COVID-19: Sweden’s Reckless Approach

With half the world’s population living under enormous social restrictions due to the coronavirus, one European country has taken a starkly different approach. Madeleine Johansson reports on the reckless approach of Swedish authorities.

While most of Europe is on lockdown as a result of the coronavirus, the Swedish situation is much different. Primary schools and pre-schools remain open and children are still playing team sports in their free time. Restaurants, bars and cafes offer table service only, but they are still running, and Swedes continue to shop and socialise. In other words, in comparison to the rest of Europe and much of the world, Sweden remains open for business.

Yet Sweden is not untouched by COVID-19; there are over 7000 confirmed cases. However, since testing has been limited from the beginning of the outbreak, the real number is probably much larger. At the time of writing, 477 people have lost their lives to Covid-19 according to official figures. These figures are significantly higher than Norway (5700 cases and 73 deaths) and Denmark (4600 cases, 187 deaths), who have much tighter restrictions on their populations.

So why has the country taken such a different approach to dealing with this crisis?

The Swedish Approach

The Swedish government—made up of the Social Democrats, The Liberals and the Centre Party—has been following the advice of the national public health officials at Folkhalsomyndigheten. Anders Tegnell is the State epidemiologist at the authority and has been the face of the decisions in Sweden.

Though Tegnell never uses the term herd immunity, he believes that shutting down the country and enforcing a lockdown has repercussions that are as bad as people dying from COVID-19. Tegnell, who was educated in London, followed the same approach as the UK, until Boris Johnson’s spectacular U-turn in the face of public and scientific pressure. But whilst the UK fell in line with WHO recommendations and the rest of Europe, Sweden held the line and continues to be open for business.

The main recommendation throughout the crisis has been that any person who is sick or elderly should stay at home. Social distancing is encouraged, but not mandated. These recommendations disregard the fact that scientists believe that people are contagious during the incubation period, as well as the mounting evidence that asymptomatic people can be contagious.

People have been asked to work from home where possible, but employers have not been compelled to ensure this. Furthermore, business has continued as usual in workplaces where it’s not possible to work from home.

From the 12^th of March until the 27^th of March the recommended minimum number of people in a social setting was 500 people, then it was reduced to 50 people, with exceptions in place for schools, libraries, swimming pools and private parties. Only on the 1^st of April was the advice finally amended to include social distancing in shops, shopping centres, gyms and public transport. People have been advised against attending private parties and any gatherings. The latest recommendations represent a gradual shift in strategy, but this change may be too little too late. The effects of the same relaxed approach can be seen in the UK right now, where the lockdown came late in the spread of the virus. We are now witnessing the devastating consequences of this approach.

Anders Tegnell, and his colleagues at the public health authority, have defended the strategy by arguing that Sweden’s health care system is capable of dealing with the crisis; that Swedish people will listen and adhere to the advice without requiring strict controls; and that any measures adopted need to be balanced with the impact on the economy. Each reason should be examined in detail.

The Healthcare Myth

Although the Swedish healthcare system has a reputation abroad of being very good, the facts are quite different. Sweden’s healthcare system has been decimated by cutbacks since the 1990’s banking crisis, leaving it extremely vulnerable to this pandemic. The country has fewer intensive care units than Ireland at 5 per 100 000 people compared to Ireland’s 6.5, and less than half of the EU average of 11.5. In the 1990s there was a stock of 2100 spare ventilators in case of an emergency, but now there are none.

The strategy pursued by Ireland and most other countries is based on trying to flatten the curve of infections in order to not overwhelm the intensive care units, and therefore save as many lives as possible. In Italy, doctors have told horrific stories of having to choose which patients to put on ventilators and which patients to leave to die. Based on the experiences of other countries, it is clear that Sweden is in a precarious position.

Swedish Culture

The second reason touted for Sweden’s approach so far involves a cultural assumption about the Swedish population in relation to both living conditions and behaviour. In terms of living conditions, it’s certainly true that Swedish people tend to live in smaller households than many other countries. According to official statistics 40% of households are single people or couples without children. Swedish people seem to socialise less compared to their European counterparts, based on percentage of income spent on eating out. The other argument is that Swedish people trust the authorities and the government and will take action based on information rather than strict rules.

But there are problems with these arguments about Swedish culture. Firstly, there is no evidence that these cultural differences will combat the spread of the coronavirus. Experience from other countries further along in this pandemic shows that even were Tegnell’s reasoning correct, these assumed cultural differences would still not result in the amount of social distancing required to flatten the curve.

Secondly, this argument disregards many minority groups such as migrants and refugees who tend to live in larger households and socialise more frequently in groups through religious and family gatherings. In addition, many who have fled their home countries will be extremely sceptical of authorities and have less access to information. As of last week, out of the 100 or so people who died from COVID 19 in Stockholm, 15 of them were Swedish-Somali. This outbreak occurred where they were all living in the suburbs of Stockholm and had been socialising collectively. This disproportionately high number of Swedish-Somali deaths can be blamed on overcrowded housing, poverty, poor health and lack of language appropriate communication.

Additionally, another outbreak in the Syrian-Orthodox community in another poverty-stricken suburb has taken the lives of 8 people. The strategy of a reliance on a trust in the authorities and the media is leaving behind many minority communities. This strategy is having devastating consequences in communities that are already suffering from inequality and poverty.

Public Health vs the Economy

The third reason for Sweden’s relaxed approach is that the measures must be regarded not only in consideration of public health, but also with consideration to the economy. This argument was made by the CEO of Stockholm’s Chamber of Commerce Andreas Hatzigeorgiou who said: “We have to combine looking at minimising the health effects of the virus outbreak and the economic impacts of this health crisis.” As late as Friday 3 April, the Prime Minister Stefan Lӧfven said that: “We have to lessen the impact on the economy and jobs, and reduce the worry among the population.” In the same interview with a major newspaper he said that thousands of people will die from the virus.

This approach is equating people’s lives with the economy, which could have devastating consequences. Regardless of the current approach, the Swedish economy is already suffering from what is now a global crisis. Last week, the major Swedish bank Swedbank forecast that the economy would contract by 4% in 2020. The current downturn in the Swedish economy is broader and faster than during the financial crisis of 2008. Unemployment will reach 10% already by the summer, despite unprecedented measures introduced by the government. Furthermore, the more death and destruction COVID-19 brings, the more the economy and the social fabric of Sweden will be damaged.

The Dissenters

Anders Tegnell’s strategy does not have unanimous support. In fact, at the time of writing this article, Sweden is debating switching to a lockdown strategy that more closely mirrors the rest of Europe. This is because over 2000 scientists and doctors have signed a letter outlining their concern with the strategy pursued by the Government, by advice from Folkhalsomyndigheten. They have been calling on the Swedish government to follow the WHO recommendations of testing more and closing down schools, restaurants and bars. One of the undersigned is Olle Kӓmpe, immunologist at the Karolinska Institute, who argues that understanding the level of spread through testing is crucial to isolate the virus. Currently, just over half of Swedish people support the government’s approach, however as this crisis escalates that number might dwindle fast.

It’s still too early to judge whether the Swedish approach will lead to disaster. The last few days have shown worrying increases in numbers of diagnosed cases and deaths, and it’s possible that Sweden now stands at the brink of a similar scenario that has been seen in Italy and Spain. If that comes to pass, the responsibility must be put firmly on the shoulders of both the Public Health Authority and the Swedish government for their reckless approach. An approach which has put the economy before public health.