Has Sweden Botched Its Coronavirus Response?
WHY YOU SHOULD CARE
How Sweden fares could hold critical lessons for other countries like the U.S., torn between maintaining a lockdown and revving up the economy.
By Heba Habib
Curfews, school closures, bans on gatherings — Europe is fighting desperately against the coronavirus. There’s an exception, though: Sweden is dealing with the crisis with surprising sangfroid.
Just across the Øresund Bridge that connects the southern Swedish city of Malmo to Danish capital Copenhagen, Sweden’s smaller neighbor has closed schools, kindergartens, restaurants and cafes, prohibiting all gatherings of more than 10 people. But in Scandinavia’s biggest economy, gatherings of up to 50 people are still allowed, and primary schools remain open. As do cafes and restaurants, though they need to maintain greater distance between their tables.
That approach is now sparking concerns among public health officials as coronavirus cases mount across Scandinavia — Sweden alone had 3,447 reported cases as of Sunday, with 102 deaths. At stake is also Scandinavia’s reputation as a leader and trendsetter in public health — a status progressives in America frequently cite as an example. Sweden’s deputy state epidemiologist, Anders Wallensten, has argued that strategies to battle the virus can vary between nations depending, among other factors, on “what stage a country is in with regards to the epidemic.”
Sweden’s chief epidemiologist, Anders Tegnell, has told Danish public broadcaster DR that his country’s approach is based on the belief that the virus has already spread too far within Sweden. Closing schools, he argues, could increase the risk of children spreading the virus to elderly neighbors. That “keep things open” approach is one that U.S. President Donald Trump is believed to be considering too, in light of the toll of a mass lockdown on the American economy.
But experts worry Sweden might be setting itself up for a disaster. In March, five senior scientists and doctors criticized the country’s approach in a letter published in Läkartidningen, the journal of the Swedish Medical Association. “Sweden’s strategy for dealing with the situation seems to consist mainly in contact tracking and isolation of the sick,” they wrote. “The strategy can work if there are only a few cases.” It might already be beyond that stage. “More delays and chances can have fatal effects on public health in Sweden,” they cautioned.
There are risks in not acting carefully on this.
Henrik Sjödin, public health researcher
SVT, Sweden’s national broadcaster, has published parts of an email thread of health experts accusing the country’s public health authority “of incompetence and lack of medical expertise.” And there’s growing concern among some experts that Sweden is effectively following “herd immunity,” a controversial tactic of purposefully letting the virus spread among people at low risk until immunity levels rise and the virus fades away on its own.
“There are risks in not acting carefully on this and to assume we can rely on a herd-immunity strategy, since there is so much that is unconfirmed about the virus,” says Henrik Sjödin, a public health researcher at Umeå University.
While Tegnell has rejected suggestions that Sweden is pursuing herd immunity, he recently told a local newspaper that approach wouldn’t be contradictory with the government’s core strategy — to ensure “a slow spread of infection so that the health services have a reasonable workload.”
Emma Frans, an epidemiologist, says the government — by not imposing stricter regulations — is placing too much responsibility on individual citizens. That hasn’t worked. “Privileged people who can work from home are going to their summer houses or going to the north of Sweden to ski with their coughing children,” she says. They’re in turn spreading the virus to rural areas that otherwise had few cases, she adds.
Sofia Leje, the public health administrator in Åre, one of Sweden’s most popular ski resorts, says there are fears it could turn into a second Ischgl, the Austrian ski resort that became a major hub for the spread of the virus across Europe.
In the leaked email thread between scientists, Joacim Rocklöv, a professor of epidemiology and public health at Umeå University, questions the government’s motivations. “Does this mean this is a calculated consequence that the government and public health authority think is OK? How many lives are they prepared to sacrifice so as not to risk a greater impact on the economy?”
But that approach — which mirrors Trump’s concerns over the impact of a prolonged shutdown on the U.S. economy — could backfire on Swedish industry, warns Nordea Markets, a leading Nordic investments firm. It has suggested that Sweden’s model could turn the country into a market “pariah,” and that its assessments leave the firm struggling “to be optimistic on the Swedish kroner’s behalf.”
Anders Björkman, a professor of infectious diseases at the Karolinska Institute in Stockholm, disagrees with much of the criticism of the government’s approach. But he too agrees the government is failing on testing. “The backbone of infectious disease control is surveillance, in order to optimally understand the epidemic,” he says.
In the first few weeks of the pandemic in Sweden, anyone who had returned from a high-risk area or who had come in contact with an infected person and was showing symptoms could be tested. That’s no longer the case. Only people who belong to a risk group or have serious breathing problems are considered a priority. Otherwise healthy people who display symptoms of COVID-19 aren’t being tested, but are advised to stay home until they recover in order to not overload already-struggling hospitals.
“Health care services were not prepared for this,” Björkman says. For that, he blames administrators and politicians who decided at the turn of the century to scale down health care investments to “save money.” Still, he is surprised by the lack of preparedness. “We know epidemics can happen, we had SARS, we had H1N1, so why not have a big supply of masks and ventilators on standby?”
All of that means that if Sweden’s approach leads to an explosion in cases, the country will struggle more than most to manage the crisis. Sweden’s hospital bed shortage is the worst in Europe. In 2015 it had 2.4 available beds per 1,000 people, according to the Organization for Economic Cooperation and Development, fewer than Ireland and the U.K. at 2.6 per 1,000 — even though Sweden’s overall standard of health care is still considered high.
Frans blames the lack of responsibility shown by citizens on an individualistic culture, and the fact that Sweden hasn’t dealt with a warlike situation for over a century. She’s disappointed that Sweden has failed at demonstrating that under its democracy, people don’t need to be forced into quarantine, but do so on their own as an act of responsibility.
“We can’t even take the responsibility of having a boring time for a couple of weeks,” she says. “Everything will change after corona.”
- Heba Habib, OZY AuthorContact Heba Habib