Sweden’s Unconventional Approach to Covid-19: What went wrong

While most countries endured harsh lockdowns during March 2020, Swedes went on with their lives largely as before, indulging in nightlife, visiting elderly relatives, and so on. Government officials hoped that a large enough portion of the Swedish population would gain immunity to COVID-19, making the diseases’ spread less consequential. At the time, many were curious about Sweden’s unconventional approach. Swedish authorities received both negative and positive reactions. Conservative politicians, such as Donald Trump and Boris Johnson, praised the Swedish approach, while politicians in neighboring Nordic countries, such as Finland and Norway, remained skeptical. Yet after Imperial College London released a study in March predicting 510,000 deaths in the United Kingdom and 2.2 million in the United States, even the Johnson and Trump administrations adapted with stricter measures than before. However, the Swedish didn’t budge, and instead, made maintaining the health and stability of the economy the nation’s top priority.

Private emails published by Foreign Policy reveal that Swedish health authorities had subscribed to the herd immunity hypothesis––no matter the potential cost. Publicly, however, the government denied that their goal was to reach herd immunity. Nonetheless, hospitalization rates increased faster in Sweden than in any other European country, and also far exceeded those of other Nordic countries. On December 18, 2020, Sweden registered almost 479 new COVID-19 related deaths, exceeding deaths in Norway. The situation became so complex that Norway placed troops on the Swedish border for the first time since World War II. Sweden’s original argument that lockdowns and restrictions would hurt the economy was later disproved; Sweden ended up faring worse economically than other Nordic countries.

 

Bar Graph 1: Number of Coronavirus infections by country in the Nordic Region

Peet Tull, former Public Health Agency Director of Sweden, was one of the individuals who constructed Sweden’s infection control unit. As the pandemic unfolded, Tull wrote an email to Anders Tegnell, the Swedish State Epidemiologist, expressing severe concern as early as February 2020. On March 15, 2020, Tull proposed three possible approaches to manage the pandemic: 1) halt all movement and contact for a month 2) follow World Health Organization recommendations regarding intensive testing, tracing, and quarantine protocols and 3) allow the virus to spread in order to achieve herd immunity. Tull warned that “option three appears to me as defeatist and headless strategy, which I would never have accepted in my previous role.” From the beginning, Tegnell had agreed to pursue herd immunity because he saw no plausible evidence of ways to stop the spread through the same means other countries had successfully used.

Along with other Nordic countries, Sweden is often admired as an exceptional model of a social democratic welfare state, where citizens enjoy high living standards, equality, and social security. Sweden also has a reputation for welcoming large groups of refugees and immigrants during humanitarian crises: first in the 1990s, when the country accepted 100,000 refugees from the Balkans, and again during the Syrian crisis, when Sweden welcomed the most immigrants per capita of all European countries. Although the Swedish welfare state certainly deserves ample praise, the outbreak of the pandemic has led some to question this image of Swedish exceptionalism. It has even caused an identity crisis for many Swedes and Nordics.

Sweden is far from being as homogeneous as it’s often depicted in American media. Today, up to one out of three Swedes have an immigrant or foreign background. According to a local newspaper, half the people that died from the virus on March 16 in Stockholm were Swedish Somalis, despite only making up roughly 6% of the population. Hussein Farah, an imam at a Mosque in Stockholm, explains that, in the area where several Swedish Somalis died, families tend to live in relatively small spaces where intergenerational contact is common. This intergenerational socialization is common to families with non-European backgrounds, yet Swedish authorities did not sufficiently consider this diversity of living conditions––and the risk such conditions pose to elderly populations––when approaching the pandemic. This disregard for diversity and multiculturalism reveals the ethnocentric view among Swedish authorities and resulted in a large proportion of the population being put at avoidable risk.

The pandemic especially exacerbated existing issues with the Swedish Elderly Care System. In 2017, the National Board of Health and Welfare shared with the daily newspaper, Svenska Dagbladet, that 40,000 people, or 15.6%  of all who received elderly care, were undernourished, partly owing to a lack of human resources and training. After a heatwave in 2018, another study showed that 600 elderly deaths had occurred––most in nursing homes and hospitals––due to lack of adequate air conditioning. Since the beginning of the pandemic, accounts of lack of training and resources have skyrocketed, including staff complaints about a lack of protective equipment. One elderly home in Stockholm is currently under investigation for misconduct. The group’s CEO has admitted that “the elderly care sector and the broader society were not prepared.”

Despite early evidence of Sweden’s unpreparedness for the global pandemic, public officials remain intransigent. In response to questions about the government’s faith in voluntary adherence to risk-mitigation recommendations, Anders Tegnell responded: “No, we will keep on this path … This is how we work in Sweden. We have a big understanding of this and a huge adherence to the rules.” To many, Tegnell’s words reflect a particularly Swedish trait: an unwillingness to admit when they have made a mistake because the country is so used to being in high regard for its many progressive policies.

Bar Graph 2: Change in Annual GDP for 2020  by different countries and regions. Sweden suffered a higher GDP change than other Nordic Countries despite their policies of prioritizing the economy

Last November, Sweden’s government finally mandated the closure of bars and restaurants, effective at 10:30 pm. This policy change came in response to the second wave of COVID-19, when Sweden did not see the estimated decline in mortality rates it had hoped to achieve through herd immunity. Criticism arose within the country, with many Swedes opposing the authorities’ laissez-faire public health policies. However, Swedes weren’t necessarily calling for more lockdowns or restrictions. Their main concern was a lack of clear guidelines and discrepancies between public health and government authorities. In February 2020, when Sweden first began preparing for the pandemic, Anders Tegnell emphasized giving clear guidelines to the public so that Swedes could make responsible individual decisions. Swedes could then continue their lives while keeping the economy running, and public health authorities would amend their recommendations as the pandemic developed. However, a lack of clear instructions from the authorities quickly became the norm. Two things made these instructions particularly flawed. First, there were too many guidelines that impacted mundane aspects of everyday life, which led the public to largely ignore them. Second, there was constant discrepancy between policies from the public health authorities and the leading political party, the Swedish Social Democratic Party. While policymakers worldwide put renewed emphasis on established recommendations throughout the pandemic, Sweden would have profited from more straightforward guidelines earlier on.

Sweden currently has the highest per-capita death of any European country, making it difficult to imagine their policies will be remembered as anything short of disastrous. While the goal was to give Swede’s independence in exchange for responsibility, the models’ main flaw was its lack of guidance and enforcement mechanisms. The government failed to provide the public with clear, rational guidelines. In addition, the tension between the leading party and public health authorities has led to the circulation of contradictory information, further confusing the public. If Sweden had smoothed out these internal obstacles, the “Swedish model” could have become––as the authorities hoped––an ideal blueprint for other countries to follow. Instead, it will be remembered as a failed approach to a lethal pandemic.