As most governments around the world impose strict social distancing measures to try to stop the spread of the coronavirus, Sweden has tried something quite different — and it’s unclear if it’ll prove successful or lead to more deaths.
For months, the Scandinavian nation allowed large gatherings to form, schools for younger children to remain open, restaurants to serve late-night guests, and resorts to welcome thrill-seeking skiers. Although some restrictions were in place and many people observed general safety and social distancing measures, Swedish health authorities felt it was better to have much of the country operating somewhat normally instead of shutting it all down.
On a theoretical scale of activity, where most countries brought it down to zero in the hope of quickly ramping up to 100 again, experts say Sweden has tried to keep the country at a simmer of 30 to manage the crisis for months to come.
“The reason given by Swedish authorities is about resilience,” Peter Lindgren, the managing director of the Swedish Institute for Health Economics, told me. “We may have to do this for a long time, and if you put all the heavy stuff in place at once, it will be quite difficult to maintain that. By having some measures in place and trying to be a bit more proportional, it’s possible to actually keep this under control.”
Sweden’s neighbors have taken a more aggressive approach during the Covid-19 outbreak. Denmark and Norway, for example, quickly closed their borders along with schools and industry to maximize social distancing. The chart below shows that those two countries have done better than Sweden in keeping the number of cases down.
There are sharp differences in COVD19 strategists between the Nordic countries. And also a distinct difference in results as measured in deaths. pic.twitter.com/Egw51K02Xk— Carl Bildt (@carlbildt) April 16, 2020
But Swedish officials, and particularly chief state epidemiologist Anders Tegnell, argue theirs is the right way forward. “Locking people up at home won’t work in the longer term. Sooner or later people are going to go out anyway,” Tegnell told reporters recently. He’s also repeatedly said it would be good for the Swedish population to gain immunity to the disease, though he’s flatly denied purposely seeking “herd immunity.”
Whatever the true goal, Sweden’s strategy appears to be troubled.
As of April 9, Sweden’s rate per capita of confirmed deaths from the coronavirus is higher than the rate of its fellow Scandinavian countries or the US. Hospitals are overcrowded and staff members are overworked, and the military has begun setting up field hospitals in major cities, including Stockholm, the country’s capital and the epicenter of its outbreak. The government is now seeking extraordinary powers to impose further restrictions.
Some experts I spoke to estimated that as many as 4 million Swedes — out of a population of around 10 million — may eventually contract the disease. And Swedish Prime Minister Stefan Löfven stated this week that “thousands” in his country will die from Covid-19.
Experts note it’s still too early to tell if the Swedish government’s methods will prove successful in the end. But most Swedes I talked to said they’re unhappy being the world’s guinea pigs at such a dangerous time.
“I didn’t sign my informed consent for this experiment,” virologist Cecilia Söderberg-Nauclér of the Karolinska Institute, a medical research center near Stockholm, told me. “I don’t know if [my family and I] can stay in a country that is not protecting its population.”
Many Swedes adopted social distancing. But not all of them.
As the outbreak started to hit Scandinavia, Norway restricted outdoor gatherings to no more than five people and encouraged those inside to keep 6 feet away from each other. Denmark was one of the first countries in Europe to close its borders as it also shuttered schools and restaurants and limited outdoor groups to 10 or fewer.
Sweden’s government, by contrast, said it was okay for up to 500 people to meet outside. Schools for children 16 and younger would remain open, as would other establishments from restaurants to hair salons. And the government refused to close borders because, in Tegnell’s words last month, “We are not in the containment phase. We are in the mitigation phase,” because the virus had already hit the country.
The government was clear, though, that Swedes should adopt the usual social distancing measures to flatten the curve. And experts told me the population typically trusts what officials say and abides by their guidelines, allowing officials not to have to impose strict measures.
Top Swedish officials say that two-way trust is paying off. “It is a myth that life goes on as normal in Sweden. Many people stay at home and have stopped traveling,” Sweden’s Minister of Health and Social Affairs Lena Hallengren told me. “There is no full lockdown of Sweden, but many parts of the Swedish society have shut down.”
Hallengren offered some data points to make her case. Ridership on public transportation in Stockholm has dropped about 60 percent, she said. Nearly all domestic flights in Sweden have been canceled. All the major ski resorts in the country have closed voluntarily. And local media reports that 85 percent of people who’d planned to travel to Gotland, a popular Swedish vacation island, have canceled their trips ahead of Easter weekend.
Ludvig Beckman, a political scientist at Stockholm University, agreed with this general view. “A large majority are following the government’s advice,” he told me. “It’s pretty empty out there.”
Even critics of the government’s handling of the outbreak like Söderberg-Nauclér said that “it was a great thing from the beginning to trust people.” But, she noted, not everyone would reward Stockholm’s trust — and that’s where major problems have arisen.
Sweden’s lax coronavirus approach could put its people in danger
Knowing that events were capped at 500 people, organizers purposely sold 499 tickets to customers. Some older people, feeling little pressure from authorities, continued to go out into busy public squares. And bars, a central hangout spot for many young people in Stockholm, still served patrons deep into the night.
“Is it really that damn bad?” Sandra Bergkvist, a 28-year-old grocery clerk in Sweden, asked in an interview with the Washington Post this month while drinking beer with friends. “Of course we’re worried about people in the risk groups, but if it wasn’t for media it wouldn’t have been this hysterical.”
That nonchalance may have led to the country’s worsening coronavirus numbers.
The number of confirmed Swedish Covid-19 deaths has risen to more than 650, as of April 9. That brought the death rate per million in Sweden — Scandinavia’s biggest economy — to about 65. By comparison, Denmark’s rate was near 40 while Norway’s was near 20.
And Sweden’s numbers are likely to get even worse: One-third of all of Stockholm’s nursing homes have at least one case of the coronavirus.
In response, the government has taken some important steps, such as restricting gatherings at outside venues to 50 people and telling those at restaurants to sit only at tables, not stand crowded around the bar. It’s also seeking extraordinary powers to impose further measures, which could lead to forced closures of business, schools, airports, railways, and more. The military is also setting up a field hospital in a major conference center in the capital.
“The government is ready to adopt stricter measures to combat the virus whenever we consider it necessary,” Hallengren said.
But virologist Söderberg-Nauclér isn’t buying it: “It’s too late to try and stop” a larger outbreak, she told me.
Which means many Swedes are now potentially at risk of contracting the deadly virus who wouldn’t have been had the government imposed these measures much sooner.
Sweden’s health care system was better prepared than most for a major outbreak
Estimates vary among experts I spoke to, but the country’s health system likely has had somewhere between 500 and 1,000 beds available in hospital intensive care units. This follows a quick ramp-up from the government and lots of funding for a universal health system that’s considered top-tier worldwide, with well-trained physicians.
According to Lindgren of the Swedish Institute of Health Economics, hospitals typically have enough equipment for 48 hours should no shipments of protective equipment like masks arrive. However, he said, the national government has been good about buying and distributing materials to caregivers when needed.
And while physicians are overworked as cases increase, Lindgren said, the number of new admissions to intensive care units over the past two weeks has remained flat, at around 30 to 40 people per day.
Critics, though, note that recent reforms to the nation’s health care system led to an unnecessary shortage in the stockpile of protective materials before the crisis and lower capacity at hospitals.
So Sweden may be better off than most, but it could struggle to deal with a rapid uptick in coronavirus cases like many other countries.
Sweden’s Public Health Agency has a lot of autonomy. That worries some people.
Still, many Swedes see no need to panic. “I think our government is doing the right thing,” Margareta Eriksson, a retired 67-year-old in Stockholm, told the Washington Post this week.
That sense of security comes partly from widespread trust in the Public Health Agency. It’s a mostly independent organization that takes the lead during major public health crises like disease outbreaks and is heavily protected from political interference.
No government minister actually oversees the agency, which gives Tegnell, the government’s chief epidemiologist and response coordinator, a lot of room to make decisions as he sees fit.
“There’s cause for a [government] minister to get sacked if they interfere” with independent public bodies, Lindgren told me. “The scandals that get reported here are when ministers try to place undue influence on the experts.”
That became clear during my interview with Health Minister Hallengren, who said the government defers to the agency on a lot.
For instance, “the government relies on advice from the Swedish Public Health Agency regarding school closures,” she told me. “If the Swedish Public Health Agency makes the assessment that all schools in Sweden should close in order to fight the spread of Covid-19, the government is prepared to do so” after coordinating between the two sets of authorities.
That all seems good on the surface. During a medical crisis — especially one as large as the coronavirus outbreak — it’s important for politicians to step aside and let the experts lead the way. But that only works if the experts offer sound advice, and it’s not clear Tegnell is.
Critics say he’s trying to have the country develop herd immunity, a controversial approach that aims to have many millions contract the disease so the wider population is resistant to infection down the line. It’s an idea that seemed to take hold in governments in the United Kingdom and the Netherlands — before models showing such a policy would merely lead to more deaths led them to change course.
Tegnell firmly denies that developing herd immunity in Sweden is his goal, but he has told reporters it’s “not contradictory” to his aims, either. Stockholm University’s Beckman noted that Tegnell recently said Sweden only has two options: Either everyone gets vaccinated or the country develops herd immunity.
It’s comments like these that make the Karolinska Institute’s Söderberg-Nauclér deeply skeptical of the government’s aims. She and more than 2,000 other academics and experts signed a petition requesting that the government pursue a different strategy. “It’s my responsibility as a scientist” to call them out, she told me. “I don’t trust authorities. I trust data.”