我的《信報》文章(2020年
4月29日A16頁) 足本
《警惕 瑞典控疫的「使人活、讓人死」模式》
2020年4月16日，一家食品生產商租用包機，將150名羅馬尼亞勞工運抵英國;這些外勞只在上落飛機時進行健康檢查，毋須隔離甚麼14天，直往農場幫助收採農作物。據報公司正安排另外5-6班此類包機。似乎官商均認為新加坡的外勞廣泛感染情況不會在英國發生。
隨著疫情逐漸舒解，西方政府正計劃「退出策略」(Exit Strategy)，以盡快恢復正常生活，重啟經濟活動。
歐盟於4月15日列出三項先決條件:
<1>
病毒的傳播明顯減少、
<2> 足夠的醫護能力、
<3> 足夠的追溯傳染鏈能力。
但多國政府已爭先放鬆限制的措施。
4月13日，儘管西班牙新增3,477確診病例，政府仍允許30萬非必要工種職員重返崗位。
在意大利，4月13日有3,153宗新確診，東北區的威尼托州自14日起，容許書店和服裝店每周營業兩天，並取消不准離家超過200米的禁令。
德國4月19日仍有2,458宗新確診，唯自20日始，書店、花店、時裝店、車輛銷售點、面積小於800平方米的商店重新開放。
4月20日，大量沒有戴口罩的示威者在美國要求停止封城令、居家令、「1984奧威爾式噩夢」(Orwellian
nightmare)，認為染病與否是個人選擇，不應由政府決定。4月25日，柏林也發生類似的抗議。
[Note 1]
據此趨勢看，即使距離「零確診」還很遙遠，歐美的控疫管理將不可避免地會逐步轉向「瑞典模式」:16歲或以下的學生如常上課(包括幼兒園)，酒吧、飯店、美容理髮店、滑雪及各類運動場…保持開放，政府除了禁止超過50人聚集、建議保持社交距離外，大體上讓人們如常生活，例如自行決定是否上班。
政策的理據，是相信公民懂得運用個人判斷力、承擔個人責任，亦即:「要是我生病了，我不會出外與別人接觸」，且相互信任。故此，官員毋須施行自上而下的控制，全社會容忍社區疫情持續，讓人被感染、讓患者死亡。
[Note 2]
到4月25日，瑞典確診病例為18,177（每百萬人中有1,800，鄰國挪威1,383，芬蘭808），死亡人數為2,192（每百萬人中有217，挪威37，芬蘭34）。
首都所屬的斯德哥爾摩郡，人口237萬，佔全國死亡總數一半以上，即多於千例 (香港人口750萬，僅有4人死亡) 。
[Note 3]
近期的數據、報導揭示，由於政府沒有規定護老院員工必須配戴口罩、沒有要求採取相關預防傳染措施、沒有提供相關物質、沒有派人協助及監督(「四個沒有」) ，而許多顧慮失去收入的低薪員工(很多是少數族裔)，即使有輕度不適仍然照常工作，最終導致大量長者染病。
[Note 4]
本來染病不等於會輕易死亡，但是瑞典的每千人均病床數目偏低:瑞典2.6、挪威3.9、芬蘭4.4、意大利3.4、法國6.5、德國8.5、香港4.9、中國大陸4.2 (世界銀行數據) 。換句話說，在疫情中如常生活的瑞典，病患者較多，病床(醫療設施) 卻較少，死亡率偏高並不意外。
[Note 5]
要分析控疫政策，法國哲學家福柯 (M. Foucault 1926-84) 建構的「使人活、讓人死 (make live, let die)生命政治」學說，甚有參考價值(其理論基礎之概要，見拙文《中共使人活、讓人死的管治模式》刊2016年 9月20日《信報》) 。
比對瑞典和大中華的控疫措施、數據，似乎我們側重「使人活」，而瑞典偏重「讓人死」(沒有褒貶之意) 。雖說他們的高死亡率與我們無關，但有兩點必須警惕。
首先，當歐美放鬆控疫措施(瑞典化)，於感染病例減少但仍然維持每天數以百計的同時，「謹慎地」容許大量群眾每天上班、上學、社交、出遊…海陸空人流會逐步恢復(最近有人建議政府簽發「免疫護照」 方便旅客出國，被世衛批評此舉增加持續傳播的風險) ;漸漸地，當愈來愈多人由於業務或其他需要，真的來到我們這裏(「零確診」)，怎辦?難道每位訪客都強制隔離14天? 經濟復甦又從何說起?
[Note 6]
在有效疫苗普及之前，也許切實的方法是要求所有訪客，在抵達時通過準確而可靠的測試，並同意遵守某些規則，例如記錄曾往何處?與誰相聚?不管措施如何影響私隱，我們旨在「使人活」。
另一點必須警惕及深思的，是為何這麼多院舍長者染病而死?偏重「讓人死」這種瑞典模式有甚麼含義?
瑞典（人口1,010萬）有52％家庭是單身戶，比例是全歐最高(平均只有33％);另有24％是沒有孩子的夫婦戶。離開父母開始獨居的瑞典青年通常為18-19歲(歐洲平均26歲) 。2017年一項研究顯示，超過55％的16-24歲青年沒有與任何近親進行社交活動。
瑞典一句著名的諺語是「單獨就是堅強」(ensam
är stark)，為擁有(極端的)個人主義而感到自豪。斯德哥爾摩大學教授 Gunnar
Andersson指出，瑞典的個人主義文化有歷史因素，也歸因於充裕的社會福利，可直接從政府獲得輕易負擔的住房、醫療、教育。
[Note 7]
如果在其他歐洲國家，安老院長者佔COVID-19死者半數(世衛數據)，是傳染初期官民粗心大意而造成，那麼瑞典發生前述的「四個沒有」，也許是因為不在乎那些孤獨的老人。他們關心的是個人的快樂(加拿大也有安老院因欠缺政府協助、員工逃亡，親友少問，多天後才被發現31名院友死亡)。
[Note 8]
反觀大中華地區，疫情一開始，政府、機構、公眾趕緊給院舍老人送口罩、消毒劑、手套等防護物資。我們的死亡率不僅低，安老院也罕有成為傳染群組。
偏重「讓人死」的瑞典在《世界快樂報告2019》排名第七，我們則遠遠落後。是的，我們既勞碌工作，也要攜幼、扶老，壓力巨大(眼看年老父母患重病，心裏苦啊!)、身心疲憊。但若然逍遙自在的個人快樂，是建基於任由父母孤單老死，這些所謂的快樂指數、世界排名有甚麼意義?
[Note 9]
在選擇個人快樂和關懷長輩之間，我們在疫情中再一次領略祖國傳統的美!
Notes for Referemce
[Note 1]
UK, Apr 16, 2020
A food producer has chartered a flight to fly 150
Romanians into the UK on Thursday to help pick fruit and vegetables.
A further five or six more charter flights to the
UK are currently being discussed, Air Charter Services added.
"There will be health checks at both ends
and the middle seat of the middle row will be kept empty to ensure a form of
social distancing," it said
EU,
Apr 15, 2020
The European Commission has presented its exit plan, an
attempt, essentially, to co-ordinate an EU wide response … focus on three main pre-conditions:
1. Significant decrease in the spread of the #coronavirus
2. Sufficient health system capacity
3. Adequate surveillance and monitoring capacity
1. Significant decrease in the spread of the #coronavirus
2. Sufficient health system capacity
3. Adequate surveillance and monitoring capacity
Spain,
Apr 13, 2020
The controversial return to work for an
estimated 300,000 non-essential staff got off to a slow start …
Overall cases rose to 169,496 from 166,019. The
health minister, Salvador Illa, said the epidemic had passed its peak. The
challenge now was to consolidate the second stage of the struggle against the
virus and to reduce new infections, he said.
Italy,
Apr 14, 2020
… in the north … Veneto officials are talking of a "soft
lockdown". Bookshops and clothing stores can open for two days a week,
says Veneto governor Luca Zaia, and a ban on exercising more than 200m away
from home has been lifted.
2020-04-12
156,363 cases
2020-04-13
159,516 cases
Germany,
Apr 20, 2020
Bookshops, florists, fashion stores, bike and
car outlets and other shops smaller than 800 sq m were permitted to reopen on
Monday morning. In Berlin a few schools allowed final-year students to sit
exams. Pupils arrived wearing face-masks and took their seats at widely spaced
desks.
2020-04-18
137,439 cases
2020-04-19
139,897 cases
星島日報 2020-04-20
std.stheadline.com/instant/articles/detail/1250812/即時-國際-歐洲確診個案突破100萬宗-多國分階段放寬居家令
歐洲感染新冠肺炎人數突破100萬，逾10萬人死亡，病死人數佔全球超過近三分二，但多國疫情持續有放緩跡象，準備分階段放寬「居家令」。
Protests in the USA on Apr 20, 2020
(CNN)Anger over
shelter-in-place orders boiled over this weekend, with protesters ignoring
social distancing guidelines and packing sidewalks and streets.
"Freedom over fear," read one protester's sign in
Indiana.
"Shutdown the shutdown," another sign in Maryland
said.
A protester in Maryland says she's worried about her future if
businesses don't reopen soon.
In Indianapolis, protester Andy Lyons said he understands the
health risks. But he wants the government to back off.
"If I get sick, then I am going to bear the consequences of
my getting sick," Lyons told CNN affiliate WTHR. "If anybody else gets sick,
they bear the consequences of their free choice without government coercion to
do so. That's what this is about."
Across the country, more protests are popping up in both red and blue states.
Michigan, Ohio, Kentucky, Minnesota, North Carolina, Utah,
Colorado and Washington have all seen protests in recent days.
"All of a sudden this is going from a
pandemic to an Orwellian nightmare,"
Brandon said, noting how many people in his network reacted similarly to the
news about data tracking.
Protests in Germany on Apr 25, 2020
https://www.bbc.com/news/av/world-europe-52426378/coronavirus-berlin-march-against-lockdown-measures
About 200 protesters gathered in the German
capital, Berlin, to protest against coronavirus measures, which they say are an
infringement of their constitutional rights.
[Note 2]
Sweden Apr 20, 2020
“It’s the Swedish trust in government,” says
Linus Bohman, 28. “No one told me you have to stay home right now,” agrees his
friend, Fredrik Glückman, a history student at Lund University. “We’re not in
quarantine. And as soon as we hear from our government that we have to stay in,
like you do in Britain, then we will do it.”
While every other country in Europe has been ordered into ever more stringent coronavirus
lockdown, Sweden has remained the exception. Schools for pupils up to 16 years, kindergartens,
bars, restaurants, ski resorts, sports clubs, hairdressers: all remain open, weeks after everything closed down in next door Denmark and
Norway.
Sweden
Mar 28, 2020
[Note 3]
The Worldometer, COVID-19 CORONAVIRUS
PANDEMIC, date by country
[Note 4]
The Guardian, “Anger in Sweden
as elderly pay price for coronavirus strategy”, Apr 19, 2020.
It was just a few days after the ban on visits to his mother’s
nursing home in the Swedish city of Uppsala, on 3 April, that Magnus Bondesson
started to get worried.
“They [the home] opened up for Skype calls and that’s when I saw two employees. I didn’t see any masks and they didn’t have gloves on,” says Bondesson, a start-up founder and app developer.
“When I called again a few days later I questioned the person helping out, asking why they didn’t use face masks, and he said they were just following the guidelines.”
That same week there were numerous reports in Sweden’s national news media about just how badly the country’s nursing homes were starting to be hit by the coronavirus, with hundreds of cases confirmed at homes in Stockholm, the worst affected region, and infections in homes across the country.
“They [the home] opened up for Skype calls and that’s when I saw two employees. I didn’t see any masks and they didn’t have gloves on,” says Bondesson, a start-up founder and app developer.
“When I called again a few days later I questioned the person helping out, asking why they didn’t use face masks, and he said they were just following the guidelines.”
That same week there were numerous reports in Sweden’s national news media about just how badly the country’s nursing homes were starting to be hit by the coronavirus, with hundreds of cases confirmed at homes in Stockholm, the worst affected region, and infections in homes across the country.
Since then pressure has mounted on the government to explain
how, despite a stated aim of protecting the elderly from the risks of Covid-19,
a third of fatalities have
been people living in care homes.
Last week, as figures released by the Public Health Agency of
Sweden indicated that 1,333 people had now died of coronavirus, the country’s
normally unflappable state epidemiologist
Anders Tegnell admitted that the situation in care homes was worrying.
“This is our big problem area,” said Tegnell, the brains behind the government’s relatively light-touch strategy, which has seen it ask, rather than order, people to avoid non-essential travel, work from home and stay indoors if they are over 70 or are feeling ill.
The same day prime minister Stefan Löfven said that the country faced a “serious situation” in its old people’s homes, announced efforts to step up protections, and ordered the country’s health inspectorate to investigate.
Lena Einhorn, a virologist who has been one of the leading domestic critics of Sweden’s coronavirus policy, told the Observer that the government and the health agency were still resisting the most obvious explanations.
“They have to admit that it’s a huge failure, since they have said the whole time that their main aim has been to protect the elderly,” she said. “But what is really strange is that they still do not acknowledge the likely route. They say it’s very unfortunate, that they are investigating, and that it’s a matter of the training personnel, but they will not acknowledge that presymptomatic or asymptomatic spread is a factor.”
The agency’s advice to those managing and working at nursing homes, like its policy towards coronavirus in general, has been based on its judgment that the “spread from those without symptoms is responsible for a very limited share” of those who get infected.
Its advice to the care workers and nurses looking after older people such as Bondesson’s 69-year-old mother is that they should not wear protective masks or use other protective equipment unless they are dealing with a resident in the home they have reason to suspect is infected.
Otherwise the central protective measure in place is that staff should stay home if they detect any symptoms in themselves.
“Where I’m working we don’t have face masks at all, and we are working with the most vulnerable people of all,” said one care home worker, who wanted to remain anonymous. “We don’t have hand sanitiser, just soap. That’s it. Everybody’s concerned about it. We are all worried.”
“The worst thing is that it is us, the staff, who are taking the infection in to the elderly,” complained one nurse to Swedish public broadcaster SVT. “It’s unbelievable that more of them haven’t been infected. It’s a scandal.”
Einhorn was one of 22 researchers who on Tuesday called for Sweden’s politicians to break with the country’s tradition of entrusting policy to its expert agencies, and to seize control of Sweden’s coronavirus strategy from the agency.
“This is our big problem area,” said Tegnell, the brains behind the government’s relatively light-touch strategy, which has seen it ask, rather than order, people to avoid non-essential travel, work from home and stay indoors if they are over 70 or are feeling ill.
The same day prime minister Stefan Löfven said that the country faced a “serious situation” in its old people’s homes, announced efforts to step up protections, and ordered the country’s health inspectorate to investigate.
Lena Einhorn, a virologist who has been one of the leading domestic critics of Sweden’s coronavirus policy, told the Observer that the government and the health agency were still resisting the most obvious explanations.
“They have to admit that it’s a huge failure, since they have said the whole time that their main aim has been to protect the elderly,” she said. “But what is really strange is that they still do not acknowledge the likely route. They say it’s very unfortunate, that they are investigating, and that it’s a matter of the training personnel, but they will not acknowledge that presymptomatic or asymptomatic spread is a factor.”
The agency’s advice to those managing and working at nursing homes, like its policy towards coronavirus in general, has been based on its judgment that the “spread from those without symptoms is responsible for a very limited share” of those who get infected.
Its advice to the care workers and nurses looking after older people such as Bondesson’s 69-year-old mother is that they should not wear protective masks or use other protective equipment unless they are dealing with a resident in the home they have reason to suspect is infected.
Otherwise the central protective measure in place is that staff should stay home if they detect any symptoms in themselves.
“Where I’m working we don’t have face masks at all, and we are working with the most vulnerable people of all,” said one care home worker, who wanted to remain anonymous. “We don’t have hand sanitiser, just soap. That’s it. Everybody’s concerned about it. We are all worried.”
“The worst thing is that it is us, the staff, who are taking the infection in to the elderly,” complained one nurse to Swedish public broadcaster SVT. “It’s unbelievable that more of them haven’t been infected. It’s a scandal.”
Einhorn was one of 22 researchers who on Tuesday called for Sweden’s politicians to break with the country’s tradition of entrusting policy to its expert agencies, and to seize control of Sweden’s coronavirus strategy from the agency.
She argues that the reason why Sweden has a much higher number
of cases in care homes than in Norway and Finland is not because of the homes
themselves, but because of Sweden’s decision to keep schools and kindergartens
open, and not to shut restaurants or bars.
“It’s not like it goes from one old age home to another. It comes in separately to all of these old age homes, so there’s no way it can be all be attributed to the personnel going in and working when they are sick. There’s a basic system fault in their recommendations. There’s no other explanation for it.”
“It’s not like it goes from one old age home to another. It comes in separately to all of these old age homes, so there’s no way it can be all be attributed to the personnel going in and working when they are sick. There’s a basic system fault in their recommendations. There’s no other explanation for it.”
Bondesson’s mother, who has dementia, is worried, he says. “She is aware of most things that you talk about, it’s just that she might have bad short-term memory, on and off,” he said. “She had also been questioning the lack of face masks. She thinks it’s really sad to have to be there constantly for weeks and not to know when it’s going to end.”
Forbes,
“Sweden: 22 scientists says coronavirus strategy has failed as deaths top
1,000”, Apr 14, 2020.
According to Aftonbladet, Jan Lötvall, a professor at the University of Gothenburg,
said that Swedish people have not understood the seriousness of the situation
because they have received unclear messaging from health authorities and elected officials.
The researchers now want rapid change. They suggest that
schools and restaurants should be closed as in Finland. In addition, healthcare
professionals working with the elderly must use proper infection control
equipment and a mass testing of health personnel must be carried out.
The group highlighted the last three days
before the Easter vacation began. In the
period April 7-9: "10.2 people per million inhabitants died of COVID-19
each day in Sweden. In Italy, the figure was 9.7. In Denmark it was
2.9, in Norway 2.0 and in Finland 0.9," stated the letter.
[Note 5]
World Bank, “Hospital beds (per 1,000
people,” most recent year, most recent value.
[Note 6]
WHO Apr 24, 2020
Some governments have suggested that the detection of antibodies to
the SARS-CoV-2, the virus that causes COVID-19, could serve as the basis for an
“immunity passport” or “risk-free certificate” that would enable individuals to
travel or to return to work assuming that they are protected
against re-infection. There is currently no evidence that people who have
recovered from COVID-19 and have antibodies are protected from a second
infection.
At this point in the pandemic, there is not enough evidence
about the effectiveness of antibody-mediated immunity to guarantee the accuracy
of an “immunity passport” or “risk-free certificate.” People who assume that
they are immune to a second infection because they have received a positive
test result may ignore public health advice. The use of such
certificates may therefore increase the risks of continued transmission.
BBC, “Coronavirus: Immunity
passports could increase virus spread”, Apr 25, 2020.
Many countries including Germany, Italy and the UK
are beginning to test samples of their populations for antibodies. In the UK,
25,000 people will be tested every month for the next year - both for
antibodies, and to check if they currently have the virus.
This could provide more information about
whether (and for how long) the disease confers immunity to those who have
recovered. And that would give us a clearer idea about whether testing
individuals and giving them some kind of immunity status might be an option in
the future.
Last week Chile said it would begin issuing "health passports"
to people deemed to have recovered from the illness.
Once screened for the presence of
antibodies to make them immune to the virus, they could rejoin the workforce,
officials said.
In Sweden, which has chosen to keep large parts of society open,
some scientists believe people may end up with much higher immunity levels
compared with those living under stricter regulations.
[Note 7]
Eurostat: Over half of Sweden’s households
made up of one person 2016
In 2016, the EU had 220 million households. The most common type of household was composed of one person
(33 % of the total number of households), followed
by households consisting of couples without children (25 %) and couples with
children (20 %).
Among the Member States, over half of households in Sweden (52 % of all households)
were one person households
22nd August 2019
In Sweden, the most common age to leave home is
between 18 and 19, compared to the EU average of 26 … according to Eurostat figures.
…
“It is special in
Sweden – and the Nordics – that there is much less variation in leaving age
than other countries,” explains Gunnar Andersson,
professor of demography at Stockholm University.
…
Andersson explains that Sweden’s
“culture of individualism” dates back centuries, with teenagers in rural
communities typically leaving home to go and work on another farm. In more
recent years the norm of young people living alone has, he says, remained
realistic thanks to Sweden’s strong welfare state
which, in theory, should enable them to have access to affordable housing,
healthcare and education without relying on relatives or partners for help.
A 2017 study by Statistics Sweden found that more than 55% of 16 to 24 year-olds don’t socialise with any
close relatives.
…
Her words recall an old Swedish
proverb: “ensam är stark” – “alone is strong”.
[Note 8]
星島日報 2020-04-23
std.stheadline.com/instant/articles/detail/1254232/即時-國際-護理院染疫死者佔歐洲一半-世衛形容-人間悲劇
世界衛生組織歐洲區域主任克盧格（Hans Kluge）表示，在歐洲死亡的新冠肺炎確診病人中，最多一半是入住護理院的人士，指這是「想像不到的人間悲劇」。
克盧格在記者會上稱，在疫情打擊下，歐洲的護理院出現令人十分憂慮的情況，根據歐洲各國估計，歐洲疫情死亡的病人，有一半是入住護理院的人士，這是「想像不到的人間悲劇」。據統計，全球疫情死亡人數達18萬多人，其中逾11.5萬人在歐洲死亡。克盧格指出，在護理院工作的護理人員工作超負荷，而且薪金偏低。他形容這些護理人員是「無名英雄」，呼籲有關方面為他們提供更多保護裝備和支持。
克盧格在記者會上稱，在疫情打擊下，歐洲的護理院出現令人十分憂慮的情況，根據歐洲各國估計，歐洲疫情死亡的病人，有一半是入住護理院的人士，這是「想像不到的人間悲劇」。據統計，全球疫情死亡人數達18萬多人，其中逾11.5萬人在歐洲死亡。克盧格指出，在護理院工作的護理人員工作超負荷，而且薪金偏低。他形容這些護理人員是「無名英雄」，呼籲有關方面為他們提供更多保護裝備和支持。
星島日報 2020-04-19
std.stheadline.com/instant/articles/detail/1250275/即時-國際-加安老院看護集體逃離致31長者亡-支援者淚湧-太不人道
新冠肺炎下醫護疲於奔命，全球多國都發起向醫護拍掌以示支持及打氣。然而加拿大一間安老院機構的護士卻害怕感染新冠肺炎，居然「集體逃亡」，留下長者在院內自生自滅，最終31名長者死亡，其中至少5人死於新冠肺炎。
VOA
News, “WHO Europe: Up to Half of Deaths in Care Homes”, Apr 23, 2020.
LONDON - The head of the World Health Organization’s Europe
office said up to half of coronavirus deaths across the region have been in
nursing homes, calling it an “unimaginable tragedy.”
In a press briefing on Thursday, WHO Europe director Dr. Hans Kluge said a “deeply concerning picture” was emerging of the impact of COVID-19 on long-term homes for the elderly, where care has “often been notoriously neglected.” Kluge said health workers in such facilities were often overworked and underpaid and called for them to be given more protective gear and support, describing them as the “unsung heroes” of the pandemic.
In a press briefing on Thursday, WHO Europe director Dr. Hans Kluge said a “deeply concerning picture” was emerging of the impact of COVID-19 on long-term homes for the elderly, where care has “often been notoriously neglected.” Kluge said health workers in such facilities were often overworked and underpaid and called for them to be given more protective gear and support, describing them as the “unsung heroes” of the pandemic.
VOA
News, “Europe’s Nursing Homes are likely Coronavirus Hotspots, Officials fear”,
Apr 14, 2020.
VOA
News, “Coronavirus Creates Nightmare for Spain’s Nursing Homes”, Apr 14, 2020.
[Note 9]
World Happiness Report 2019: Ch 2 Happiness by country
ranking
7. Sweden
25. Taiwan
76. Hong Kong
93. China
