Nations around the world are using different tactics to deal with the novel coronavirus, but almost all of them involve some form of lockdown and social isolation orders. Sweden however, decided to go in another direction. Despite 26,670 cases and 3,256 deaths (as of May 12), many experts are asking – is Sweden’s approach the right way to tackle the coronavirus?
The nation kept bars, restaurants and other public spaces open, and to many outside observers it looks like people are behaving as if life was perfectly normal. However looks can be deceiving. Sweden hasn’t forced stay-at-home measures, rather the nation is betting on its citizen’s smarts to enforce social distancing. The government believes voluntary social distancing is the right thing to do – a move backed by the public.
Onus on the People
Sweden’s approach has put its state epidemiologist at the front and centre of the coronavirus response. Unlike other nations, Dr. Anders Tegnell has been at the forefront of government news conferences and policy making, with a strong focus on facts and figures. By keeping the politicians away, the nation has sent a strong message to the public – our experts know what they are doing, and they are in charge. This has led to high levels of awareness amongst the Swedish public.
While the government has banned gatherings of over 50 people and visits to elderly care homes, almost all other efforts are taken up by citizens without being enforced. Public transport usage has dropped, large numbers are working from home and many refrained from travelling over the Easter weekend. Around 9 in 10 Swedes say they keep at least a metre away from people at least some of the time, up from seven in 10 a month ago, according to a major survey by polling firm Novus.
As a result, Intensive care beds around the country are still available, and the army field hospital set up at the Älvsjö conference centre in Stockholm is yet to be used. In the capital of Stockholm, the epicentre of the virus, the number of cases has somewhat plateaued indicating that Sweden seems to have got its response right.
“To a great part, we have been able to achieve what we set out to achieve. Swedish healthcare keeps on working, basically with a lot of stress, but not in a way that they turn patients away.”State epidemiologist Dr. Anders Tegnell
Despite the general support for the lighter measures adopted by the government there are a growing number of critics from within the country’s scientific community. The nation has more cases and deaths than its neighbours Norway (8,132 cases and 224 deaths as of May 12) and Finland (5,984 cases and 271 deaths as of May 12). Sweden is also amongst the top 10 nations when it comes to coronavirus cases. It has higher death rates in relation to its population size than anywhere else in Scandinavia.
“There are too many people dying,” says Claudia Hanson, an epidemiologist based at Karolinska Institutet, Sweden’s largest medical research facility. Dr. Hanson was one of the 22 scientists that wrote a damning criticism of the Swedish response in April in Sweden’s leading daily.
In response, Dr. Tegnell said that a large reason Sweden had such a huge number of cases compared to their neighbours was down to the virus finding its way into care homes. Unlike most nations, Sweden is also including care homes in its official statistics, and these are responsible for 50% of all deaths. He also argued that while the nation has more cases in the short term, the second and third wave will be milder in Sweden than most other nations.
Following a Different Path
When modelling the impact of the coronavirus at the outset of the pandemic, Dr. Tegnell and his team went down a different path as compared to other nations. The team used simulations which anticipated a more limited impact of the virus in relation to population size than those made by other scientists, including those behind a major report by Imperial College, London.
Unlike other nations, a core aim of the Swedish strategy was to impose measures that could be imposed over a longer period of time. Despite lockdowns lasting just four weeks in the UK, USA and India, these nations have now begun easing rules and allowing more people outdoors. This current method does little for the long term health of its citizens, or the economy.
In contrast, Sweden has ensured that their economy is still running, but without sacrificing the safety of most of its citizens. The Public Health Agency denied rumours that their strategy was based on herd immunity, but rather on the idea that a large number of cases were likely to be mild. The nation is also aided by its relatively low population density (about 25 people per square km), which acts as a natural barrier to the spread of the virus.
While herd immunity may not be the official strategy, it is a byproduct of Sweden’s response. Many scientists now believe Swedes will end up with much higher immunity levels than those living in nations in full lockdown. A public health agency report in April suggested around a third of people in Stockholm will have been infected by the start of May. Prof Johan Giesecke, ex-chief scientist of the European Centre for Disease Prevention and Control (ECDC), believes at least half of all Stockholmers will have caught the virus by the end of the month.
Until a vaccine is developed, this kind of immunity is important to maintain. Epidemiologist Emma Frans said: “When it comes to studies and other types of coronaviruses, they have shown that people get immune. Maybe not long-term immunity, but even if we only get this kind of short-term immunity, it may be enough to stop this pandemic.”
However, there’s still so much we don’t know about the coronavirus. It is unclear as of now if Sweden’s method will work in the long term, especially since more people are likely to step outdoors over the coming weeks as the weather turns warmer. Despite Prime Minister Stefan Lofven’s warning that it is “not the time to relax”, more and more Swedes are spending time outdoors.
If infection rates spike in the coming days, Sweden could be forced to implement more stringent measures. Either way, Swedes, like the rest of us are slowly adapting to the ‘new’ normal, a world where social distancing is the norm.