Even though different nations are at different stages in their pandemic curve, international media often make cross-border comparisons that frame Sweden’s coronavirus response as a failed experiment. Several news outlets have recently focused on the country’s high death rate, noting that its government did not mandate a full lockdown similar to other European countries and U.S. states.
A New York Times article describes “Sweden’s grim result” as “a cautionary tale,” while a CBS News headline from mid-July reads, “Sweden becomes an example of how not to handle COVID-19.” But Swedish health officials say such conclusions are premature, especially considering confirmed infections continue to surge in multiple regions of the world.
“I’m looking forward to a more serious evaluation of our work than has been made so far,” said Swedish state epidemiologist Anders Tegnell, the architect of the plan, in a recent radio interview. “There is no way of knowing how this ends.”
In the meantime, Sweden will likely continue to be both praised and condemned for not following the pack. And those conclusions, backed up by visually stimulating graph charts that reinforce a hodgepodge of narratives.
Comparing the epidemic curve in Belgium (11.5m pop), which locked down early on 17 Mar, and Sweden (10.2m pop), with no lockdown. Chart depicts deaths by date of occurrence, with Sweden per capita adjusted. Total per million: Belgium (844); Sweden (547). pic.twitter.com/W7u5pCQ8MV
— Paul Yowell (@pwyowell) July 11, 2020
Amazingly, I still hear from people who think Sweden's Covid response is a success story. Mostly they seem to be looking at total deaths and not realize that Sweden only has 10 million people. Per capita it looks terrible, although not as bad as America 1/ pic.twitter.com/swQQaVZ0PH
— Paul Krugman (@paulkrugman) July 19, 2020
Some people misunderstood my graph comparing Sweden to New York State, confusing it with NYC. I thought it was unfair to compare Sweden to NYC so I didn't. Given all the comments and misunderstanding, I wanted to clear things up with both.
There is nothing for NY to celebrate. pic.twitter.com/9ojSFLuonj
— Yinon Weiss (@yinonw) July 15, 2020
Here are the five things you need to know about Sweden’s response at this phase of the COVID-19 pandemic.
1. Sweden’s “open” policies appear to have resulted in a higher mortality rate than neighboring countries, while its economy ended up slightly better off.
According to CBS News, “the death toll from Sweden’s outbreak is now the fifth-worst in the world, per capita. The country’s mortality rate from the coronavirus is now 30% higher than that of the United States when adjusted for population size.”
However, a correspondent from the network recently visited the country and found that Swedes appear to support the government’s strategy still.
Sweden never imposed a lockdown and now has a coronavirus mortality rate much higher than the U.S., and could face a devastating second wave. https://t.co/WvvB381jMO
— CBS News (@CBSNews) July 19, 2020
The NY Times notes that “thousands more people died than in neighboring countries that imposed lockdowns.”
Recent counts indicate there have been at least 5,667 deaths from coronavirus in Sweden, while none of the other Nordic countries have eclipsed 700.
Sweden is the largest Scandinavian nation with a population of more than 10 million people — nearly twice the size of Denmark, Finland, or Norway. It has roughly the same number of residents as Los Angeles County, California.
L.A. County has reported 4,213 deaths. The county’s median age is 37, about four years younger than Sweden’s population.
On Tuesday, Swedish health officials projected at least another 3,000 deaths there.
“The elevated death toll resulting from Sweden’s approach has been clear for many weeks,” the Times concluded.
The Times acknowledged that “Sweden’s economy has fared a little better” than its neighbors, with “nearly equal economic damage.”
Earlier this month, Sweden’s central bank projected the country’s GDP would contract 4.5% this year. Despite not going into full lockdown, Swedes voluntarily limited shopping and spent less money. At the same time, the disruption of global supply chains had a negative effect since the country is dependent on exports.
As CNBC reported on Friday:
Sweden’s economy hasn’t been unscathed but its contraction seems to be less dramatic than what other countries are facing. A Capital Economics report from mid-June noted that Sweden’s GDP would likely shrink 8%, compared with the harder-hit countries with lockdowns like the UK, where the contraction would be closer to 25%. That said, other reports have found that Sweden’s economy didn’t perform all that differently than its neighbors, including Denmark. Despite less stringent lockdowns, unemployment still rose and consumer spending fell.
2. Many of Sweden’s COVID-19 deaths have been older adults who resided in long-term care facilities.
Like many countries, Sweden’s high mortality rate is linked to older adults in nursing homes who tend to have weaker immune systems.
The International Monetary Fund published data last month that indicated that nearly half of Sweden’s coronavirus-related fatalities had occurred in nursing homes, while “the 70+ age group accounted for almost 90 percent of all deaths.”
“We did not manage to protect the most vulnerable people, the most elderly, despite our best intentions,” Sweden Prime Minister Stefan Löfven admitted.
Sweden kept its country relatively open during the coronavirus pandemic, but its elderly paid a price https://t.co/1xOruvjELT
— CNBC Tech (@CNBCtech) July 17, 2020
Sweden put measures in place at the early stages of the pandemic intended to safeguard its senior citizens. Still, the virus is thought to have spread through elderly care facilities by asymptomatic healthcare workers who did not know they were infected.
Swedish newspaper Dagens Nyheter reported (translated to English):
The Swedish Public Health Agency already on 10 March recommended relatives from carrying out “unnecessary visits” to nursing homes and hospitals, and on 1 April the government decided to introduce a pure ban on visits. The government had previously given what was called a “sharp recommendation” against visiting nursing homes.
By the end of April, the virus had spread to 75% of Stockholm’s 101 elderly care facilities, the Times reported.
Several medical professionals believe procedures have discouraged hospitals from admitting elderly patients to free up ICU beds. Some say care home employees were forbidden from administering oxygen to sick residents without a doctor’s approval. Other reports allege elderly deaths have been accelerated with morphine, which can potentially cause a patient to stop breathing. One study projected one-third of Sweden’s old folks who died might have survived if they had received aggressive treatment.
3. Sweden insists achieving “herd immunity” is not its main strategy, but many believe it is an unstated goal.
Those who have criticized Sweden’s response have said the country’s strategy is a prolonged experiment with “herd immunity,” which would mean a sufficient portion of the population catches the virus, recovers, then develops antibodies that would theoretically protect against future COVID-19 infection. According to the NY Times, “the precise herd immunity threshold for the novel coronavirus is not yet clear; but several experts said they believed it would be higher than 60 percent.”
Scientists in Sweden and abroad have accused the country of dangerously pursuing "herd immunity." https://t.co/mkMNWGygK6
— USA TODAY (@USATODAY) April 28, 2020
While some speculate herd immunity is “the secret goal,” Swedish officials have denied it was ever part of the government’s public health plan. After President Donald J. Trump suggested Sweden had adopted such an approach, Swedish Foreign Minister Ann Linde said his perception of the official policy was “factually wrong.”
“We do not have a herd immunity strategy in Sweden,” she told CNN’s international audience in April.
Talked to @cnni about how Sweden tackles Covid-19. We use legislative restrictive measures and recommendations, in close cooperation with @Folkhalsomynd and other authorities. Key to our strategy is trust. Watch full clip here: https://t.co/DDOx9yW8qv pic.twitter.com/wudfl3SRYQ
— Ann Linde (@AnnLinde) April 9, 2020
Critics cite statements from Sweden’s Public Health Agency as evidence that herd immunity is an unstated objective, pointing to mandatory schooling for young children as further proof. Others say classes remained in session partly for the mental and physical well-being of the schoolkids while avoiding problems related to child care.
Tegnell added fuel to public confusion after he called herd immunity a “great concept” and said the idea was “not contradictory” with efforts to flatten the curve and relieve the burden on hospitals.
4. Sweden didn’t mandate a full lockdown, but life was not normal.
A New York Times headline from May reads, “Sweden Stayed Open. A Deadly Month Shows the Risks.” The article described Sweden’s plan as “a moderated response,” noting that officials “chose not to implement a nationwide lockdown, trusting that people would do their part to stay safe.”
Many have praised Sweden for staying open during the coronavirus outbreak.
We looked at the data: Yes, Sweden is better off than many countries that enforced strict lockdowns. But its outbreak has been far deadlier than those of its neighbors. https://t.co/Dk5ZtU97p9
— The New York Times (@nytimes) May 15, 2020
Another Times article published earlier this month said Sweden’s “laissez faire approach” has “allowed the world to examine what happens in a pandemic when a government allows life to carry on largely unhindered.”
But Sweden’s foreign minister called such a characterization of the country’s response a “myth.”
“It’s a myth that life goes on as normal in Sweden,” Foreign Minister Linde said months ago.
Some Swedish health officials have argued that its voluntary measures to “flatten the curve” and lessen the burden on hospitals were not that different than those mandated by other nations.
“Basically we are trying to do the same thing that most countries are doing – slow down the spread as much as possible,” Tegnell said during the early stages of the pandemic. “It’s just that we use slightly different tools than many other countries.”
Sweden prohibited gatherings of more than 50 people, issued physical distancing guidelines and encouraged people to work from home whenever possible. Swedes were asked to avoid unnecessary travel. According to reports, many residents willingly self-isolated and curbed their public outings. Vulnerable groups were urged to stay home, and visits to elderly care facilities were prohibited. High schools and universities closed, but elementary and middle schools remained open. So did playgrounds, restaurants, bars, gyms, and stores.
Sweden! No lockdowns, no school closures. Life went on normally, thanks to expert medical advice not to disrupt life. pic.twitter.com/BUbM8PjTsA
— Jeffrey A Tucker (@jeffreyatucker) July 20, 2020
According to reports and studies, Swedes generally complied with the government’s suggested measures. Some say Sweden’s more lenient approach has lessened the unintended consequences that could result from complete lockdowns, such as social unrest, drug use, loneliness, domestic abuse, and psychological problems.
“I think people are in better shape mentally, because we’ve been able to go out,” Mia Soderberg, a resident of Stockholm, recently told CBS News.
A researcher at Lund University, one of Sweden’s top institutions for higher learning, found that the NY Times and several other international media outlets “painted a picture of Swedes eating at outdoor cafes and strolling in the sunshine, or even skiing.” She said such depictions resulted in a mistaken belief that the country wasn’t taking the outbreak seriously.
As the rest of Europe lives under lockdown, Sweden keeps calm and carries on https://t.co/ev9iueoVZ3
— The Guardian (@guardian) March 28, 2020
“There is a double misconception that Sweden ‘stayed open’ to promote herd immunity and to save the economy,” Rachel Irwin told The Daily Wire in an email. “Public health was always the main concern – not the economy.”
She noted that Sweden’s main cinema chain closed in mid-March due to low attendance, while the country’s primary ski operator closed its facilities at the beginning of April.
Sweden still has not recommended face coverings, and wearing them in that country is not the norm.
Tegnell told TT Newswire: “It could send out signals that it’s OK to go out if you’re sick [if you wear a mask]. That would break a successful communication. The foundation of the Swedish strategy is to stay home if you are sick and keep social distance. Recommending face masks could go against that.”
5. Sweden has no plans to change course.
CBS News recently reported that “there’s no indication” that Swedish authorities are about to change strategy.
At a press conference on Tuesday, Sweden’s chief epidemiologist said the country had experienced a significant decrease in COVID-19 spread.
“The epidemic is now being slowed down, in a way that I think few of us would have believed a week or so ago,” Tegnell said.
“It really is yet another sign that the Swedish strategy is working,” he continued. “It is possible to slow contagion fast with the measures we are taking in Sweden.”
This Slate article doesn’t quite accurately portray the current state of COVID-19 in Sweden…
Sweden is down to well below 5 deaths per day.https://t.co/LLymoOIvaV pic.twitter.com/PRNWfuC5wa
— James Todaro, MD (@JamesTodaroMD) July 14, 2020
Last month, Mr. Tegnell reportedly told a Swedish radio station that there was “a potential for improvement in what we have done.”
“If we were to encounter the same disease again, knowing exactly what we know about it today, I think we would settle on doing something in between what Sweden did and what the rest of the world has done,” he said.
Several international media outlets picked up quotes from the interview, which some people mistook as an admission of failure.
Architect of Sweden's coronavirus strategy admits too many died https://t.co/aakdwi1FzY
— The Guardian (@guardian) June 3, 2020
Tegnell clarified his statements the following day, as reported by the Local Sweden:
Tegnell’s comments quickly grabbed headlines both in Sweden and in international media. But he told the Public Health Agency’s daily press conference at 2pm on Wednesday that they should not be interpreted as a rejection of the entire strategy. He said that with the benefit of hindsight there are always things that can be improved, but that he and his team would nevertheless not drastically have changed the strategy.
“We still think that the strategy is good, but you can always make improvements, especially when looking back. I personally think it would be rather strange if anyone answered anything else to such a question. You can always do things better,” he said, adding that he did not necessarily think he had been misquoted, but that his comments had been overinterpreted.
Sweden’s leaders have repeatedly stressed that the measures are designed for the long haul, that the fight against the virus is a “marathon, not a sprint.”