All you wanted to know about Sweden's policy (but were afraid to ask)

Contrary to popular opinion, Sweden’s handling of the coronavirus crisis is not so unusual. Sweden is not a coronavirus-denier, it is not continuing business as usual and it does not seek herd immunity; it is just trying to flatten the curve by social distancing using methods suitable for its society and its political culture. For example, the decisions are made at the professional level and not the political one, most of the directives are recommendations not obligatory orders and there is almost no enforcement through fines or police action.

Published in "Haaretz":

The essential differences, compared to other countries, are few: Sweden did not close its elementary schools or its kindergartens; it did not recommend the wearing of masks and did not impose general lockdowns, because the authorities decided that these steps would do more harm than good.

The uniqueness of the Swedish model might therefore be defined as “non-imposing of lockdown.” This is a significant difference, but – and the conspiracy theorists will forgive me – it does not prove that Sweden treats the coronavirus like “flu with PR.”

The main argument of critics of the Swedish model is the high mortality rate, about 11,000 in a country of 10 million. While this is a human tragedy, even if we ignore the fact that the population of Sweden is very elderly (about 20 percent are age 65 or over), the number of the dead compared to the number of inhabitants is still much smaller than in other countries in Europe that imposed strict lockdowns, like France and Great Britain. The experience in Europe so far has shown that lockdowns do not necessarily reduce the level of mortality.

The focus on the “failure of the Swedish model” in this matter is absurd and its purpose is to justify the policy of lockdowns. Why isn’t anyone talking about the “failure of the Belgian model,” for example? The number of dead in Belgium, which imposed severe lockdowns, is about 1,800 per million inhabitants. In Sweden, the number is less than 1,100 per million.

“But even the king of Sweden himself said the Swedish model failed,” goes another common claim. King Carl Gustaf XVI did stammer something in an interview about the high number of the dead being a failure, but he did not relate to any specific component of the Swedish model, and certainly not to the fact that no lockdown was imposed. The criticism expressed by the king is also accepted by the state authorities, which concede the failure to protect nursing homes. But more importantly – and the monarchists will forgive me – the king of Sweden does not deal with the matter, he is not particularly knowledgeable about it and he has no influence or political power whatsoever.

One of the reasons lockdowns were not imposed in Sweden is that until the beginning of 2021, the law did not permit this. The government could and indeed did restrict public events and initiated emergency action, but it did not have the authority to close restaurants, malls or gyms. Laws can be changed, but the Swedes are hesitant when it comes to restricting personal freedoms and human rights. That is one of the reasons that they seek to change behavior voluntarily, without orders and fines. There are many indications that change has indeed been achieved this way.

In Sweden it is easier to maintain discipline, trust and solidarity. Many claim that this is because its population is homogenous (a polite way of saying they don’t have ultra-Orthodox communities or an Arab population). But the image of the Swedes as blond and obedient, hard-working and doing as they are told is false – a quarter of the population is made up of immigrants or second-generation immigrants. That is in fact a great challenge, but with a social-democratic welfare system, ethnic variety does not necessarily contradict trust and social responsibility. On the contrary – and the Greeks and the Hungarians will forgive me – a lack of trust in the authorities and concern over government corruption are common in quite a few countries that are more ethnically homogenous.

Another issue absent from the public debate is the global addiction to tables and numbers, which can be drawn and understood quickly: The number of infected, the number of seriously ill, the number of dead. It will be years before the price of the lockdowns will be measured and calculated, but public health is a broad concept, and there are reasons to believe that the advantages of the Swedish model will be recorded in the future with regard to phenomena like depression, addictions, violence, weight gain, diabetes, disrupted treatment of other illnesses, poverty, unemployment and more.

This is the price of a lockdown: It’s high, it's tough, and it must be paid over the course of years. Sweden decided to avoid this although the temptation was great. Nevertheless, hospitals in Stockholm never got to the situation of hospitals in Lombardia and Madrid; excess mortality in Sweden over the past few months is lower than that of Switzerland and Austria; and the number of seriously ill patients in Sweden is lower than in Romania and the Czech Republic. Like every other country, Sweden made mistakes in dealing with the pandemic. But not imposing a lockdown wasn’t one of them. Comparing the illness and mortality rates in Sweden and Israel is problematic because it’s hard to compare a warm, young country with closed borders and lot of experience with emergency situations to a cold and aging country with open borders that last experienced war in 1814. But, on second thought,  that last part may not be such a disadvantage. Perhaps treating the pandemic like a military battle is a metaphor that got out of control, and produced sweeping, brutal solutions when what may really have been needed were complex, balanced and long-term solutions. I hope the generals will forgive me, but after all, the coronavirus is a virus, not an army, and COVID-19 is an illness, not a war

Sweden’s Coronavirus Crossroads: Get Tougher Than the Go-easy Approach?

STOCKHOLM – Once the coronavirus spread to Europe, Sweden captured the world’s attention with its low-key approach to fighting the pandemic. During the first wave in the spring, the Swedish government eschewed lockdowns and kept the elementary schools and preschools open. Gyms, restaurants and workplaces have also remained open throughout the crisis. Although measures like social distancing, working from home and discouraging large events were implemented, most were merely recommendations; no one would be fined. The policy was carried out at the recommendation of nonpartisan health experts and won the public’s trust.

At the wave’s peak, Sweden had one of the world’s highest death rates, yet this wasn’t attributed to the relaxed approach but to the failure to protect the elderly in retirement homes, where half the people who died had resided. The strategy came under fresh scrutiny this week following the release of an official report stating that the government had failed to sufficiently protect Swedes in retirement homes.

Commuters at a railway station in central Stockholm, December 2020, TT News agency, Reuters

Still, by summer, the belief was that perhaps the “Swedish model” was more sustainable than strategies elsewhere based on coercion and lockdowns. The number of infected people had decreased significantly; coronavirus wards in hospitals emptied and the death rate was not excessive.

But in the second half of October the second wave struck and now many of Sweden’s hospitals are overwhelmed. According to the Swedish statistics agency, the November death rate was the highest per capita in a decade and highest in absolute figures since November 1918 – during the Spanish flu pandemic. “The health system is overloaded,” Björn Eriksson, the health and medical care chief for the Stockholm region, said in a television interview. He described an event of historic proportions. “Never have we needed so much medical care at one time point in time, and an improvement doesn’t appear likely soon,” he said.

Worsening daily number

In recent days, 7,000 new coronavirus cases a day have been plaguing Sweden, whose population is 10 million. The number of patients in hospitals this week reached nearly 3,700, topping the peak of the first wave. The number of average daily fatalities is lower than in the spring, but with the total death toll approaching 8,000, there are fears the situation is getting worse. Sweden’s plight is no different than that of several other European countries now facing a second wave, but its per capita patient number is lower than in Switzerland, Austria, the Netherlands and the Czech Republic, where a similar number of tests are being done. Sweden comes in 25th in the world in deaths per capita – doing far better than Britain, Spain and Italy.

However, the situation in Sweden is far worse than in its neighbors Denmark, Norway and Finland, whose mortality and infection rates are among the lowest in the world. The numbers may be going up, but the Swedes are loyal to the model they created. Even in the second wave they decided not to impose a lockdown and kept schools and preschools open. The economy is functioning and although some people are wearing masks in public spaces, they’re still a minority. In recent days medical experts have slammed the public health agency, claiming that not enough has been done to slow the spread of the virus, and even Prime Minister Stefan Löfven appeared to be critical. Löfven told the daily Aftonbladet this week that the experts had underestimated the second wave, and the government is drafting a bill enabling the closure of shopping centers, gyms and public transportation.

The Royal Swedish Opera practicing social distancing, Stockholm, October 2020

Tactical change

However, the legislative process could take months and there’s no indication the government plans to implement a lockdown at this stage. Sara Byfors of Sweden’s Public Health Agency told Haaretz that while the country’s strategy hasn’t changed, stricter measures have been taken. “The Swedish strategy is to reduce mortality and the serious COVID-19 infection rate to a minimum and make sure the health system can cope and provide medical care to those who need it,” she said.

“The steps we’re taking to achieve this goal have changed in the course of the pandemic. In the autumn the government took steps like banning alcohol sales after 10 P.M. and limiting gatherings to eight people. We’re also very clear in our message that social interactions must be restricted, so the strategy has remained similar but the measures may change.” Additional measures have been implemented such as remote learning for school kids and the closing of some retirement homes to visitors. But these steps might not be enough: The hospitals are stretched to capacity, the death rate is rising and nonurgent medical procedures are being postponed. Last week, following the resignation of a large number of health care workers, the head of the Swedish Association of Health Professionals, Sineva Ribeiro, called the situation ”terrible.”

The head of emergency preparedness at the National Board of Health and Welfare, Johanna Sandwall, told Haaretz it saddened her to see nurses and other health workers quit during the crisis. “We don’t have an analysis yet as to whether it will affect national planning and what the repercussions will be,” she said. “At the moment the health system is stretched extremely thin due to the medical staffs’ exhaustion and the many COVID-19 patients. We have to take various steps to handle urgent needs.”

Either way, there is still no agreement on the Swedish strategy. Unlike those who say the current crisis stems from the soft approach and Sweden’s refusal to close everything down, many note that a raft of countries that shunned lockdowns are faring worse. This is reflected in infection rates, mortality, delays in treating strokes and heart attacks during lockdowns, and worsening cases of depression, obesity and addiction to drugs, cigarettes and alcohol, amid worsening violence, poverty and unemployment. The Swedish authorities also say it’s too early to judge their approach. At this stage they’re focusing on bolstering the health system and trying to prevent the virus from spreading. Conclusions will have to wait for the crisis to pass, they say.