The Swedish response to COVID-19 has been much less intense than in any other European country, including its Nordic neighbors. Sweden not only bypassed widespread lockdowns but kept primary school open, continued to discourage the use of masks (barring specific situations), and until recently kept asymptomatic contacts of COVID-19 patients uninsulated (happily assuming a low transmission capacity).
This heterodox strategy, apparently let it go, let it go, has dazzled “deniers”, ultraconservatives and “liberals” around the world. Some protesters in the September protests against the restrictions in Berlin carried Swedish flags. The American and British conservatives present Sweden as the demonstration of success in avoiding lockdowns. And the signers of the Great Barrington Declaration, who claim a fast path to “herd immunity” (a concept explicitly denied by the Swedish strategy), also suggest that the Swedish path is the right one to recover the economy.
But it’s not obvious that the Swedish data, health or economic, can support such excitement. Nor that Sweden is the unrestricted paradise that the supporters of generalizing their supposed strategy claim. Far from it that the countries that have used lockdowns do not have things to learn from the Swedish way.
Health data
If you stick to health data, “playing Swedish” doesn’t seem like a good idea. At least compared to the other Nordic countries. Both in confirmed cases per million inhabitants (Figure 1) and –and above all– in deaths per million inhabitants (Figure 2), Sweden has much worse records than Denmark (5 times fewer deaths), Finland or Norway (10 times fewer ).
Global data for Sweden are even worse than the average for the European Union, despite being heavily weighed down by poor records from the UK, Spain, Italy and France. And not only because of a higher peak in the first wave, but especially because of the slow descent of the mortality curve in the absence of confinements (Figure 2).
If we look at the excess mortality monitored by EuroMoMoSweden is the only Nordic country that shows a clear excess of mortality (Figure 3) and that, again due to the slow descent of the curve, did not normalize until the end of July.
Figure3. Excess mortality (from all causes) during 2020 in the Nordic countries. The blue band indicates the expected mortality and the blue line the mortality observed in 2020. The last weeks (in yellow background) underestimate the mortality due to the delay in registration. The graph can be interpreted as the percentage of excess mortality over expected (for example, Sweden in week 15 of 2020 had a mortality that was 13% higher than expected). / EuroMoMo
Regarding how close the Swedes are to reaching the always speculative threshold of 70% of people who have passed the infection to reach the, no less speculative, herd immunity, the data indicates that seroprevalence is situated around 15%. That is, far from the 40% that the The Swedish Public Health Agency (the Swedish Public Health Agency) expected to reach in May 2020.
Economic data
The fall in GDP in the Nordic countries in the second quarter of 2020 does not seem to be much affected by the imposition or not of landfills. Sweden, with an 8.6% reduction in GDP, showed the largest drop despite the absence of landfills. Denmark (-6.9%), Norway (-5.1%) and Finland (-4.5%) have held up better. The Netherlands, Germany and the United States are also in this range of falls.
Comparing with the economies of Spain, Italy or the United Kingdom can be a good trick of illusionism, but the economic response does not have as much relationship with the coping strategies of the COVID as with the previous characteristics of each economy. And, however you look at it, the data does not support that Sweden has had a better economic performance than its Nordic neighbors.
The lion is not as Swedish as they paint it
On the other hand, the repeated and topical presentation of Sweden as the country that did not adopt population measures to stop the pandemic is very unfair with the Swedish strategy, full of restrictions, very well described in a recent post.
The Swedish governance structure, with 21 counties managing health care (with infectious disease units with broad powers, including to enforce isolations) and 290 municipalities (managing community care and social services), makes it difficult to speak of an answer homogeneous global. In fact, and like Spain, Sweden had an extremely uneven transmission by regions, concentrating cases and deaths in Stockholm.
But Sweden was not passive. Since the beginning of March, it restricted visits to social and health centers, ordered the isolation of symptomatic patients (abolishing wage penalties for sick leave and offering compensation to COVID patients to stay at home), imposed restrictions on travel and He strongly recommended telecommuting (and continues to do so).
Sweden also made a notable effort to maintain social distancing. Already in March they banned the events of more than 500 people, which in April they reduced to 50. They published instructions for the hotel industry (and closed the premises that did not comply with them). Although the schools remained open for students up to 16 years old, those over this age, including universities, switched to teaching early on-line (although they reopened – keeping their distance – from August).
In addition – and perhaps above all – Sweden has maintained and maintains important risk education and information campaigns, including those directed – in their own languages - at ethnic minorities. Minorities that, as in other countries, presented a higher proportion of affected.
Can you be Swedish outside of Sweden?
The Swedish strategy has not only seduced. It has also been heavily criticized. The Science Forum COVID-19 (better known as “the 22”, due to the number of scientists and doctors who initially made it up) has been very hard on the strategy of his country and with Anders Tegnell, the chief official of the Folkhälsomyndigheten, architect of the controversial strategy in a country where the Constitution does not allow the Government to “influence” how government agencies carry out their work.
Also reputed scientific publications such as British Medical Journal O Science, just like him Independent Advisory Group for Emergencies from the United Kingdom, have pointed out the weaknesses of the Swedish approach to the pandemic. Remarking that nothing indicates superiority over its Nordic neighbors, rather the opposite.
Currently, when cases rebound in Europe from the first wave lockdowns, Sweden is holding out with modest rallies (also its Nordic neighbors, especially Finland and Norway, as shown in Figure 1). Rather than due to greater population immunity, it is likely that Swedes are more Swedish than anyone else and follow social distancing measures more strictly despite having fewer mandatory rules.
Perhaps it is because they trust more in Public Health that from the beginning has opted for a long-term strategy (and not 15 days, every 15 days), such as explained Tegnell in an interesting interview in which he is even reasonably cautious about the impact of vaccination and is committed to a vision of global public health (not only infectious) that addresses social determinants.
Perhaps it is because their messages are not contradictory. Or perhaps because they have avoided the political “circus”. Perhaps because Public Health trusts its population as much as the population in its Public Health.
Perhaps the Swedish way is suitable for the Swedes: a rich country, with a thriving social status, powerful health and social services, and great mutual trust between the administration and the population. Perhaps the Swedish way is not the best idea in countries with great social inequalities and very weak or very weakened social and health developments.
As Richard Smith recently pointed out in the Blog British Medical Journal, all judgments about the success of the different strategies in this pandemic are provisional, simply because the pandemic is not over and in many respects it is unpredictable.
Perhaps, perhaps also, we can all learn something from how others do things.
Salvador Peiro, Researcher, Health Services Research Area, FISABIO SALUD PÚBLICA, Fisabio
This article was originally published on The Conversation. read the original.
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