What is clear is that so far Sweden has had a more protracted outbreak with far more deaths per capita than its neighbours. The Swedish prime minister even ordered a public inquiry into his government’s handling of the coronavirus crisis in July after the country recorded more than 5,000 Covid-19 deaths. But virus numbers recently having reached amazingly low levels. The most common number of Covid-related deaths announced for each day of the past week in Sweden has been zero with few patients needing intensive care.
While it is early to pick the longer-term winners and losers from the pandemic, the Nordic nation has been both hailed as a success and condemned as a failure for its relaxed approach. But, which is it? There is increasing interest in this question.
THE SWEDISH EXPERIMENT
It’s been a difficult six months for Sweden. Normally used to being uncontroversial liberal paradise, its unorthodox approach to the coronavirus pandemic resulted in global scrutiny as the eyes of the world turned on the “Swedish experiment”.
Instead of closing down its economy, the country issued comparatively light restrictions — banning public gatherings of over 50 people (private ones were exempt from the ban) and otherwise encouraging the country’s 10 million people to respect physical distancing and work from home if possible while recommending that old and vulnerable people shield themselves. But all schools for under-16s, shops, bars, restaurants and gyms remained open. Masks have not been recommended as health officials believe that face coverings outside of health care facilities create a false sense of safety that could see sick people leave home and ignore social distancing.
At first, the strategy seemed to be going badly. The infection quickly took hold in Stockholm, many of the large care homes had outbreaks, and already by the end of April deaths per capita in Sweden dramatically exceeded neighbouring Norway and Denmark (although throughout remained less than the UK, Spain, Italy and Belgium). In May, the country recorded the most Covid-19 deaths per capita in Europe, despite a sparsely distributed population and a well-regarded hospital system. But soon after, deaths began to fall. And they continued to fall through the summer, even as Swedes gathered in more crowded places like beaches and restaurants and mostly without masks.
The lighter approach on lockdowns meant the Swedish economy was spared somewhat, shrinking 8.3 percent in the second quarter, and the government is forecasting an overall 4.5 percent decline for the year — better than Spain and France, but comparable to the other Nordic countries. The European Union overall saw a decline of 11.9 percent during the same period, so the Swedes did better than average. The Swedish unemployment rate appears to have peaked at 9.8 percent in June, and was down to 8.8 percent in August. That’s actually on the higher end among European Union countries.
Swedish government officials have insisted that saving the economy was never the purpose of their controversial coronavirus strategy. Its aim was to save lives and reduce pressure on the country's health care system. The rationale given by the architect of the Swedish strategy, state epidemiologist Anders Tegnell, was to consider overall public health not just Covid-19. The crisis was “a marathon, not a sprint”, he has repeatedly said, arguing Sweden’s approach may prove more sustainable than lockdowns.
LESSONS TO BE LEARNED BUT QUESTIONS REMAIN
Today, Sweden has fallen beneath its Scandinavian neighbours Denmark and Norway, heralded as “example nations” for their decisive action but now suffering a big surge in case numbers. Prof Sneppen, an expert on the spread of Covid-19 even proclaimed in Denmark’s Politiken that the pandemic in Sweden "running out of steam.”
A World Health Organization Europe official suggested the continent could learn broader lessons from Sweden that could help the virus battle elsewhere. “We must recognise that Sweden, at the moment, has avoided the increase that has been seen in some of the other countries in western Europe,” WHO's senior emergency officer, Catherine Smallwood, said recently. She added: “I think there are lessons for that. We will be very keen on working and hearing more from the Swedish approach.”
Big questions remain, however, about the Swedish approach.
Dorit Nitzan, the WHO’s regional emergency director for Europe, has stressed there was no “one size fits all” solution and every approach should be based on situation and context. If the WHO was keen to learn more from Sweden, it was because it saw the country as one that had “adapted its response to its people’s behaviour and background, and leveraged that to make it effective”.
‘Nitzan stressed that Sweden’s approach may not be applicable everywhere. Other countries should take into account that in Sweden, the social contract between the government and its population is historically based on a very high level of trust, she told The Guardian. “That is the way the Swedish people and the government interact.”
In addition to the high level of government trust, there are also social factors that could be having an effect therefore imposing Sweden's model on countries with different systems and cultural practices is risky.
More than 50% of Swedes live alone, for example, more than any other country in Europe. Sweden's cities are less dense than many in the UK and US, for example, yet there is no consensus on what role density plays in the spread of Covid-19.
In Sweden, if you have any symptoms of a cold, you are advised to stay at home for two weeks. Whether you are a banker, teacher or bus driver, Sweden's strong social safety net means a person is paid their full wages during this period.
"We can see no merit in Sweden being held up as an example for us," said Dr. Gabriel Scully, part of Independent SAGE, a group of experts who have banded together to offer the public alternative advice to the UK government's official advisory body, known as SAGE. He called Sweden's approach "ineffective" and pointed out that the country's Nordic neighbors, like Finland and Norway, had more successful responses, with far fewer deaths.
In a briefing, the group argued that the UK could be more vulnerable to the virus than Sweden if restrictions were kept loose. There are generally higher financial pressures in the UK. Residents spend more of their income on housing and unemployment benefits are lower, for example, which may influence people's risk-taking behaviour.
‘Following the Swedish example, therefore, should not mean adopting the exact same measures, she said. “There are lessons to learn from every country. None has done it perfectly; all have made mistakes. Each country’s strategy to curb COVID-19 should be based on its specific situation and context, and be both scientifically sound and culturally acceptable. This is Sweden’s approach”.’
The recent interest in Sweden has also marked a return to the debate on "herd immunity," the idea that if a certain percentage of your population is immune to a virus, the virus cannot transmit easily and will eventually die out. Scientists say that many viruses can be combated this way when 60-70% of a population is immune but that is usually achieved with a vaccine.
Curiously, there’s not much sign that Swedes have developed herd immunity. Blood surveys of residents of Malmö in April estimate that only 4% of the city’s population have those antibodies, well short of herd immunity. The number for Stockholm is 17%.
Sweden also hasn’t been completely immune to a rise in cases as it also seen an uptick in infections the past week, and Tegnell himself has conceded that authorities may now need to implement tighter restrictions at the local level and recommend mask-wearing in public areas, like shops, for the first time since the virus arrived -- something he has spoken out against doing for months. On Thursday last week, Swedish Prime Minister Stefan Löfven described the increase in cases as "worrying."
Sweden's Public Health Agency denied the country was backpedalling in its approach, saying in an email to CNN that it had always been prepared to advise the use of masks and impose restrictions in certain situations.
