Two Antithetical Approaches to the COVID-19 Crisis: A Controversial Outlier Versus a Low-key Over-achiever

When a novel virus comes along, such as we are facing now, there is no medical vade mecum, no universal guidebook to follow, no one proven route to safely navigate the crisis. Governments weigh up the choices, then in consultation with medical experts, decide on a strategy and do modelling on how to chart the optimal course through the unpredictable straits of COVID-19. Local factors in each country, the conditions, the capacity to respond, the culture, all shape what direction the fight against the virus takes.

The following focuses on just two of the 212 countries and territories which have reported cases of the novel coronavirus disease. The two countries, Sweden and Vietnam, have very different societies, cultures and political systems. Each has followed its own distinct strategy and have produced results that are polarities apart from each other.

🇸🇪 Sweden One thing you can’t accuse the home of ABBA and Ingmar Bergman of is sheepishly following the flock. While countries like the US and the UK ‘sleepwalked’ for precious weeks at the start of the crisis, Sweden went out on a limb. From the get-go, Sweden identified itself as an outlier, a contrarian country in the coronavirus war. It adopted a particular course and implemented it. Or to put it another way, Sweden opted for a “change very little”,  “wait and see” position, which amounts in effect to the pursuit of a “herd (or community) immunity” approach. Put simply it means you intentionally expose as many people as possible in the community to infection and so (the theory goes) the majority become immune to the virus. It’s effectiveness hinges on (quickly) minimising the number of high-risk people overall. For it to work, there needs to be an infection rate of at least 60%. Critics of herd immunity, and there are many in both the medical and non-medical world, describe it, among other things, as a “let it rip” strategy✱.

Getting back to Sweden’s experience, the Social Democrat government under Stefan Lofven, and state epidemiologist Anders Tegnell, were at the outset confident of success with a “let it happen ASAP” approach. Sweden stopped organised sporting fixtures and closed university buildings but it eschewed a strategy of mandatory lockdowns (restaurants, bars, cafes and schools for pupils under 16 all stayed open) for a libertarian-like “principle of responsibility”, trusting the Swedish populace to “behave like adults” and do the right thing voluntarily.

The figures tell a different and disconcerting story: Sweden with a population of just 10.33 million has a reported Covid death toll of 3,225 (as at 10-May-2020) – with capital Stockholm overwhelmingly the primary hotspot. As illustrated below, compared to it’s Nordic neighbours Sweden’s mortality figures resonate like a distress beacon in the ocean, and in per capita terms it even outstrips the horrendous, spiralling toll of the US.

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The mortality rate for Sweden has prompted even the Swedish chief medical scientist Dr Tegnell to comment that it is now a “horrifying large number” [‘Sweden’s near “horrifying” death toll of 3,000 from coronavirus with 87 new fatalities, including a child under ten’, (Ross Ibbotson), Daily Mail (UK), 07-May-2020, www.dailymail.co.uk]. The body responsible, the Swedish Public Health Agency has come under mounting pressure (increasingly internal) for the current situation. A group of 22 scientific researchers from Swedish universities and institutes have called on the SPHA for a rethink of the strategy and a more cautious approach [‘Sweden: 22 Scientists Say Coronavirus Strategy Has Failed’, (David Nikel), Forbes, 14-Apr-2020, www.forbes.com].

A consequence of “granny-killer metrics”   A leading molecular virologist from Sweden’s Karolinska Insitutet has accused the government of taking unnecessary risks and sacrificing the elderly (half of the total deaths are from aged care homes), as well as placing the health of their carers and hospital workers in jeopardy [‘Sweden urged to reconsider controversial coronavirus advice as infections rise sharply’, (John Varga), Express, 07-May-2020, www.express.co.uk].

A Stockholm bar: elbow distancing only

Defending the hard to defend The Swedish authorities have tried to defend its strategy—citing dramatic drops in the use of public transport and a survey which the agencies conclude is evidence that people are practicing safe distancing from each other during the crisis (Ibbotson)—unfortunately the visual evidence from photos and videos within Sweden suggests otherwise with crowded restaurants, bars and parks still the norm and few people seeming to be social distancing. So far, the government for the most part is holding the line and appears to be committed to the long haul, although they have now given some ground, banning outdoor gatherings of more than 50 (Nikel)ㅁ.

There are some outside observers who still take a sanguine view of outlier Sweden’s methods of dealing with the crisis. Stanford School of Medicine (US) professor, Michael Levitt, has been critical of other countries with a different approach, the so-called “first mover” countries like Australia, Austria, New Zealand, Denmark, Czech Republic, Israel and Greece, who he says have paid too heavy a price for locking down their communities – resulting in severe damage to their economies, social upheaval, the loss of an academic year for students, and still having not attained herd immunity [‘Granny-killer metrics don’t add up in Australia’s costly coronavirus battle’, (Andrew Probyn), ABC News, 08-May-2020, www.abcnews.com.au]. No doubt the decision-makers in Sweden would find this external support comforting, and of course Sweden could turn around and say to the growing number of doubters that it’s approach is keeping people in jobs, keeping businesses from closing down, and the economy afloat … but at what a human cost! This is the Solomonic trade-off.

(Source: www.irishtimes.com)

Update since originally published: (information updated to 21-May-2020) SWEDEN has overtaken the UK, Italy and Belgium to record the highest coronavirus per capita death rate in the world. Sweden has recorded 6.08 deaths per million inhabitants, higher than the UK, USA and Italy (www.express.co.uk/).

☤~ ☤~☤

🇻🇳 Vietnam With international media attention on the COVID-19 dilemma focused largely on the US and the Eurocentric world, the efforts of Vietnam in the war against coronavirus has garnered little notice till recently. Many observers would be surprised to discover that the South-East Asian country has had zero recorded deaths from the virus, out of a total of 288 confirmed cases (10-May-2020). Surprising…for a few reasons. First, it seems a bona fide claim, unlike some of it’s S.E. Asian neighbours who claim also to have done well with little to substantiate it. As a general rule, S.E. Asian numbers, even more so African numbers, are often problematic as there has been an inadequate amount of testing carried out to gauge progress accurately✮.

(Photo: AP)

Second, Vietnam shares a (northern) border with China, the country of coronavirus origin, plus in normal times Vietnam is a busy destination with frequent international flights from nearby Taiwan, Hong Kong and China itself, leaving it, one would think, quite susceptible to to the importation of the infection. Third, Vietnam has an estimated 97 million people but for a medical emergency of this magnitude it lacks the allocatable resources and health infrastructure of the more economically dynamic Asian states. It simply can’t afford to engage in the level of mass testing that say South Korea has managed [‘Vietnam shows how you can contain COVID-19 with limited resources’, (Sean Fleming), World Economic Forum, 30-Mar-2020, www.weforum.org].

Why has Vietnam done so well in the war against the “invisible enemy”? Part of the explanation is that Vietnam has approached the crisis very much like a military campaign. In fact war rhetoric has been employed by the government, which constantly speaks of “fighting the enemy”.  The country’s response was early and proactive, border closures, rigorous mass quarantines of whole towns for weeks, were implemented up front, not just as a last resort like some places elsewhere [‘How Vietnam is winning its “war” on coronavirus’, (Rodion Ebbighausen), DW, 16-Apr-2020, www.dw.com]. The authorities conducted targeted testing and thorough contact-tracing procedures. To compensate for the country’s limited resources they created low-cost test kits for wide distribution (“70-minute rapid test kits”).

“Rice ATMs” initiative: Made available 24/7 to Vietnamese people during the time of pandemic   (Photo: www.vietnamnet.vn)

An ingrained culture of compliance  The key to what Vietnam has achieved is the central government’s ability to secure almost universal integration into the fight against the disease. Communist Vietnam’s authoritarian one-party state structure with a highly organised army and security apparatus makes this task more easily obtainable (whereas in a liberal society where plurality is the norm this would be nigh on impossible). The regime can much more easily mobilise the people to adhere to it’s rules and restrictions…there is a prevailing culture of compliance, and a range of effective mechanisms in the hands of Hanoi to attain that compliance. The government-controlled media and the high numbers of Vietnamese people exposed  to social media have facilitated this. Apps have been a standard part of the public information campaign to get the government message out –  and the degree of transparency about COVID-19 and the government’s plan to counter-attack it, has raised public confidence and made it more receptive to what Hanoi is saying   [‘The Secret to Vietnam’s COVID-19 Response Success’, (Minh Vu & Bich T Tran), The Diplomat, 18-Apr-2020, www.thediplomat.com].

The government has called on a raft of idiosyncratically-Vietnamese cultural devices to creatively drive home it’s theme. ”Viral hand-washing” songs have been popularised among the people and most effectively, the regime have resorted to propaganda art, something with a long tradition in communist Vietnam. Calling on the familiar slogan, “In war, we draw” (again, invoking the war metaphor), the government has fostered a patriotic response in Vietnamese to get 100% behind the war on the virus (#TogetherWeWillWin), resulting in the production and dissemination of visually-powerful and meaningful posters like these two (above and below). COVID-19 has also prompted the release of special stamps to help unify the Vietnamese people [‘“In a war, we draw”: Vietnam’s artists joint fight against Covid-19’, (Chris Humphrey), The Guardian, 09-Apr-2020, www.theguardian.com; Fleming].

Coercion and collaboration Another side of Vietnam’s use of “soft power” to get everyone thinking as one can be seen at work in the coronavirus emergency. The socialist ethos in Vietnam operates on one level as a “surveillance state“…ordinary Vietnamese are conditioned, not just to obey rules, but to help the authoritarian regime’s realisation of it’s goals by spying on neighbours and reporting back to the authorities the activities of non-conformists or of anyone breaching the public health regulations (Humphrey).

Notwithstanding this further encroachment on civil liberties, the Vietnamese people as a whole, having accepted the seriousness of Hanoi’s fight against coronavirus, are on board, and appear genuinely proud of their country’s success in avoiding thus far any serious outbreak of the epidemic in a country with a healthcare system woefully ill-equipped to deal with harmful effects on it’s large population (Ebbighausen).

The Vietnamese achievement, having been successful so far in keeping a lid on the epidemic, might lead it’s citizens to feel or at least hope that they are out of the woods. But even if they are in the clearing now, there’s another forest looming largely in the shape of the economy, which of course is another matter entirely. Over 85% of Vietnam’s enterprises have been adversely effected by the crisis. Tourism, which Vietnam like so many is highly dependent on,  could be looking at a loss of $US3 to $US4 Bn in 2020, and so on down the line of the country’s businesses. At the moment business leaders in Vietnam are preoccupied with exploring new economic opportunity that may arise for the country post-crisis [‘Vietnam is set to lose billions due to coronavirus, and it’s already feeling the impact of the deadly outbreak’, (Kate Taylor), Business Insider Australia, 25-Feb-2020, www.businessinsider.com.au].

EndNote: Peering inside that can of worms The UK Johnson government initially toyed with the idea of going the herd immunity route, before being awakened to it’s senses by a vociferous chorus of British medical experts recounting the dire ramifications of such a gamble. After chief epidemiologist Prof Neil Ferguson did some remodelling, the UK government (belatedly) switched to a suppression approach. The Netherlands in March announced it would follow Sweden’s strategy but the Dutch prime minister then walked back the herd immunity line, opting instead for what has been described as “lockdown light” [‘Caught Between Herd Immunity And National Lockdown, The Netherlands Hard Hit Bt Covid-19 (Update)’, (Joshua Cohen), Forbes, 27-Mar-2020, www.forbes.com]

────── ✱  the medical critics would be quick to point out that, if herd immunity can’t be accomplished by vaccination (and there is no vaccine for coronavirus yet, not even on the horizon), then it is an extremely risky business to dabble in. It puts the old and vulnerable into the position of sacrificial pawns for the greater good; it can also expose a country’s health-care system to intolerable demands on its resources (not to neglect the heightened personal danger for nursing staff and medics); a third drawback with the approach is that mortality from coronavirus is a reality for the under 70s and under 60s as well ㅁ in an implicit admission of a failure of it’s voluntary compliance arrangements, Sweden announced recently that it would close bars and restaurants which flaunted the social distancing guidelines [‘Sweden is shutting down bars and restaurants where people defied social distancing guidelines’, (Kelly McLaughlin), Business Insider, 28-Apr-2020, www.businessinsider.com] ✮ like Myanmar for instance which admits to only six deaths from the virus. A population of 55 million, according to a World Bank estimate it has only 249 ventilators in the whole country. The Myanmar regime’s lack of transparency, the sheer logistics of trying to safely social distances and the attribution of it’s very low fatality level to the country’s diet and lifestyle, cast more than reasonable doubts on the true extent of the epidemic in the republic [‘Zara’s Billionaire Owner Was Praised For Helping in the Coronavirus Crisis. Workers In Myanmar Paid the Price’, (Nishita Jha), BuzzFeed News, 07-May-2020, www.buzzfeed.com]