Besides refusing to close down businesses, restaurants and schools in response to the coronavirus pandemic, Sweden also has refused to close its borders, even to travelers from countries with large and uncontrollable outbreaks, such as Iran. Pictured: Dr Lars Falk, a department head at Karolinska Hospital in Solna, drops his daughter and her friends off for football practice in Stockholm, Sweden, on April 20, 2020 during the coronavirus pandemic. (Photo by Jonathan Nackstrand/AFP via Getty Images)
The World Health Organization (WHO) recently described Sweden as a "model" for battling the coronavirus. "I think if we are to reach a new normal, I think in many ways Sweden represents a future model of -- if we wish to get back to a society in which we don't have lockdowns," Dr. Mike Ryan, executive director of WHO's Emergencies Program, said. "They've been doing the testing, they've ramped up their capacity to do intensive care quite significantly," he added.
"And their health system has always remained within its capacity to respond to the number of cases that they've been experiencing... Sweden has put in place a very strong public policy around social distancing, around caring and protecting for people in long term care facilities and many other things,".
"What it has done differently" he added, "is it has very much relied on its relationship with its citizenry and the ability and willingness of citizens to implement physical distancing and to self-regulate."
As noted by Paul W Franks, Professor of Genetic Epidemiology at Sweden's Lund University:
"The Swedish approach to COVID-19 could not be more different from its neighbours', placing much of the responsibility for delaying the spread of the virus and protecting the vulnerable in the hands of the public... Swedish bars, restaurants and schools remain open. Under the blue skies and blazing sun Sweden has enjoyed lately, people have flocked to parks and beaches, bars and cafes. Nevertheless, Sweden has a high number of people living in single households, and citizens are generally respectful of public health advice and guidelines".
Is Sweden, however, really a "model" to the rest of the world? Several of Dr. Ryan's assumptions seem to be, at the very least, questionable.
As of May 6, Sweden, which has a population of 10.18 million people, had 2,854 deaths, which corresponds to 280.27 deaths per million people. In comparison, the other countries of the Nordic region, Denmark, Norway and Finland, which all went on lockdown, had 503, 215 and 246 deaths respectively, corresponding to 86.76, 40.46 and 44.58 deaths per million people, respectively.
Besides refusing to close down businesses, restaurants and schools, Sweden also has refused to close its borders, even to travelers from countries with large and uncontrollable outbreaks, such as Iran.
"Historically, it has not been a great idea to stop flights. The latest example is probably Italy. There they canceled all flights to China, but they still got a big outbreak," said state epidemiologist and bureaucrat Anders Tegnell in late February. Tegnell has since become the face of Sweden's coronavirus strategy. Tegnell stressed that stopping flights from Iran would complicate helping the country with its outbreak. "If you shut down [flights from] Iran, you cannot help the country with protective materials and such," he said.
As late as February 29, for example, 11 planes from Northern Italy and 1 plane from Iran landed in Arlanda airport in Stockholm, but no measures were taken to check people for the virus or put them in quarantine. Flights from Iran were only stopped on March 2 and as late as March 5, Tegnell criticized the Scandinavian Airline SAS for stopping all flights to Italy, a decision that he said, "lacked medical and scientific basis". Only on March 17, when the EU made its recommendation, did Sweden stop all non-essential travel to its airports. Despite that, 40 planes have landed every day at Arlanda airport in Stockholm, where travelers have not been tested for Coronavirus upon landing or asked to go into quarantine.
In late February, Minister of Social Affairs, Lena Hallengreen, said that she believed that Sweden's readiness for the pandemic was "good". Two months later, she told Aftonbladet that the strategy had been "a failure" with regard to the most vulnerable population group, the elderly. On May 5, the Sweden Democrats called for a special debate to be held in parliament regarding the deaths during the corona crisis in Sweden's nursing homes.
"Sweden has twice the death toll as our Nordic neighbors combined. One of the reasons is that the government has failed to protect the elderly," said the party's group leader Henrik Vinge in a press release.
"The fact that Sweden has not been able to protect vulnerable groups from infection has been identified as a failure by government officials. The development has been particularly devastating in nursing homes in the Stockholm region, which first suffered from widespread infection... 123 [nursing homes] out of 227 in the region had already been infected... by Easter weekend, according to a new survey. The fact that Sweden, unlike other countries, has had too limited testing... and that personnel have not been provided with the necessary protective equipment has probably contributed to the deaths in Swedish nursing homes. Witnesses also allege that there have been cases of staff working despite symptoms... and that it has been difficult to make [nursing home] employees follow basic hygiene practices."
Sweden used to have a storage of seven million respiratory masks, as well as protective suits for adults and children during the Cold War. "The various types of respiratory protection were collected in emergency storages around the country with up to 250,000 pieces in each. The number varied depending on the size of the municipality. In the first decade of the 21st century, the stock was considered redundant and obsolete and everything was burnt," states a brief text on the website of the Army Museum in Sweden. Although several of the masks were no longer functioning, 2.2 million respiratory masks were still adequate, but were burned anyway.
On March 28, realizing that Sweden was facing a shortage of protective equipment for medical personnel, Swedish regional authorities appeared simply to have lowered the protection requirements.
"Healthcare workers are worried that the country's regions have lowered the requirements for personal protective equipment -- for example, mouth protection will not be the standard", noted Swedish Radio. According to Mia Lehtonen, a nurse at Karolinska's staffing center and elected representative for the Healthcare Association:
"Back then [at the beginning of the outbreak] we would have mouth protection with HEPA filter, a cap... long-sleeved protective coat, rubber boots, gloves that were taped to the long-sleeved coat, and now - just a few weeks later - we are supposed to work according to just basic hygiene routines."
In some hospitals health care personnel had to resort to protecting themselves with rain ponchos.
Despite the spread of the pandemic outside of Sweden -- and neighboring countries such as Denmark and Norway locking down offices, businesses and schools -- Tegnell opined that Swedish employees should not be allowed to work from home due to "equality" concerns:
"There is an equality aspect in this. There are certain groups in society that can [work from home], but not all, and how will we see to it so that we continue to have equality in society and that everyone has the same chance to stay healthy?"
Five days later, in mid-March, he encouraged people to think about working from home.
Even before mid-March, Sweden stopped testing how many people had been infected by the virus. "Now it is no longer important to know exactly how many people are infected in Sweden", said Tegnell. Instead, authorities would look at how many people were committed to a hospital.
Some Swedish municipalities have even kept the number of infected elderly in their care a secret, according to Svt nyheter:
"For a long time, Sörmlands Media has tried to get information from all the county's municipalities on how the spread of infection in elderly care looks, how extensive it is and where it is located. The municipalities have replied that they lack knowledge about the extent of the spread of infection and have said that it is also not possible to find out. Sörmland Media's review, however, shows that the information is not correct and that the municipalities actively concealed the information... Some municipalities have also failed to report the number of infected persons to the National Board of Health and Welfare's national reporting tool for orders for protective clothing. Something that, according to Sörmlands Media, may have affected the safety of the infection prevention work".
Criticism of the government's strategy has been articulated by 22 scientists, who wrote that the pandemic was being handled by "officials without talent". One of the scientists behind the criticism, Dr. Stefan Hanson, a Swedish infectious disease expert, told the Canadian Globe and Mail:
"I think it's a risky business and we don't know anything about herd immunity. The only thing we know is that a lot of people have died. These are human beings, not just figures. And if we would have chosen another approach, this number would have been much smaller."
According to the Globe and Mail:
"Dr. Hanson believes Dr. Tegnell deliberately pushed herd immunity and he should have followed the Norwegian, Danish and Finnish approach and introduced a lockdown. 'You cannot take risks with people's lives if you don't know what risks you are taking'".
"The COVID-19 death rate [in Sweden] is nine times higher than in Finland, nearly five times higher than in Norway, and more than twice as high as in Denmark," where there were lockdowns, Hans Bergstrom, former editor-in-chief of Dagens Nyheter, Sweden's leading daily newspaper, wrote in April.
Despite not going into lockdown, Sweden's economy is still taking a hit, although less severe than other European countries. Many Swedes, particularly those who are older, are limiting social interaction, travelling less and therefore consuming less in shops and restaurants. Sweden has also been exporting less because of the lockdowns in other countries. "Sweden's government estimates... a 6% contraction in domestic consumption this year. Combined with a forecast 10% drop in exports, Swedish authorities predict, the result will be a 7% decline in overall 2020 economic output" according to The Wall Street Journal.
WHO – and the media -- might wish to reconsider using Sweden as a model.
John Richardson is a researcher based in the United States.