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Stockholm COVIDians

The origins and results of the Swedish model for combating the coronavirus

© ISTOCK

Sweden is the only country of the European Union that has not taken strict measures against the coronavirus pandemic. The country’s COVID-19 death rate is growing, unemployment is close to record high levels and GDP could fall by 10%. But does this prove that Sweden’s strategy is ineffective? The HSE School of World Economy invited experts to assess its implications for Swedish society.

Life Without Lockdown

The Swedish strategy relies not on coercive force, but citizens’ awareness and their trust in the government, as seen in the following:

 Sweden has no state of emergency or quarantine;

 it is recommended (not ordered!) that all citizens practice hygienic standards and social distancing and stay at home if possible, that employers enable employees to work from home and that the elderly avoid social contacts;

 nursery schools and primary grades remain open while older students study remotely;

 public transport continues to function and no travel restrictions are in place;

 gatherings of up to 50 people are permitted;

 businesses remain open, including service sector enterprises such as stores, fitness centres, cafés and restaurants — although people cannot line up at bars: everyone must sit at tables that are set a specified distance apart.

The Public Health Agency of Sweden, an expert body that reports to the Ministry of Health and Social Affairs, determines the policy for dealing with the pandemic. Anders Tegnell, Sweden’s state epidemiologist and the architect of its anti-virus strategy, is one of the Agency’s leaders.

An interview with Anders Tegnell about Sweden’s fight against COVID-19

Tegnell is a proponent of the ‘herd immunity’ theory that states that an infection will stop spreading within a geographically limited population once a large enough number of the individuals in that population is immune. Such immunity can be innate, the result of vaccination or acquired if the person has recovered from the illness and become resistant to further infection. Explaining the rationale for this approach, Tegnell said that 'the strategy is rooted in a “long tradition” of respecting “free will,” as well as the high level of trust and respect Swedes have for the public authorities', claiming at the same time that the Swedish policies are not an attempt to achieve herd immunity.

“All countries are trying to reduce the number of contacts between people, and so are we,” says Swedish state epidemiologist Anders Tegnell. “But based on our traditions and common sense, Swedish society has remained open. The pandemic can last for a long time, keeping people isolated for months is dangerous, just as relaxing restrictions abruptly would be because it could trigger a new wave of the virus.”

‘Sweden is essentially continuing normal life,’ said HSE School of World Economy Deputy School Head Natalia Supyan. ‘Some people admire its example and believe that such a policy will help avoid serious economic repercussions and a prolonged recession. Others accuse the government of experimenting on its citizens.'

British Prime Minister Boris Johnson initially listened to scientists who advocated the herd immunity strategy but changed his mind after seeing a report by epidemiologists from Imperial College in London and seeing the infection and mortality rates climb. The scientists told him at least 250,000 British citizens would die.

The problem is that no one has been able to say how much of the population would have to contract COVID-19 to achieve herd immunity. Estimates range from 29% to 75%. It is also unknown whether resistance to the virus would last for six months or a year and whether it would provide protection against other strains of SARS-Cov-2. Tegnell does not have answers to these questions either. Then why did Sweden choose such an unconventional and potentially dangerous policy?

In Search of Origins

Historian Natalia Plevako looks to the country’s past. ‘There are three important factors that must be taken into account when analyzing why the Swedes’ behave as they do. First is the existence of autonomous state administrations whose origins date back to the 17th century. They now report to ministries that set their budgets, but those ministries do not interfere in their activities.’

The Public Health Agency of Sweden is one example of this type of autonomy. This expert body reports to the country’s Ministry of Health and Social Affairs, but during a pandemic, the Agency’s epidemiologists determine the government’s policy for combatting the virus.

Also at play, says Plevako, is ‘the Swedes’ desire for consensus, a process of negotiation. As one political scientist said, a consensus is sometimes more important than the truth for them. And it truly is very important — the people of this country always need to reach decisions that everyone would obey. The last reason is deeply rooted in religion. According to the country’s Protestant ethic, that which is forbidden is not allowed and that which is not forbidden is also not allowed. Swedes might not always believe in God or go to church, but they behave obediently regardless.’

As the number of infections rose, however, the authorities stopped relying only on the obedience of the general population, especially considering that it includes many migrants who have not fully assimilated to and adopted the local culture. For this reason, before the annual spring festival on Walpurgis Night (April 30 – May 1), the City Council of Lund promised to scatter a ton of chicken manure along the pathways of the city's central park to scare away celebrants. It turned out to be unnecessary: the threat alone was enough to deter people from gathering.

‘Lagom’ and Rationality

Historian Pyotr Topychkanov points to other reasons as well. 'In addition to the above, there are several cultural features that affect the policy of the Swedes. They often cite two concepts: 'lagom’ (meaning ‘in moderation’, and ‘inget stress’ (meaning ‘don’t stress over it or resort to extreme measures.’ These characteristics describe the state’s strategy for dealing with the crisis,’ he said.

‘The decision not to close kindergartens and schools is dictated, first, by the desire to keep medical personnel on the job,’ Topychkanov added. Otherwise, 25% would take leave to care for their children. Second, it reflects their understanding that this is a long-term crisis. The Swedes measure the quality of the risks involved in terms of not only the number of sick and dead. There are other dangers as well: remaining at home leads to an increase in domestic violence and psychological problems,’ he said.

Plevako agrees that the Swedes are trying to see the big picture. ‘The Swedes are rationalists. Primary school classes remain open, and why? For a rational reason — because parents work and have no one with whom to leave their children. The grandmothers are on self-isolation. Closing down would lead to a negative result.’

Without Looking at the Numbers

The experts also explain that the Swedes take a rational approach to the COVID-19 statistics. ‘It’s not that the authorities disregard the numbers, but they decided that the number of infections is not the main criteria,’ explained Tolychkanov. ‘One explanation is that the Swedes let the virus run its natural course so that most people would become infected, thereby making it pointless to count the number of cases. It also saves the government the unnecessary expense of diverting important medical personnel to airports and workplaces to measure everyone’s temperature.’

Number of COVID-19 infections in Sweden compared to neighbouring countries

Source: Worldometer (data for May 7, 2020)

It is worth noting that such rationality in the Swedes sometimes borders on inhumanity. For example, back in 1934, the country adopted a law on eugenics to combat mental illness and hereditary diseases. It provided the legal basis for tens of thousands of ‘voluntary’ sterilizations. According to various estimates, from 31,000 to 63,000 people were sterilized in this way — an enormous number for such a small population. Sweden repealed the law only in 1976 and the government paid compensation to victims of sterilization until 2003.

The Cost of Failure

The only indicator that Sweden pays attention to is the death rate, and that is growing. As of May 13, 3,460 people with a confirmed COVID-19 diagnosis had died. Many of them were residents of nursing homes. The Swedes shift much of the blame for this to the service staff. Most are migrants, do not speak Swedish well and did not follow the established safety rules for interacting with people in the highest risk group.

The relative mortality rate also speaks volumes. It is much higher in Sweden (343 people per million) than in neighbouring Denmark (92), Finland (51) or Norway (42). At the same time, Sweden has a population of 10.2 million, as compared to the other Scandinavian countries whose populations range from only 5.3 million to 5.8 million.

‘Nursing home staff were not tested early on,’ said Natalia Plevako. ‘Then they began testing, but it was too late: by mid-April, approximately two-thirds of the residents were infected. The Swedes admit their mistake. It turned out that the country was unprepared for the emergency and the hardest hit was the older generation, which is large there: 20% of the population is 65 or older.’

Age distribution among those who died from COVID-19 in Sweden

Source: SVT (data for May 7)

What Comes Next?

‘The authorities think that Stockholm has reached a stable plateau,’ said Pyotr Topychkanov. ‘Across the country, approximately 500 people are now in intensive care and more than 1,600 people have received or are now receiving emergency treatment. Hotspots are expected to emerge in other parts of the country as well. But because much of the population is concentrated in the Stockholm area, resources from the capital will be deployed to cope with the outbreaks elsewhere. From a medical standpoint, the situation is predictable. The big question is what will happen with the economy,' he said.

The Frightening Unknown

According to economist Alexei Volkov, the outlook for the Swedish economy is bleak: ‘In the week of March 16-22 alone, 18,000 people lost their jobs, with 56% of them in Stockholm. Unemployment stood at 6.5% — 6.8% before the pandemic, but with as many as 95,000 people joining those ranks in the last two months, that figure had already risen to 8% by the end of April. The unemployment growth rate turned out to be even higher than during the financial crisis of 2008, with the government anticipating joblessness to reach, at best, 9% — 10% by summer, or at worst, 13.5%.

Sky News: Could Sweden’s controversial COVID-19 plan pay off?

Macroeconomic indicators will also take a big hit. ‘GDP is expected to fall from between 4% and 10%,’ Volkov said. 'In the case of the former, a rebound of 3.5% is predicted by 2021, and if the latter, by 5.2%. It is impossible to say with any precision what will happen. The pandemic is continuing and I am not sure that the actual figures will fall within the ranges predicted. Time will tell.’

To support businesses, the Swedish government has adopted several anti-crisis packages worth approximately 350 billion kronor ($36.3 billion).

 Businesses received an extension of up to one year on their taxes, including VAT.

 Small and medium-sized businesses received credit guarantees.

 Employers can shorten the workday for employees and pay them proportionately less, but workers still receive more than 90% of their usual salary thanks to compensation from the state.

 For the first time since the 1990s, workers receive paid sick leave starting from the first day they stay home.

 The government assumed responsibility for all companies’ sick leave costs in April and May, as well as most of the costs associated with work furloughs.

 Leaders promised additional funds for local authorities.

The Calm before the Storm

Does the coronavirus spark political debate in Sweden? Experts suggest that, on the contrary, the country remains calm. The Public Health Agency of Sweden acts independently of politicians, whose debates have little influence over the doings of epidemiologists.

‘The crisis is so strong and unexpected that political parties were pretty much in agreement regarding strategy,’ said Natalia Plevako. ‘Even the Sweden Democrats and Moderate Party — that usually criticize the government sharply — supported it. But disagreements will mount when it comes to the economy and adopting a budget,’ she said.

Lessons for Democracy

Sweden emphasizes that its strategy for combatting COVID-19 does not violate people’s rights and freedoms: the country did not go into lockdown, movement is not restricted and citizens are not threatened with bans and fines. What’s more, the crisis did not serve as a pretext for scaling back democratic procedures.

‘The Swedish authorities have not imposed structures on top of democratic institutions,’ explained Pyotr Topychkanov. ‘All measures are discussed and implemented within the framework of existing formats. For example, this is the same health care system that existed before the crisis, but now its hour has come and it is performing its function. This is a good lesson for other states. The authorities and the measures they have taken remain transparent and accountable, and once the crisis has passed, it will be possible to judge who did what and which mistakes were made.’

Is It Right or Wrong?

Opinions differ among experts. Natalia Supyan said, “Now we see that this path has not saved the Swedish economy from a substantial increase in unemployment, from the necessity of switching to part-time employment and extending financial support to businesses, or from seeing its economic growth rate decline. The strategy’s effectiveness in terms of people’s health is also in question,’ she said. ‘The relative mortality rate per million people is very high. But what next? It is impossible to draw a conclusion for the medium or long term: we can only state that none of the policies in place around the world has yet shown itself to be a complete panacea.’

Pyotr Topychkanov continued to defend Sweden’s chosen path as reasonable. ‘The Swedish authorities do not try to offer a static set of rules for fighting the coronavirus. They state directly that the situation is changing, that they do not know how it will evolve and can only wait and see. When others, including officials from neighbouring countries criticized Sweden, the authorities did not engage in a war of opinions. They took the long view and continued their policy. When asked in one interview whether the strategy was successful, Anders Tegnell answered simply, “It’s working.”’

The Stockholm region turns a conference centre into a field hospital for COVID-19 patients

It remains unclear whether the conviction that ‘it’s working’ takes into account the fact that the number of deaths in Stockholm in April was up 81% over the previous year (according to the Financial Times) and that a mobile military hospital had to be deployed post haste in Gothenburg. Similarly, it remains unclear whether the theory of ‘herd immunity’ holds water given that nobody knows how long those who have recovered from COVID-19 remain immune to it or some other strain of the virus.

That is why Natalia Plevako was cautious in drawing conclusions regarding the Swedish approach. ‘There is no definite and unanimous opinion,’ she said. ‘Some people within the country oppose the strategy and Sweden's neighbours have criticized it sharply, especially because they chose a different path. Recently, however, both the World Health Organization and epidemiologists in Denmark and Norway are looking more closely at the Swedish model. Because no one knows how many months or years the epidemic will last and whether a vaccine will be found, they are beginning to say that such a policy might bear fruit.’

IQ

This online discussion took place on May 6, 2020. View the video of the entire discussion here:

The following individuals offered their assessment of the Swedish approach:

 Alexei Volkov, Head of Section of European Countries’ Economy, Institute of World Economy and International Relations (IMEMO) of the Russian Academy of Sciences;

 Natalia Plevako, leading researcher, Head of the Nordic Center of the Institute of Europe of the Russian Academy of Sciences;

 Pyotr Topychkanov, senior researcher at the Stockholm International Peace Research Institute (SIPRI), co-author of the Telegram channel SwedenLife.