, is that people understand how to protect themselves and how to protect others. That’s the most important base that any country can have, whether they locked down or haven’t locked down, and as they begin to lockdown. The other problem, in many countries is, that the lockdown occurred without any thinking about an exit strategy. And so right now countries are trying to decide, and Johan, you may want to say something about this, but countries are trying to decide how to lockdown and what, really, should they be watching to see when they might want to decide to lockdown again? So all of these things are occurring, but Sweden has put people at the base of this and I think that’s most important for a lasting and sustainable intervention.
Professor Johan Giesecke, MD, PhD
I think David, what you just said about – I don’t know any single country in Europe that had any idea how they would get out of the lockdown. The exit strategy was never discussed. So, I was saying to myself, on country-after-country did it, or took up different restrictions, how are they going to get out of there? Have they even thought about that? But I don’t think anyone did, when the lockdowns started. So I agree with you.
Emma Ross
So…
Professor David Heymann CBE
Lock – Emma, lockdowns in Europe were done to flatten the curve. Clearly, as Johan said earlier, to flatten the curve at the hospitals, to make sure that hospitals weren’t overwhelmed, after the lesson that occurred in Italy, where hospitals were overwhelmed. Asia never went to that strategy. They kept a strategy of trying to keep the reproductive number less than one. And I think that’s entirely different than what Sweden has done, which is try to control an increase in the number of people infected, in order that they can let this virus enter as it will, but in a more controlled environment. I don’t know if that’s right, Johan, or not, but that’s my understanding, yeah.
Professor Johan Giesecke, MD, PhD
I agree.
Emma Ross
So, just to – the Swedish approach has been labelled a ‘huge experiment’. But what I want to get is a bit of a historical perspective on so-called lockdowns, to look at how we got here. I mean, where did the idea of lockdowns come from? It doesn’t seem to – didn’t come from WHO recommended measures. Is it basically an extension of age-old quarantine approach or is this an entirely new beast? I mean, have we ever seen this before, in response to an epidemic?
Professor Johan Giesecke, MD, PhD
There was some attempt in the US in the Spanish flu, weren’t there? There were some cities that managed to keep infection out, for the first round, but then it came back in the second wave. But there are some examples.
Professor David Heymann CBE
And I think the world was influenced by what China did early on as well. China really did lockdown, and they stopped international travel and by doing that, I think nobody would say that they didn’t slow down the international spread. They did slow down international spread and other countries saw this, had an opportunity to prepare. Some did, some didn’t. But, then when it came to deciding what to do, many followed that same example of China, because China had reported success with that intervention, which appears to have been successful, in some way, in keeping the reproductive number down. But now what do you do after you begin to exit from that, keeping the number down?
Emma Ross
So this is really for both of you. Now that people are – some countries are emerging from lockdown, do you think that it is going to be viable for them to kind of shift over to the Swedish approach? Or is that something that you would have had to have pursued right from the beginning, and they’re going to have to do something different now? Is it viable to say, “Okay, well, you know, no more lockdown. We’ll go to what Sweden’s doing?”
Professor David Heymann CBE
Johan.
Professor Johan Giesecke, MD, PhD
No, I think you can still get out of a lockdown, but you must do it very gradually and over time, unless you want to have a big wave of cases. If you stopped everything in the UK tomorrow, all restrictions were gone, you’d have a huge wave of cases coming. So you have to do it slowly, and in steps.
Emma Ross
So in steps would be towards the Swedish way, because you’re not doing nothing. You still have restrictions and measures.
Professor Johan Giesecke, MD, PhD
We have measures. You can’t be more than 50 people in a crowd. Restaurants are open, but they have to have five feet between the tables and you have to eat at the table. You can’t stand up and have your beer, you must sit down and have your beer. That is quite a lot of things that…
Emma Ross
Well…
Professor David Heymann CBE
Yes, and I would…
Emma Ross
Go ahead David.
Professor David Heymann CBE
Yeah. I would expect also that lockdown will not just be – and exiting will not just be all at once. There may be certain regions in England or in Germany or other parts of the world, where they feel they can unlock earlier because transmission has been low. But there’s a handicap, and that is not understanding who’s been infected in the past because of this problem with the antibody testing, that isn’t sensitive enough to pick up previous infections and is being studied right now, in most countries, trying to be validated. So, there are – there – unlocking is not just the government says, “We’re all unlocking, tomorrow, they unlock. And I think they will follow the Swedish model of no mass gatherings, social distancing in places like restaurants, physically distancing, a whole series of things, but it won’t be just, “Today we’re unlocking.” It’ll be, hopefully, a gradual unlocking, like Sweden has done and has maintained. And it’s interesting because in Asia, some countries that have been trying to not lockdown have begun to lockdown certain places, in order to keep this reproductive number below one and in so doing, they will have a population that’s susceptible and then they’ll be in the same situation, what do we do when we exit?
Emma Ross
Yeah, so that on not lockdown to lockdown. Johan, I wanted to ask you, honestly, how good is compliance? I mean, might Sweden impose lockdown in the near or mid future, or slightly tougher restrictions, ‘cause I read this week that you’ve had to threaten to close down some restaurants in Stockholm…
Professor Johan Giesecke, MD, PhD
Yes.
Emma Ross
…which is being characterised by critics as the beginning of a U-turn. Is it a U-turn?
Professor Johan Giesecke, MD, PhD
No. I mean, five restaurants were closed down, but they will open again when they toe the line. I think this is a psychological thing by the authorities, to some extent. Don’t – we’re saying now that we can see the light at the end of the tunnel and then people sort of drop everything and say it’s back to normal. And the Prime Minister spoke on TV yesterday and he was very clear that all the restrictions we have, we keep. We’re not changing policy now that things – when things seem to go the right way.
Emma Ross
So, how much of the core classic outbreak control measures of the finding every suspected case, testing them, isolating and treating them if they’re sick, contact tracing, quarantine, is Sweden doing as part of its approach?
Professor Johan Giesecke, MD, PhD
It was initially, when the cases came back from the Alps, during the spring break in the schools. But then, after one week, two weeks, the cases were too many. There were too few people doing contact tracing and the community spread was evident. But we will have to do it once more, and then that’s when we climb down and we’re getting closer to the finish of this outbreak, then we’ll do it again, for the fin – last cases. Contact tracing, isolation and so on.
Emma Ross
Well, and this is for both of you. WHO keeps saying that for every country, finding every case, testing, you know, isolating, contact tracing and, you know, chasing down every contact, that that has to be done to get on top of this and yet, so many countries are struggling with it. Are – if they’re not doing it, are they doomed or how – is it an ideal? Would be lovely to have or is it really a must and what do we do with that difference between what WHO’s insisting must be done, and what is actually happening, and what does that mean for our hope?
Professor David Heymann CBE
Emma, maybe I’ll step in and just say that good outbreak control requires identification of cases, contact tracing and isolation of those contacts who are, or become, infected. That’s the standard procedure done in all outbreak containment activities, and what’s interesting in this outbreak of this disease is that it can be done, as people begin to stepdown. Germany continued to do it all along. Other countries like Sweden and probably, likely, the UK and other countries will begin to put that in place, when it’s possible to do that again, and that will remain a basis of outbreak control, identification of cases, contact tracing. But WHO doesn’t say that it has to be done at all times. What’s interesting is, I was going to say, though, is that it’s not like influenza. Influenza, you cannot get influenza into a position where you can then contain outbreaks, because it spreads in a different manner. Johan may disagree or he may agree with that, but that’s my view, that this is an unusual disease, in that when countries begin to stepdown, they can reinstitute again these procedures of contact tracing and isolation of patients and contacts. Johan.
Professor Johan Giesecke, MD, PhD
Oh, I agree, and I agree that WHO isn’t saying that you should be contact tracing all the time. I agree with that and I think it’s just like you said, it has to be modified to the situation and the country, and maybe parts of the country, which is legally problematic, I learnt, because to make laws that only apply in one county is not easy, from a legal point of view.
Emma Ross
Okay. This is a question for you, Johan, about Sweden having taken quite a bit of flak…
Professor Johan Giesecke, MD, PhD
Yeah.
Emma Ross
…on its approach. How tough has that been to deal with and has there even been a smidgen of a wobble, in terms of your confidence in the approach?
Professor Johan Giesecke, MD, PhD
There have been instances when that’s happened, and the guy who’s taken most the flak is Anders Tegnell, the present State Epidemiologist. But it’s fascinating, Emma, I’ve been answering questions from foreign Journalists for four weeks now. I’m working now for the Public Health Agency. They’ve dusted me off and brought me back in. Is, for the first two weeks, that’s until ten days ago, all the calls were, “What are you doing in Sweden? “You’re crazy.” “Die dummen Schweden.” “You’re killing your old people just to get herd immunity.” But the last ten days, the questions from Journalists and media have changed completely from one day to the next. Now they are genuinely interested in what we’re doing and how it’s working, and I can almost say which day it turned. It’s no more this flak that you called it. It’s much more serious interest.
Emma Ross
Hmmm hmm, and do you think there’s anything special about Sweden that meant that it was able to take this approach when other countries weren’t? I mean, things like – is there something different about Swedish people, compared to other people, or the density of your population or you’re, you know, better prepared? What is the contextual uniqueness that – why we’re seeing you do this?
Professor Johan Giesecke, MD, PhD
I think this would have worked in most countries. I agree that probably the trust between authorities and the population are – the trust is a bit bigger in Sweden than in many other countries. But even in other countries, people are not stupid. They understand what’s good for them, and what’s good for their fellows. One more thing, sorry, we’re Epidemiologists. We only talk about big numbers and if not 100% follow the rules or the restrictions, that doesn’t matter, as long as 99 – 90% are doing it.
Professor David Heymann CBE
And Emma, I’d just add that I think countries understand, everybody, including Sweden, that the most important – one of the most important things to do is to protect the elderly in nursing homes and care homes, and to make sure that government pays attention to that and innovates. Because that’s an area where government can have a great impact, if they’re helping these nursing facilities understand, and providing them with the tools that they can use to prevent the virus from entering into those homes and I think that’s what’s most important. Others have to learn on their own, but the people who are captive in homes such as the nursing homes, must be – their protection must be facilitated by the people working with them and by governments stepping in and helping those people protect the best.
Emma Ross
So that’s interesting you say that, because that’s been from the beginning, “Let’s protect the vulnerable and the elderly.” But that doesn’t seem to have been going very well…
Professor Johan Giesecke, MD, PhD
No.
Emma Ross
…in several countries. What are your thoughts on that, Johan?
Professor Johan Giesecke, MD, PhD
We’ve all failed, I think. We’ve all failed, and nursing homes, care homes are a problem, I think, in every country in Europe, have outbreaks, and problems. I talked to an Irish Journalist the other day who told me there were 200 outbreaks in care homes in Ireland. Belgium has had a big problem. Many countries. So I think that is extremely – I agree with David, it should be done. But I think it’s much more difficult than we thought from the beginning. It only takes one little slip by one person to have it spread in the care home [pause].
Professor David Heymann CBE
Emma, you’re on mute.
Professor Johan Giesecke, MD, PhD
You’re on mute. I can’t hear.
Emma Ross
Sorry. Yes. Any other final thoughts before we move on to the questions, from either of you? This has been really fascinating discussion.
Professor David Heymann CBE
Yeah, Emma, I would just say that I think we need to really learn from what Sweden has done, all countries, and they are learning, and I know WHO is learning as well. This has been a ship that’s been built as it’s sailing and every country has developed a modification of a basic outbreak containment strategy, some going further than others. But everything is important, as we move on and learn from what was successful and what isn’t successful, and it’s important to remember, we don’t really know the destiny of this virus even now, as to what will happen in the future with this virus.
Professor Johan Giesecke, MD, PhD
I would say that we should concentrate even more on the healthcare a bit, for the people who are infected. That, it would be the real thing, the difficult thing. Maybe new drugs, maybe a vaccine, but that will take some time. But it’s very difficult to prevent people from becoming infected. So you should concentrate on optimal care for those who are sick.
Emma Ross
Okay. So, one last little thing before we go onto the questions. If we weren’t here, I’m not here, the audience is not here, it’s just you two talking about this pandemic, what would you be saying to each other?
Professor David Heymann CBE
Well, we’ve been talking quite a bit, as you can imagine.
Emma Ross
Enlighten us.
Professor David Heymann CBE
But we’ve worked together for many years. In fact, Johan, when he had a sabbatical leave back in the late 1990s, was at WHO helping develop the framework that we now call the International Health Regulation decision tree on what might be a public health event of international concern. So there’s no-one better qualified, really, than Johan to be advising a government on what’s been done. So, my admiration is for Johan and my friendship goes back many years and I listen to what Johan says.
Professor Johan Giesecke, MD, PhD
Thank you very much. I want – what I really fear in the long run from all this are the political ramifications. That’s what scares me. When one country in Europe now has a Dictator for lifetime and you see these Black forces creeping out of the ground in many countries. That will be the remaining legacy of this outbreak, and it scares me.
Emma Ross
Hmmm, okay, on that note, thank you. Sombre ending. Well, beginning of the ques – Q&A. So, I’ll go on to the most upvoted question at the moment. Comes from Gill Bates – oh, sorry, Bates Gill. Oh, apologies if I got that the wrong way round. “How to explain the relatively low mortality per capita in other Scandinavian countries such as Denmark, Finland, Norway, as compared to Sweden?”
Professor Johan Giesecke, MD, PhD
One thing, I think, we shouldn’t count the dead now because things will happen, and the lockdown has more effect in some countries than in others. We should wait a year, and then look back and see how many deaths did we have in each member state? I think the difference will not be that great.
Emma Ross
Okay. Here is one on herd immunity from Dina Mufti, “Please explain herd immunity in layman’s terms. How does it protect the elderly and the vulnerable? Does herd immunity take place, if people get reinfected with COVID-19?”
Professor Johan Giesecke, MD, PhD
David?
Professor David Heymann CBE
Okay. Maybe I’ll start, then. Thanks, Johan, yeah. Herd immunity is – first of all, depends on the ability of the antibody, or the immune system, in people who have been infected to prevent re-infection. And so if people have developed solid – what we call solid immunity to this virus, then as the antibody is accrued in the population from infections, eventually, there will be a population that’s immune, in the majority of people, and can’t continue to transmit this virus and others who haven’t had infection, will be protected. Herd immunity is – must be very high, though, in protection. In diseases like measles or polio, I mean, it has to be up above, way above 90% of the people immune, in order to stop transmission of the virus. So, we don’t know exactly what it will be with this virus, but it has to be very high. And I think experience in Norway or in Sweden, rather, will eventually show us what herd immunity might be, sooner than happens in other countries, provided the immunity that’s being developed is that solid immunity that protects infection. Johan, supplement.
Professor Johan Giesecke, MD, PhD
The term comes from the veterinary field. It wasn’t applied to people originally, because we’re talking about herds of cows or something. Yeah, so that’s the strange reason for this word, but David is describing it very well, and the disease wants to infect people around itself, and it’s looking around for cases to infect. But at one point, it only finds already immune people around, and then the disease dies out.
Emma Ross
Okay. I want to pick up on what that means for Sweden. In some of your previous interviews, you were talking about Sweden – Stockholm will reach herd immunity by X date, or whatever. But with the evidence emerging that the antibody response might be weak for some, or that antibodies might not confer immunity, or if so, who knows for how long, how does that affect what you now expect, in terms of herd immunity, and the Swedish strategy in general?
Professor Johan Giesecke, MD, PhD
We know now from several different angles that the immunity in Stockholm County, not Sweden, but Stockholm County, which has two and a half million inhabitants that about half a million of the people there have been infected already. So that’s about 25% or so. We know that and it’s growing exponentially, because, you know, in all of Europe, transmission of this virus is almost at a peak right now. We don’t see that, but it’s happening around us all the time. It’s been slower in the countries with the working lockdown, a bit quicker otherwise. But we believe we’ll reach herd – if herd immunity is 60% of the population being immune, we think we’ll reach that point by the end of May, in Stockholm, still. Stockholm County. The rest of the country is behind a bit.
Emma Ross
Okay, there’s a follow-up question, upvoted, from Hans Fuchs on this topic, which is, “Is Sweden pursuing a herd immunity policy, or I is – or are you just saying that a policy of voluntary lockdown compliance works better in the long run than a mandatory one?”
Professor Johan Giesecke, MD, PhD
You can’t have a mandatory lockdown forever and mot in a democratic country. They can do it in China, but in a Western democratic, you can’t have lockdown more than – how long could you be locked down for? Three months? Six months? So everyone has to release the lockdown, or lock up the lockdown. It has to be done everywhere. There’s no way it can work in Europe.
Professor David Heymann CBE
And I might add to that that it’s also going to be important that lockdown doesn’t just sequester one population, such as the elderly, because they have to be also mixing inter – you know, within the community and they must do their own shopping and other things as well. So, the unlocking, or the transition period, can’t just sequester one population and say, “We’ll keep them isolated and the rest of the people can go on with life.” There has to be an equal approach to this for all population age groups.
Emma Ross
Okay. Here’s a frequently upvoted question from Robert Martin. “86% of the fatalities in Sweden due to the disease affected people over 70. Why do countries get it so wrong when it comes to the elderly population?”
Professor Johan Giesecke, MD, PhD
Well, like I said, it’s mostly from care homes, from nursing homes and about 50% of all deaths are in old people from nursing homes. So, I don’t think you can prevent that, actually. It spreads, it’s too contagious, this disease.
Emma Ross
Okay. Here’s one from John Gillani, “It seems the weakest link in the chain seems to be the health services. What capacity” – hold on, where has it gone? It’s moved around, sorry. “What capacity is being used in Sweden, and are the health professionals being overwhelmed and catching COVID-19 or are they managing?”
Professor Johan Giesecke, MD, PhD
So far, they’re managing and that was one of the problems with the Imperial paper. It didn’t adjust for the ability to build more ICU beds. In Sweden, they trebled in two weeks. Ordinary wards were turned into ICU wards. So it wasn’t that difficult to increase the capacity quite substantially in a short time. It’s never gone beyond 90% of the ICU beds, ‘cause we always had 10% of the beds empty, and now it’s more than that.
Emma Ross
So do you think ICU bed capacity is the lynchpin between having to go into lockdown and not having to? That an alternative approach could have been, well, let’s ramp up bed capacity rather than lockdown or is that oversimplifying things?
Professor Johan Giesecke, MD, PhD
That’s – it’s probably oversimplifying a bit. But it’s not bad as a suggestion.
Emma Ross
David, what do you think?
Professor David Heymann CBE
Yeah, I would agree with that as well. And, you know, what’s even more sad is that countries had the opportunity to prepare when China had locked down. And many countries didn’t create excess beds that they might have needed until after they began to lockdown and so everybody was caught off guard on this, for various reasons. But getting that reserve surge capacity has always been at the heart of influenza planning, and of planning for many other outbreaks. And so, countries that didn’t have that surge capacity were caught unawares, and the next time, hopefully, they will have that capacity available. And they have developed it now in many countries, and that will be useful, if there is an increase in patients requiring hospitalisation, as the exit strategies and as the lockdown begins to occur.
Professor Johan Giesecke, MD, PhD
You’re right, and preparedness has been bad in almost all countries. Finland is the only country that really has PPE enough for an outbreak such as this and everyone else is scouting around the world to buy masks and gowns and stuff, and I can’t think of any country that was well-prepared, when it comes to materials and stuff.
Professor David Heymann CBE
In Europe, but in Asia, Johan, as we know, Singapore and Hong Kong and other countries, yeah.
Professor Johan Giesecke, MD, PhD
No, no, yeah. Sorry, I was just talking about Europe.
Professor David Heymann CBE
Right, the countries that had – countries that had SARS and MERS corona outbreaks in the past learned.
Professor Johan Giesecke, MD, PhD
Yes.
Professor David Heymann CBE
And they really did ramp up their surge capacity.
Professor Johan Giesecke, MD, PhD
It’s fascinating. I learnt yesterday, do you know how much this blue surgical mask used to cost and what it costs now on the open market? It used to be three pence and now it’s £2.00. Fascinating.
Professor David Heymann CBE
Fascinating.
Emma Ross
That – I just want to pick up on that pandemic preparedness question. It does make me wonder, was preparedness being done incorrectly? Were they chasing the wrong disease X? Did they do it correctly, but they decided not to follow it? What does this outbreak show us about pandemic preparedness, particularly in Europe? David said that – and you’ve both agreed that in Asia they seem better prepared. What does this tell us about what we have to do with preparedness for next time? We were preparing. There were exercises, there were plans. What happened?
Professor Johan Giesecke, MD, PhD
Good question. When it comes to material, PPE and stuff, I don’t think countries were very well-prepared and we saw exportation limitations from some countries who would not export PPE to other countries within the Union, which is interesting. But on the other, more structural side, I’m not sure that we were that bad prepared.
Emma Ross
Well, the surge capacity, what about that? That didn’t ramp up.
Professor Johan Giesecke, MD, PhD
No, but you can’t have what would have been, in the UK, couple of thousand ICU beds standing empty all the time, just to be prepared for the next outbreak.
Emma Ross
But you can have a plan that says the minute we move in that mode, we get on it now, not a month later.
Professor David Heymann CBE
And they did, Emma. They did.
Emma Ross
They did? Okay.
Professor David Heymann CBE
They took the ExCeL Centre in London and other places and they rapidly ramped up the capacity. They didn’t do it before the outbreak began, as most countries didn’t. But as soon as they really realised what was going on, that was a ra – and that was part of the contingency planning, I think in all countries, that they would be able to ramp up and they had ideas of where they would ramp up. So, I think, in fairness to European countries, they did have these plans, but they were just caught really unawares. They weren’t – it costs money to ramp these things up, and it just wasn’t, you know, something that countries wanted – that took lightly. It costs a lot of money to do that.
On the other hand, what’s happening in all countries that did lockdown, and I’m not sure what’s happening in Sweden on this, but it is that people who have routine healthcare needs are not being seen as much as they should be seen and as a result, there’s increased mortality in this group of people as well. And there’s also this widening of the inequalities gap, which is also very important in health in the future, and I’m just wondering if Johan has any view of what happened in Sweden, on people who don’t have COVID, but who needed routine healthcare. Are they able to get it and have they been able to get it?
Professor Johan Giesecke, MD, PhD
Well, I mean, that’s a balance in a lockdown situation. But, I mean, all surgery that is not urgent has been shutdown. People are not getting – they have to wait in line, and we haven’t seen more deaths from other causes, but there’s clearly an under-serving of – for other diseases right now. They have to wait longer, and they’re probably more sick when they get into hospital, also. That’s something that’s been observed. That people with heart problems come in far too late now, compared to just two months ago.
Emma Ross
Yeah. Okay, there’s a question here from Hannah Devlin at The Guardian and this, she says, is a question for David. “Do you think some of the regions of the UK already meet, or are close to meeting, the government’s criteria for lifting the lockdown? If so, do you think preparations should be made now, for an easing of restrictions in areas where transmission is very low?”
Professor David Heymann CBE
You know, I don’t know what the government is planning, but I think that that would make good sense, to prepare for a phased-in unlocking, which goes to areas where there’s less risk. That’s just common epidemiological sense. You don’t do everything at once. You do an analysis and, as I said, the analysis is inhibited by the lack of understanding of what the antibody testing really is showing. But you do an unlocking, based on where transmission is less, hoping that it’ll stay lower in that area, as you begin to prepare in other areas. So I would think that in the thinking that’s going on in the UK, as it is in other countries, it’s not about just unlocking everything at once, but going where they feel the risk is less. Whether it’s a sector entirely within the UK, or whether it’s a geographic region, and I think Johan might have some ideas to add to that as well.
Professor Johan Giesecke, MD, PhD
Yes, you’re right. It could be geographically different. But also, I think, in a lockup you need to take one action at a time, and you start with, say, let’s just take an example, opening the schools again. And then you follow what happens for – with spread you have to have good testing and frequent testing. Will that affect the spread? Yes or no? If it does, then you close the schools again. If it doesn’t, you keep them open and then you go on to the next restriction, which may be open restaurants, I don’t know, and you check for two or three weeks what happens then. So I think the lockup will have to be a long process. Months, until you – so it’s partly like David said, a question of geography, but also, a question of which order you would remove the restrictions you’ve put up.
Professor David Heymann CBE
And I think, just to add to that, what Asia has done is really the opposite of what Europe is doing because Asia is now understanding sectors in their populations that are at greatest risk, and they’re beginning to close down certain sectors. For example, in Hong Kong, students began to come back from Mainland China, and some of them were infected. Hong Kong decided that they needed to shutdown their amusement areas, where people go for nightlife, and different parts for a couple of weeks, to make sure that that isn’t an area where transmission occurs, as it did occur in the past. And recently, Singapore has also locked down their school sector, whereas, before the sector was open, because they felt that now, there is a risk in that sector that transmission will increase. So, Europe and Asia really at opposite ends of the spectrum. One is beginning to lockdown, and others are beginning to unlock, and I think both are able to learn from each other how to go about this.
Emma Ross
Okay. Here’s a question from Ben Wakefield, a partial question, ‘cause we’ve already covered the other part of the question. “There are some who would say that the Swedish Government have prioritised the economy over lives, and that harsher measures could have protected the population better. What are your comments on that?” And I’m going to team it with another question. Sorry about – you thought you were done with the flak, but not done. “Is it the case that Sweden over-benefited from all the lockdowns around and that it perhaps behaved selfishly, in not following what other countries did?” And that’s from Simon Quijano-Evans. So if we put those two together, again, it’s about the wisdom of the Swedish approach.
Professor Johan Giesecke, MD, PhD
Well, each country, and I’m still talking about Europe, has its own epidemic now. It doesn’t – contact with other countries are of no concern, because each one has its internal moving epidemic right now. So closing borders is a bad idea. But to answer the last question, that means that there haven’t been many people from other county coming to Sweden, or the other way round. So I think the Swedish epidemic is quite insensitive to what others are doing around us. And what was the first question again?
Emma Ross
Oh, that playing off the economy versus lives.
Professor Johan Giesecke, MD, PhD
No, I mean, an economy…
Emma Ross
And harsher measures would have protected more lives.
Professor Johan Giesecke, MD, PhD
We shouldn’t exaggerate the effect of the partial lockdown that Sweden has. I mean, the economy is hurting, and hurting badly. I mean, SAS, the main air company for the Nordic countries, it is laying off 90% of its staff. So there are big – and small businesses are going out the – going out of business all the time now. But probably a bit less in other countries – than in other countries. But the economy was never really brought into the equation, yeah.
Emma Ross
Well, this is for both of you. Do you – there is – this comes up quite a lot, that the lockdowns and the measures are a balance, a trade-off, between economy and lives. Do you really think that’s what’s going on? Is there truth to that or is that, again, an oversimplification? Is that a fair comment, that it’s a trade-off and they are not mutually exclusive, but, you know, in what way are they related, and how fair is that? To pit them against each other, in opposition?
Professor Johan Giesecke, MD, PhD
Well, in general, it could always be a problem. If you talk about Sweden, it’s never entered the discussion. All – many businesses are complaining. But like in any country, government is showing – or showing – millions, billions of Swedish crowns into the private sector, to help small businesses who have big – big businesses who have – but it hasn’t really been part of the discussion, if this was an important part of the strategy.
Professor David Heymann CBE
And I think it’s the same in all other countries. Human life is what is at the centre of this and that’s been the most important consideration for all countries, is how to protect the maximum number of lives, when this outbreak occurs, and there are different approaches to that. As transition out of lockdown becomes more important, then there will have to be a decision if countries are trying to decide whether or not they want to lockdown again, or not. They’ll have to weigh this very difficult situation of what has happened from the lessons they learned in locking down the economy to begin with. And it’s a discussion that Politicians will have to have, but certainly, the medical community will always stick to its priority of saving lives. And that has to be the way that the medical community moves forward, because the medical community has taken an oath to do that and very few Doctors are willing to put life into an equation that looks at the economy at the same time.
Professor Johan Giesecke, MD, PhD
And also…
Emma Ross
Okay. So, we’ve got about a minute left, so I wanted just, before we wrap up, for each of you to kind of give your parting thoughts on this. Who wants to go first?
Professor David Heymann CBE
I’ll go first. I’ll just say that, you know, as we face this outbreak and as we move ahead, it’s not really useful to try to destroy a government and what they’re doing. It’s more useful to find ways of working with that government, whatever the policy has been, and trying to move forward together, remembering that underneath all of this must be our own understanding of how to protect ourselves and protect others.
Emma Ross
Johan?
Professor Johan Giesecke, MD, PhD
We learned from this? My answer is no. 30 years from now, all this will have been completely forgotten, and a similar thing will happen again. I think human memory’s short ad the Asian countries learnt a lot from SARS, and they managed to do that. But I wonder, I think. We don’t – it’s costly to keep up plans and be prepared, and at some point, say, “Oh-ah, we don’t have to use that money anyway.” Many countries are diminishing their armies now because the Cold War is off and it didn’t take very long between the fall of the Soviet Union and countries in Europe to say, “Ah, we don’t need so many militaries.” I don’t think we will learn much from this, pessimistically.
Emma Ross
Okay, great. On another high. Thank you, Johan, for that. So, we’ve come to the end now. Thank you both so much for your time, and for everybody else, a full recording of this video will be on the Chatham House website, earlier than normal, because now we’re livestreaming, I think it doesn’t take long. For Journalists who may want to follow-up with David or Johan, if you email the Press Office, they’ll be able to set you up. So, please join us at…
