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A better understanding of transmission dynamics is essential in influenza pandemic planning. If a substantial proportion of transmission were to occur during the presymptomatic phase or from asymptomatic individuals, then infection control measures such as contact tracing and quarantine of exposures will be of limited value, in addition to constraints based on the short serial interval for influenza transmission. However, we have found limited evidence to suggest the importance of such transmission. The role of asymptomatic or presymptomatic influenza-infected individuals in disease transmission may have been overestimated in recent articles dealing with pandemic planning. More definitive influenza transmission studies are needed.

Sweden’s chief epidemiologist and the architect of its light-touch approach to the coronavirus has acknowledged that the country has had too many deaths from Covid-19 and should have done more to curb the spread of the virus.

Anders Tegnell, who has previously criticised other countries’ strict lockdowns as not sustainable in the long run, told Swedish Radio on Wednesday that there was “quite obviously a potential for improvement in what we have done” in Sweden.

Asked whether too many people in Sweden had died, he replied: “Yes, absolutely,” adding that the country would “have to consider in the future whether there was a way of preventing” such a high toll.

Sweden’s death rate per capita was the highest in the world over the seven days to 2 June, figures suggest. This week the government bowed to mounting opposition pressure and promised to set up a commission to look into its Covid-19 strategy.