Sweden’s Coronavirus Crossroads: Get Tougher Than the Go-easy Approach?

The daily infection rate is surging and many hospitals are now overwhelmed. The strategy hasn’t changed but the individual steps are stricter, a health official tells Haaretz

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An intersection in central Stockholm, December 2020.
An intersection in central Stockholm, December 2020.Credit: Jonathan Nackstrand / AFP

STOCKHOLM – Once the coronavirus spread to Europe, Sweden captured the world’s attention with its low-key approach to fighting the pandemic. During the first wave in the spring, the Swedish government eschewed lockdowns and kept the elementary schools and preschools open. Gyms, restaurants and workplaces have also remained open throughout the crisis.

Although measures like social distancing, working from home and discouraging large events were implemented, most were merely recommendations; no one would be fined. The policy was carried out at the recommendation of nonpartisan health experts and won the public’s trust.

At the wave’s peak, Sweden had one of the world’s highest death rates, yet this wasn’t attributed to the relaxed approach but to the failure to protect the elderly in retirement homes, where half the people who died had resided. The strategy came under fresh scrutiny this week following the release of an official report stating that the government had failed to sufficiently protect Swedes in retirement homes.

Commuters during rush hour at a subway station in central Stockholm, December 2020.Credit: TT News Agency / Reuters

Still, by summer, the belief was that perhaps the “Swedish model” was more sustainable than strategies elsewhere based on coercion and lockdowns. The number of infected people had decreased significantly; coronavirus wards in hospitals emptied and the death rate was not excessive.

But in the second half of October the second wave struck and now many of Sweden’s hospitals are overwhelmed. According to the Swedish statistics agency, the November death rate was the highest since November 1918 – during the Spanish flu pandemic.

“The health system is overloaded,” Björn Eriksson, the health and medical care chief for the Stockholm region, said in a television interview.

He described an event of historic proportions. “Never have we needed so much medical care at one time point in time, and an improvement doesn’t appear likely soon,” he said.

A subway platform in Stockholm, December 2020.Credit: Jonathan Nackstrand / AFP

Worsening daily number

In recent days, 7,000 new coronavirus cases a day have been plaguing Sweden, whose population is 10 million. The number of patients in hospitals this week reached nearly 3,700, topping the peak of the first wave. The number of average daily fatalities is lower than in the spring, but with the total death toll approaching 8,000, there are fears the situation is getting worse.

Sweden’s plight is no different than that of several other European countries now facing a second wave, but its per capita patient number is lower than in Switzerland, Austria, the Netherlands and the Czech Republic, where a similar number of tests are being done. Sweden comes in 25th in the world in deaths per capita – doing far better than Britain, Spain and Italy.

However, the situation in Sweden is far worse than in its neighbors Denmark, Norway and Finland, whose mortality and infection rates are among the lowest in the world.

The numbers may be going up, but the Swedes are loyal to the model they created. Even in the second wave they decided not to impose a lockdown and kept schools and preschools open. The economy is functioning and although some people are wearing masks in public spaces, they’re still a minority.

In recent days medical experts have slammed the public health agency, claiming that not enough has been done to slow the spread of the virus, and even Prime Minister Stefan Löfven appeared to be critical.

Löfven told the daily Aftonbladet this week that the experts had underestimated the second wave, and the government is drafting a bill enabling the closure of shopping centers, gyms and public transportation.

A performance at the Royal Swedish Opera, with the audience practicing social distancing, Stockholm, October 2020.Credit: TT News Agency / Reuters

Tactical change

However, the legislative process could take months and there’s no indication the government plans to implement a lockdown at this stage.

Sara Byfors of Sweden’s Public Health Agency told Haaretz that while the country’s strategy hasn’t changed, stricter measures have been taken.

“The Swedish strategy is to reduce mortality and the serious COVID-19 infection rate to a minimum and make sure the health system can cope and provide medical care to those who need it,” she said.

“The steps we’re taking to achieve this goal have changed in the course of the pandemic. In the autumn the government took steps like banning alcohol sales after 10 P.M. and limiting gatherings to eight people. We’re also very clear in our message that social interactions must be restricted, so the strategy has remained similar but the measures may change.”

Additional measures have been implemented such as remote learning for school kids and the closing of some retirement homes to visitors. But these steps might not be enough: The hospitals are stretched to capacity, the death rate is rising and nonurgent medical procedures are being postponed. Last week, following the resignation of a large number of health care workers, the head of the Swedish Association of Health Professionals, Sineva Ribeiro, called the situation” terrible.”

The head of emergency preparedness at the National Board of Health and Welfare, Johanna Sandwall, told Haaretz it saddened her to see nurses and other health workers quit during the crisis.

“We don’t have an analysis yet as to whether it will affect national planning and what the repercussions will be,” she said. “At the moment the health system is stretched extremely thin due to the medical staffs’ exhaustion and the many COVID-19 patients. We have to take various steps to handle urgent needs.”

People chatting at the outdoor section of a bar in Stockholm, April 2020.Credit: Andres Kudacki / AP

Either way, there is still no agreement on the Swedish strategy. Unlike those who say the current crisis stems from the soft approach and Sweden’s refusal to close everything down, many note that a raft of countries that shunned lockdowns are faring worse.

This is reflected in infection rates, mortality, delays in treating strokes and heart attacks during lockdowns, and worsening cases of depression, obesity and addiction to drugs, cigarettes and alcohol, amid worsening violence, poverty and unemployment.

The Swedish authorities also say it’s too early to judge their approach. At this stage they’re focusing on bolstering the health system and trying to prevent the virus from spreading. Conclusions will have to wait for the crisis to pass, they say.

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