"Unfortunately, we have failed to medically explore the microbial world we live in. But we can hope that we will have a short respite before the next wave", says Björn Olsen.
Photograph: Mikael Wallerstedt
"The coronavirus is not the last act. At best, it is a dress rehearsal for the next pandemic. And when this storm blows over, we can hope that we will have a short respite to prepare before the next epidemic is upon us," says Björn Olsen, a professor of infectious diseases now well-known throughout Sweden.
"I have ruined several dinners by expounding on pandemics. Finally someone would put an end to it by saying: 'Let's have a nice time now. Does anyone want dessert?'" Ten years have passed since Björn Olsen, in the book Pandemi: myterna, fakta, hoten ("Pandemic: the Myths, Facts, Threats"), had to conclude that infectious epidemics were something we prefer to talk about in a low voice. Today it's another story. Countries close down. Intensive care is overwhelmed. Funeral homes are working overtime. And everyone wants to know what the professor of infectious diseases has to say about the way a virus can paralyse our world.
"For 25 years I have lectured on what awaits us. That our current lifestyle makes the next pandemic inevitable. The message has not been popular. Many become so provoked that they leave the room. Others interrupt with indignant objections. A few nod, but no one accepts the idea that it will actually happen. Now we are in the middle of the storm, and we still lack a working strategy."
The first case of corona infection occurred in China on New Year's Eve. A day later the information reached Björn Olsen. He describes the experience as the ground falling away beneath his feet. Shortly afterwards he warned of an imminent pandemic. In mid-January, he and a colleague recommended providing temporary triage tents to accommodate the anticipated influx of many patients. Once again the apprehensions were dismissed as alarmist. But honestly, who could have really predicted the full extent of the blow to our society dealt by the virus?
"The fact that it was going to be nasty soon became clear. But I, like many others, have had to change my mindset. Instead of a short and intense influenza outbreak, we encounter a prolonged state of ill health with relatively low mortality. This places enormous demands on the health care system while simultaneously apparently not conferring the herd immunity that can offer some relief. Initially, I thought we would reach a peak in late March. Today I believe the situation may be under control in late autumn, but even then with coronavirus flare-ups."
This probably explains the lack of a clear sense of direction. No one knows exactly what we face. A few years ago an American survey identified more than a thousand viruses with the potential to cause pandemics. In China researchers estimate that 5,000 variations of bat-borne coronaviruses exist. All with unique properties. All with the ability to migrate among species. According to Olsen, the challenge demands an ability to interpret signs, a hefty dose of imagination and, above all, the courage to call attention to uncomfortable observations without political considerations.
"For me, it is a matter of morality. As a researcher, if I see that something is wrong, it is my duty to act as a catalyst for discussion. In the case of the coronavirus, Sweden has for some unclear reason departed from the precautionary principle we normally profess. We currently have three times as many deaths as our Nordic neighbouring countries combined. Many years of life have been lost and families have been unnecessarily shattered. This should not be swept under the rug, and I take particular pride in the contributions a number of colleagues and I have published in the op-ed pages of Dagens Nyheter. Unfortunately, we have been misquoted, but our calculations proved to be correct and above all have helped to energise the conversation."
Being in the spotlight of the media on a daily basis is starting to take its toll, however. Repeating the same answers to the same questions quickly loses its allure. Increasingly he declines journalists' invitations with a text message. Certainly the hope persists of representing the voice of science. Or at least being a devil's advocate. Being difficult and taking new approaches! But his armour is wearing thin.
"What I and others say as part of the public conversation should of course be evaluated. But with few exceptions, I find that many journalists forget their mission in the hunt for quick clicks. I also have difficulty with the search for conflicts where they do not exist. I have participated in discussions in which I have been accused of submissiveness after supporting epidemiologist Anders Tegnel. Right now there is no scope for challenging without reason. However, we need to express our various opinions when they differ."
And what opinion does Björn Olsen have about the right way forward in the crisis in Sweden? A brief silence is followed by demands for massive testing, analyses of coronavirus cluster spread and isolation of those infected. On the other hand, at this point in time the battle is not about the species' survival. That comes later. When we believe that everything has returned to normal. And then in the form of an educational mission: Teaching people that we are just one animal among many. That we share the ecosystem with countless, freely mobile microorganisms. That if we continue to believe we are superior, the price for our hubris will be huge. A full stop for life as we know it?
"The coronavirus is not the last act. At best, it is a dress rehearsal for the next pandemic. Unfortunately, we have failed to medically explore the microbial world we live in. But when this storm blows over, we can hope that we will have a short respite before the next wave. Then some indispensables await us: Swedish vaccine production is one. We already see how countries choose not to share when a shortage occurs. Increased identification and monitoring of viruses that start behaving differently are also inescapable. As well as better preparedness and equipment in the health care and social welfare systems. We cannot continue to rely on individual, albeit splendid, initiatives by individual employees."
Thoughts for the future. But how should we conclude our disussion? Well, why not return to Björn Olsen's younger self 10 years ago. In his book, he emphasises: "Our greatest enemy is forgetfulness. In large parts of the affluent world, decision-makers and the population have forgotten the role infectious diseases have played in previous generations. We have been convinced that modern medicine and technology will fix everything." Words that should not be mistaken for resignation. More on the order of a benevolently clenched fist. And who knows. Maybe the time has finally come to let the dessert wait until we have finished talking about that which needs to be said.
Facts: Björn Olsen
Profession: Professor of infectious diseases and chief physician, Uppsala University and Uppsala University Hospital.
On the bedside table: A small library; at the top, Ett jävla solsken ("A Damn Sunshine") about Ester Blenda Nordström, a fascinating person with the courage to go against the stream.
I'm happy to discuss: The human condition in a changing world – and birds, of course.
A famous person I met: Telly Savalas, whose path I crossed in Edinburgh. I couldn't help but praise him for Kojak, and he turned out to be a very nice person.
A scientific work I am proud of: Half asleep in the bathtub, I suddenly realised how borrelia infection moves across major geographical barriers. I woke up, wrote it down on a slip of paper and fell asleep again. Later everything was published in Nature!
When I get a day off: I like bird watching and preferably spending time with the grandchildren, but not now.
