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In an attempt to save lives and not overwhelm health systems, countries have chosen different measures to confront Covid-19. At the height of the Italian and Spanish outbreaks, people were unable to leave their homes. In the UK, they can go out for an hour a day of exercise and buy food. In the United States, activity varies by state; in Nevada, the streets of Las Vegas are empty, while in southern California, some beaches are full.
Even in the midst of variation, Sweden excels in its Covid-19 approach.
The country’s primary schools have remained open. Restaurants too, although congregating at the bar is discouraged and tables are further apart. Those who can work from home are encouraged, but nightclubs can work as long as the manager makes sure people keep their distance.
Sweden’s chief epidemiologist Anders Tegnell, who enjoys a sort of celebrity status in the country for his unflappable calm, says the strategy appears to be working: “We could have reached a peak and we’re on the plateau,” he said in a statement. briefing on April 15.
On April 26, Deputy Prime Minister Isabella Lovin defended the strategy before the BBC: Sweden sees Covid-19 as a “marathon and not a sprint,” she said, warning that citizens of countries with more extreme measures may tire of staying. at home .
The Swedes negotiated a different deal than the rest of the world: citizens take individual responsibility for social distancing and the government keeps most of society running. There are a few rules: high schools and universities are closed, gatherings of more than 50 people are prohibited, and people over 70 and those who feel sick are encouraged to stay home. But businesses largely remain open, and children who would otherwise need care are in school.
Citizens seem to be taking their responsibility seriously. Residents say they are practicing social distancing, with isolated seniors and families mostly at home, apart from children at school. Citymapper statistics indicate a 75% drop in mobility in Stockholm. Travel over the Easter weekend fell more than 90%; the government did not tell the ski resorts to close at Easter, a popular time for ski vacations, but the resorts closed anyway. Lovin told the BBC that it is a “myth that Sweden has not taken serious action.”
But whether the strategy works depends on the metrics you look at and how you interpret them.
By the numbers
At the time of publication, Sweden had 18,640 confirmed cases of Covid-19 and 2,194 deaths. That makes the country’s 217 deaths per 1 million people significantly higher than in neighboring Norway, Finland, and Denmark (whose populations are about half that of Sweden), but lower than in Belgium, Italy, or the UK. United and the Netherlands.
In addition to a higher mortality rate (both in absolute and relative terms) compared to Denmark and Norway, Sweden has had high rates of infection and death in nursing homes, where more than half of Covid’s deaths have occurred. 19 in the country. In Norway, which has similar social safety nets, the rates have been much lower.
While it represents a significant defeat for a country that prides itself on democratic socialism, Tegnell said the problem is due to weaknesses in the social safety net, not the coronavirus response. “It is not a failure for the overall strategy, but it is a failure to protect our elderly living in nursing homes,” Tegnell said at the April 15 briefing.
But Sweden’s health system has not been overburdened, a key goal for countries that have opted for the blockade. Many intensive care beds are free, Tegnell said. The country more than doubled its ICU capacity to more than 1,000 beds; 550 are currently occupied (link in Swedish). In the meantime, there is no tense debate about how to reopen society and whether there will be a second wave, because society has largely remained open.
Sweden’s economy is still expected to be hit hard. According to Magdalena Andersson, the finance minister, GDP could drop by 10% this year and unemployment could rise to 13.5%. Sweden is an export-driven economy and therefore depends on a global economy that has effectively closed. Lovin, the deputy prime minister, said 90,000 people had applied for unemployment in the past four to five weeks. Claims in Norway are much larger, in relative terms, suggesting that there has been less economic impact in Sweden.
Perhaps the strongest indicator of success for the Swedish strategy will be the country’s ability to achieve herd immunity, the protection that emerges when a virus breaks through a population. The more people acquire immunity to the virus, the fewer potential vectors exist to accelerate its spread. Patrick Vallance, UK chief scientific officer, has said that around 60% of a population needs to be infected to develop herd immunity.
But the idea of collective immunity is controversial. “[W]and I don’t know how long that [immunity] it will last and that should cast doubt on that approach, “said Rowland Kao, a mathematical biologist studying infectious disease dynamics at the University of Edinburgh. The Netherlands and the UK initially followed a collective immunity approach and quickly switched felt after projections showed that cases would skyrocket and overwhelm the health system.
Tegnell insists that collective immunity is not Sweden’s strategy. “Herd immunity is not a policy, it is a state that can be achieved,” Tegnell said. “We want as few people as possible to become infected, at a slow rate, so that the health system can cope.”
Tegnell said in a briefing that the country’s policies in the pandemic were informed by science, but also by the way the Swedes have always valued independence. “It is a long tradition that works very well,” said Tegnell. But not everyone agrees with the approach.
Not for everyone
On April 24, a group of 22 doctors, virologists and researchers criticized Sweden’s public health agency in an opinion piece published by Dagens Nyheter, the country’s leading trade newspaper. “The approach must be changed radically and quickly,” the group wrote. “As the virus spreads, it is necessary to increase the social distance. Close to schools and restaurants. All persons working with the elderly must wear suitable protective equipment. Quarantine the entire family if a member is ill or tests positive. The elected representatives must intervene, there is no other option. “
In late March, Cecilia Söderberg-Nauclér, a viral immunology researcher at the Karolinska Institute and one of the signatories to the opinion, told the Guardian that the Swedish approach “was leading to catastrophe.” A month later, she has not changed her mind. “I see no indication that we are not heading there in Stockholm,” he said in an interview with Quartz.
Söderberg-Nauclér said death rates appear to be higher than those cited by the Folkhälsomyndigheten (the Swedish health authority) of 0.1%. Between March 27 and April 3, the government randomly evaluated 773 people, finding an infection rate of 2.5% in Stockholm. Extrapolating from there, approximately 58,000 people would have been infected, which should have resulted in approximately 58 deaths three weeks later, but Stockholm has just passed 1,022 deaths, suggesting a mortality rate closer to 1.7%, he said. She doesn’t see the “plateau” that authorities are citing and suggests that ICUs could still be overwhelmed in a few weeks.
Not enough is known, he said, to follow a policy of allowing people to slowly become infected. “We should be humble because we know very little, but we are going for a strategy that has not been proven in the world, and there are too many unknowns that make this too risky,” he said. “I want to hold back and keep it under control and have faith in the medical community and understand pathology,” he said.
There are several social and epidemiological reasons that, if Sweden’s strategy works, it could only be applied within its borders. While comparisons with Denmark and Norway may be adequate, comparisons with larger and more diverse countries are not. “What works for Sweden will not work for the UK,” said Kao. Sweden’s first case also came later, so it had more time and information than other countries to begin measures of social distancing.
They may also be easier to run: Sweden has a small population of 10 million, about the size of Georgia or North Carolina, and that population is scattered. More than 50% of households are single-dwelling households, reducing the risk of transmission. Many people work from home and have fast Internet access. Some have noted that Sweden’s character is well suited for social distancing. A popular meme is a before and after Covid photo of a bus stop, with people two meters apart in both boxes.
There is also a cultural X factor. Sweden’s strategy is notable for what it says about trust in the country: between citizens, and between citizens and their institutions. The government’s trust in citizenship underpins the policies established so far, and it is trust in its institutions that, for now, leaves most Swedes supporting the current approach. But some no doubt share the dystopian sentiment described by a Stockholm resident who told Quartz: “We are all a social experiment that we do not ask to be a part of.”
What is different about Sweden?
More than 80% of Sweden’s residents say they think their country’s approach is correct. Life has changed, but children can go to school, people can work, and businesses have not been closed uniformly.
Tegnell may have criticism, but he is a calm and professional presence, who does not claim to have answers where there are none. During the briefing on April 15, he answered what he could, but to immunity questions and to know what was right, he repeatedly said “these are things we don’t know.”
“One of the real assets we have is calm, a sense of normalcy, in this difficult situation,” said Lars Trägårdh, professor of history and civil society studies at Ersta Sköndal University College in Stockholm. Tegnell said, “It is an important part of that.”
Many Swedes also think the approach is logical in the context of the country’s history, culture and values, which they consider the “rights” of many, not just the elderly and the sick, Trägårdh said. Children’s rights and gender rights are part of the calculation that decides what to close and keep open.
Tegnell echoed similar sentiments at his briefing on April 15. “When we talk about school closings, we talk about the effects of children not being able to go to school and that is important from a public health perspective,” he said, noting the importance of the first 10 years of life for results. long-term health. . With schools closed, health workers with children may not be able to work; grandparents, a large part of whom care for children, would be at risk.
“You don’t destroy the social fabric to save people, you have to pay attention and take care of society as much as you do sick people and people,” said Trägårdh.
He says that Sweden’s social contract is based on a close alliance between the individual and the state, or what he calls “statist individualism”. Citizens have innumerable protections provided by the state (unemployment, health care, good public schools, efficient government services), which in turn enables them to maximize their own options (living alone, changing jobs, having children).
Trägårdh finds it amusing that libertarian groups in the United States are the ones cheering on Sweden now, as they would normally be the ones to ridicule Sweden’s “nanny state”. Precisely because the government cares for and trusts its citizens, and because citizens trust the government, Swedes are “free” to distance themselves socially and stay safe.
Every leader faces tough decisions trying to navigate the balance of minimizing deaths with minimizing pain for the economy. Sweden has definitely opted for the road less traveled. The question is what difference will it make.
“Did Sweden try too hard to take that middle course and crash into both?” Kao asked. “Only further investigation will tell us.”
