David Pratt: How Sweden is tackling the coronavirus pandemic

Living as we did in the Swedish capital Stockholm, the contrast with our time in the Middle East could not have been starker.

In the beginning I did not warm to Stockholm. I found it lacking in the spontaneity and colour I had so much enjoyed while in Jerusalem. Somehow it seemed tame, quiet and conservative even, despite the country’s liberal reputation.

As time when on, however, and I became accustomed to Swedish ways, the place grew on me. Today Stockholm has become a city I love and is home to one of my closest friends, with whom on occasions I continue to work alongside overseas.

These days much of our online chat revolves around comparing notes on the coronavirus and our respective experience of lockdown.

Even from the start of the pandemic’s impact in Europe, what my friend told me about Sweden’s way of tackling the virus made me sit up and take notice.

I’m not alone in this reaction, given that Sweden now has one of the world’s most closely watched and controversial coronavirus response strategies.

It’s a strategy that has been met with some confusion by ordinary Swedes as well as criticism from within certain sections of the country’s scientific, political and media community. So just what is it that Sweden is doing differently and what has the reaction been at home and away?

At first glance there might not seem many difference compared to other countries’ responses. In Sweden as elsewhere people are encouraged to practise social distancing, work from home if possible and avoid non-essential travel, as well as visits to elderly relatives or hospitals.

In fact a survey from Swedish pollsters Kantar Sifo carried out for the country’s Civil Contingencies Agency (MSB) showed that around 70% of people in Sweden say they have reduced their participation in social activities to stop the spread of the infection.

But where Sweden has differed in achieving its aims in response to the virus is that the government has relied on voluntary measures, urging citizens to act responsibly and adhere to these guidelines rather than enforcing a lockdown.

All of this has given the country an air of remaining open for business even if it’s not exactly business as usual. Primary schools, cafes, gyms, bars and restaurants and most businesses have continued to function throughout the spread of the pandemic.

Some critics of the policy, both domestic and international, have been alarmed to say the least, but there remains little evidence that Swedes are underplaying the enormity of the disease rampaging across the globe. The architect of the controversial policy the country has adopted, and hero or villain of the piece depending on those Swedes you talk to, is Anders Tegnell, state epidemiologist at Folkhälsomyndigheten, Sweden’s public health authority.

The 63-year-old has become a household name in Sweden, appearing across the media and holding daily briefings outlining the progression of the outbreak with a precise, quiet demeanour.

Asked last week at a press conference as to why the government had chosen not to lock down the country, Tegnell reiterated its position.

“Basically because we think we can achieve the same results with voluntary measures, and I think that to a great extent we have shown that we can do that,” came Tegnell’s characteristically frank reply.

This candour has been a hallmark of the country’s approach to tackling the pandemic in its midst.

“We’re trying this strategy out. We don’t know if it will work or not. If it doesn’t, we’ll revisit it,” Tegnell openly admitted few weeks ago.

To date he’s stuck to his guns, but not everyone in Sweden agrees or approves, pointing to the fact that more people so far have died in Sweden compared to its Nordic neighbours.

At the time of writing, Sweden has 14,777 confirmed Covid-19 cases and 1580 people have died. According to figures from John Hopkins University School of Medicine, Sweden at face value is not doing well.

By April 22, its mortality rates from Covid-19 were the 10th highest in the world, with 17.3 deaths per 100,000. By comparison, its neighbours Denmark, Norway and Finland ranked 17th, 22nd and 31st, with 6.4, 3.4 and 2.6 deaths per 100,000 respectively.

More than half of Sweden’s deaths have so far occurred in Stockholm – 1128 as of April 23 – yet only 10% of the population lives there. Bad as all this is, it’s still a far cry from those European countries worst hit. Currently a lot of the anger in Sweden over its case and fatality figures has come from a perceived lack of shielding of older people. More than a third of fatalities have been the elderly living in care homes.

Just a few weeks ago in light of this death toll, Sweden’s prime minister

Stefan Lofven suggested the government might need to review its approach amid the prospect of many more fatalities. He accepted, too, that the failure to protect people in nursing homes stood out as a clear weakness of the government’s strategy, contributing to higher death rates than in neighbouring Scandinavian countries.

“The protection for people in elderly care should have been better,” Lofven admitted last week. “We need to look closer at what has gone wrong.”

Some Swedes have suggested that their country is deviating from most other nations’ response in order to hasten herd immunity, and in doing so risking lives unnecessarily. The public health authority denies this.

Inevitably, as in countries elsewhere facing the threat from the virus, this has resulted in some confusion and a polarisation of opinion.

“The mixed messages are plentiful, and they seem to make people want to pick sides, dig their heels in, argue that in Sweden we have a system and it works; or no, Swedes always think they know best but they don’t,” observed journalist Emma Lofgren, writing in the Swedish edition of the online newspaper The Local.

Some, however, are adamant over the stance they take. Lena Einhorn, a virologist who has been one of the leading domestic critics of Sweden’s coronavirus policy, recently told The Observer newspaper that the government and the health authority were still resisting the most obvious explanations for many of the deaths from the virus.

She argues that the reason why there has been such a high number of deaths in care homes is not because of the homes themselves, but because of Sweden’s decision not to close down other public facilities and amenities.

Einhorn is one of 22 doctors, virologists and researchers who recently criticised the health authority in an op-ed published by Sweden’s Dagens Nyheter newspaper.

It called on politicians to break with the country’s tradition of entrusting policy to its expert agencies, and to seize control of Sweden’s coronavirus strategy from the health authority.

“The approach must be changed radically and quickly,” the group wrote. “As the virus spreads, it is necessary to increase social distance. Close schools and restaurants. Everyone who works with the elderly must wear adequate protective equipment. Quarantine the whole family if one member is ill or tests positive. Elected representatives must intervene, there is no other choice,” the signatories to the newspaper article implored.

But despite such criticisms, recent polling suggests that overall Prime Minister Lofven’s strategy continues to have the support of Swedes. His personal popularity has soared, as has that of Anders Tegnell.

In accounting for this robust public display of confidence, experts point to a number of underlying factors, not the least of which is the collective trust that Sweden’s citizens are recognised for having in their government and officials.

THE country has long benefited from a politically and socially stable democracy, with a well institutionalised rule of law, trans-parency, and account-ability. This is a nation, too, with a constitution that doesn’t allow for a state of emergency during peacetime.

In other countries where such a measure exists it allows their governments to impose tougher restrictions during times of crises, something many of them have done in their efforts to combat the pandemic.

Historian Lars Tragardh, of Ersta Sköndal University College in Stockholm, believes a strict law in Sweden’s constitution prohibits the government from meddling in the affairs of administrative authorities, such as the public health agency.

“Therefore, you don’t need to micromanage or control behaviour at a detailed level through prohibitions or threat of sanctions or fines or imprisonment,”

Tragardh told the New York Times recently. “That is how Sweden stands apart, even from Denmark and Norway.”

Social solidarity among citizens is also a feature in this manifestation of trust.

“In Sweden, the path chosen may be less draconian but it is possibly more demanding, since it shifts the burden from laws and policing to self-regulation,” explained Tragardh in a recent article in The Guardian examining this trust between citizens and the state and among citizens themselves.

Culture also matters, some are quick to remind, in how any country reacts to a crisis such as the coronavirus, and Sweden is no exception.

In an essay written for The New York Review Of Books a few years ago examining why Sweden as a country so often evokes such a strong reaction, author Paul Rapacioli talked of the social precept in Nordic countries called Jantelagen, the law of Jante, a code of conduct which is said to restrain outward displays of success or excessive individualism.

“It is a reminder that you are no better than your neighbour. This may place an obligation of modesty on Swedes, but for Sweden itself different rules evidently apply,” observed Rapacioli.

“In ranking after ranking, whether the metric is social justice, democracy, press freedom, gender equality, rule of law, innovation or sustainable development, the country consistently places in the top 10, and often in the top three,” added Rapacioli, reinforcing Sweden’s reputation for often doing things differently and well.

Amidst the seriousness of the situation, however, Swedes like others elsewhere in the world faced with the coronavirus threat have also responded with their own brand of humour.

Currently the internet is awash with jokes about how naturally social distancing comes to the country’s citizens and the many years in which they have been in training for just such a scenario.

“Swedes, especially of the older generation, have a genetic disposition to social distancing anyway,” quipped former prime minister Carl Bildt recently, echoing the other widely held view that Sweden is, if not coronavirus-proof, certainly naturally coronavirus-resistant.

But all joking aside, while the country to date has stood out for its relaxed approach to fighting the pandemic, on Friday there were signs the government may adopt a tougher approach in enforcing social distancing guidelines after throngs of people headed for parks, bars and restaurants in the warm weather.

Interior minister Mikael Damberg was at pains to urge Swedes not to let down their guard.“In some places and in some situations, the recommendations aren’t being followed,” warned Damberg, while stressing that most people in Stockholm are acting responsibly.

As many bars, restaurants and businesses this weekend remain open, life in the city, as my friend in Stockholm told me last week, “feels strangely normal”.

For now the Swedish government has held fast to its almost unique approach in tackling the virus, intoning repeatedly that it is acting according to scientific advice and data not, it implies, according to the political considerations that are motivating some of Sweden’s neighbours and other countries.

For the moment the country’s “new normal” in the face of the virus looks remarkably like the “old normal”. In tackling the pandemic on its doorstep, Sweden has certainly done things differently. Whether it has done things effectively and well, time is yet to tell.