Devi Sridhar: Yes, there are lockdown lessons from Sweden

"The real lesson from the pandemic should be that where you were in terms of public health as a nation going into the pandemic shaped how you came out of it," said Sridhar. 

"This is why I find the Swedish argument fascinating - this idea that 'we could have been like Sweden'. Our population doesn't look like Sweden. 

"We're much more unequal, we're much more unhealthier, we've got different demographics.

"That should have been the lesson: why are they [Sweden] not as unhealthy as us? Why are their levels of diabetes lower, why is there less inequality? 

"Theirs is a social welfare approach to public health. Same with Denmark, Norway, South Korea, Japan. 

"So yes, it's important to look at countries' different approaches, but with the same wave of cases Scotland would never have looked like Denmark or Sweden, because even with the same rate of infections we would still end up with higher levels of hospitalisation."

READ MORE: Excess mortality - what is the data really telling us about population health?

Cumulatively, since January 2020, the UK has recorded around 10 per cent more deaths than would have been expected based on previous years. 

That compares to cumulative excess deaths tolls of around 5% in Norway and 5.5% in Sweden. 

In Japan, which has the world's most elderly population but enforced strict border controls and testing requirements, the figure is 2.5% to date, while in New Zealand - where vaccines were widely rolled out before quarantine rules for international travel relaxed - the cumulative death roll still remains 0.2% below the pre-pandemic average.

Cumulative excess mortality in the UK (based on the number of deaths since January 2020 and the number expected based on previous years) exceeds countries such as Sweden, where restrictions were lighter; countries like New Zealand which closed borders early; and Japan, which has the world's most elderly population (Image: Our World in Data) (Image: Our World in Data)

During 2020 and 2021, some critics of the UK's approach to Covid pointed to Sweden as a blueprint for lighter-touch controls.

Its bars and restaurants remained open, albeit with social distancing, and nearly all children - with the exception of the oldest teenagers - carried on going to school. 

Its GDP fell by 2.9% in 2020 compared to 9.4% in Britain, and the drop in routine operations during the first year of the pandemic was also comparatively lower, at 20% compared to roughly 35% in Scotland and England, meaning that it is grappling with a smaller waiting list backlog now. 

However, Sweden also went into the pandemic with lower levels of obesity and deprivation, which are both associated with a higher mortality risk from Covid. 

One in 10 adults in Sweden is obese compared to one in four in the UK.

READ MORE: Obesity, deprivation, women - and the surprising cost of being 'too fat'

Sweden also has much less income inequality than the UK, and it paid its citizens 80% of their salary to self-isolate versus flat sums of up to £500 in the UK for low-income workers only. 

Sweden boasts around 25% more nurses and 35% more doctors per head than the UK - putting it on a comparatively surer footing to recover from the pandemic - while levels of public trust are also higher. 

According to the OECD, 69% of Swedes have confidence in their national government compared to fewer than 40% of UK voters.

Citizens who have faith in their leaders are more likely to adhere to public health guidance and, by all accounts, Swedes were voluntarily very cautious. 

Levels of inequality in the UK (red) are much higher compared to Sweden (blue) (Image: OECD)

The UK (red) also has much lower levels of public trust in government compared to Nordic countries including Sweden (Image: OECD)

Meanwhile, trailblazing plans to prevent retailers from promoting junk food such as crisps and chocolate through multi-buy deals - first unveiled by the Scottish Government in 2017 - have been repeatedly delayed, while SNP leadership candidates have cast doubt on proposals to clamp down on alcohol marketing. 

Such legislation already exists in many European countries including Norway, where alcohol advertising has been subject to the same blanket ban as tobacco since the 1970s. 

Sridhar said it was "disappointing" to see progress on initiatives geared at tackling obesity and improving public health stall. 

"It is a shame to see that a lot of the progress in public health around junk food, diet, and physical activity has kind of fallen to the wayside," said Sridhar. 

"We talk about having fresh fruit and vegetables and exercise now almost as a luxury, and that's sad. We have to keep highlighting that. 

"So whenever I get the Sweden question I'm happy to get it, because I'm like 'let's talk about Sweden', because if we had looked like Sweden we would have had different options. 

"But we don't look like Sweden, so what would we have to do to look like Sweden? Is it higher taxation? Is it nutrition? Is it physical activity? Is it better sick leave?

"Is it longer public health cycles? Japan is fascinating because they plan their public health in 10 year cycles - what's best for the next 10 years, not what can I sell to the public in the next six months. 

"These are the questions we should be asking. Not 'look, Sweden did nothing and they're fine' - which is the cliche that we hear. 

"And also, it's not true that they did nothing. They did do quite a lot - just not in ways where the Government mandated it."

READ MORE: Nearly 7000 Scots still waiting more than two years for ops on NHS

This "bigger story" - charting how different countries went into, and emerged from, the pandemic - forms the basis for Sridhar's next book, a follow-up to 2022's 'Preventable' which is set for its paperback release on April 6. 

It comes against a backdrop of reinvigorated lockdown scepticism following the leak to the Telegraph newspaper of thousands of Whatsapp messages exchanged during the pandemic by UK Government ministers, senior civil servants, and advisors. 

Sridhar said this "mudslinging and polarisation" is unhelpful.

A herd immunity approach backed by some scientists who advocated shielding the vulnerable while allowing the virus to spread through the rest of the population, before vaccinations, would "never have worked", she added.

"How do you separate the asymptomatically infected from the vulnerable if they live in the same home? Are you going to send them to some camp?"

Professor Devi Sridhar said we should be looking to countries such as Sweden to understand why they were healthier and better equipped to cope with Covid (Image: Newsquest)

While the debate over lockdown rumbles on, there is also the difficult question of whether we are striking the right balance when it comes to 'living with' Covid. 

Despite vaccinations and antivirals it is estimated that around 500,000 immunosuppressed people in the UK remain at high risk from the disease.

Some continue to shield, with their fear of exposure made worse by the rapid spread of the virus after restrictions lifted. 

Even now it is estimated that one in 50 people in Scotland have Covid. 

"It's really tricky because I don't think there's a great answer to that - beyond hoping for better vaccines, better antivirals, and better scientific solutions," said Sridhar. 

"I think it's important to have that awareness though when you see people wearing masks and being cautious, that they might have very good reason for being worried. 

"There are more vaccines coming out and hopefully there are better antivirals, but if anything Covid transmission has become harder to control with Omicron and all its sublineages and just I don't think there's an appetite now in society to curtail social relations to the degree that you'd need to change them to have an effect on transmission."

READ MORE: Is it time we had a rethink about indoor air standards? 

Some scientists have argued that much more should be done to curb virus transmission by making indoor air cleaner through better ventilation, drawing parallels with the effects of water sanitation on disease in the 19th Century. 

"Air quality is good for everything, whether it's Covid or flu or the next pandemic," said Sridhar. 

"But I think it's one of the hardest things for buildings, and one of the most expensive to change. I don't think people think about how much cost informs public health and global health. 

"You see that with vaccinations. We don't give chickenpox vaccinations because the benefit in terms of hospitalisations doesn't justify the cost."

Concerns have been raised over the spread of H5N1 avian influenza from birds into various mammal species (Image: Getty)

As for the "next pandemic", Sridhar believes it is too soon to rule out a threat from H5N1 bird flu.

First detected among chickens in Scotland back in 1959, the pathogen has been causing alarm more recently with deadly outbreaks in South America - where it has never previously been detected - and its spread into mammals.

Hundreds of sea lions, otters, bears, and minks have died. 

"I think we have to be quite honest and say we don't know [what will happen]," said Sridhar.

"I don't think anyone expected that there would be this step change in transmission, and we're seeing it in all parts of the world.

"That's a signal that is worrying to me - all parts of the world are seeing this bird flu spillover into mammals, and very rarely into humans. 

"It has to be about surveillance, and making sure that if we did see any kind of mutations which could enable human to human transmission that we are able to move quite quickly. 

"Hopefully if we do the prep work, with testing and vaccines and antivirals, it never becomes a pandemic."

'Preventable: How a Pandemic Changed the World and How to Prevent the Next One', will be released in paperback by Penguin Random House on April 6 2023