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Sweden Is Not a Model in Managing Covid-19 but a Special Case

Sweden’s steps to cope with the coronavirus have aroused both global curiosity and condemnation, but it has been a set of “peculiar circumstances” that have shaped the country’s response, the writer explains. Here, a recent scene at Lake Kottla, Stockholm. KJELL ENGELBREKT

STOCKHOLM — For those of us who have tried to keep up with the international commentary on Sweden’s response to Covid-19 during the last months, it has been bewildering. As Sweden failed to contain the coronavirus at its borders and shifted to a mitigation strategy in March, most Western democracies moved in the opposite direction and sought to suppress it.

Within weeks, Sweden attracted the interest of scores of foreign correspondents, political commentators and public-health specialists, asking about the country’s solitary trajectory. What propelled the Swedish authorities in this direction? Was there anything they had figured out and others had not? Or were the Swedes just more willing to accept a significant public-health risk in exchange for what they hoped would be less economic pain?

The number of current confirmed cases of the virus in Sweden is nearly 84,000, and deaths, 5,821, in a nation of 10.2 million.

As an outlier, Sweden’s response to Covid-19 intrigued observers, although most elements of its national response were, in fact, not unique. But as a totality of measures, they represented an anomaly precisely when countries that successfully implemented suppression were held up as models. By aggressively testing, tracing and containing the spread, South Korea, Japan and New Zealand were considered leaders of the global response.

As a counterexample, Sweden deviated in four important ways. First, the key measures designed to “flatten the curve” — the core of which was social distancing, handwashing and a ban on public gatherings in excess of 50 people — were noncoercive; that is, not coupled to fines or such. Second, mask-wearing was not recommended (until August, this was true for all Nordic countries). Third, a lockdown in the sense that most businesses, restaurants and collective transportation stopped operating was never put in place. Fourth, children from kindergarten age to 15 years old continued to receive education in their classrooms until the start of summer holidays in late June.

Until mid-May, Sweden’s trajectory attracted mostly curiosity or positive attention, the latter not least among North American libertarians, often oblivious to the country’s reputation as a progressive welfare, or quasi-socialist, state. But by this time the number of deaths — primarily in eldercare homes relying on low-paid staff working several jobs — had risen to 4,000, prompting a sobering sentiment in the citizenry and skepticism abroad.

Within a few weeks, foreign media turned critical and outright condemnatory, as in a New York Times article titled “Sweden Has Become the World’s Cautionary Tale,” published in early July. What many people noticed was that the number of deaths in neighboring Nordic countries, like Norway, Denmark and Finland, stayed in the hundreds.

But just as Sweden’s pandemic response never truly represented a libertarian success story nor was the “cautionary tale” version on solid ground. Temporary visitors and distant observers rarely picked up on the fact that a combination of peculiar circumstances shaped the Swedish response to Covid-19 in the first place.

For instance, freedom of movement is a constitutional right in Sweden, so restricting it through a full-scale lockdown would have been illegal, as would subjecting the expert-led National Public Health Authority to political-party considerations. As to mask-wearing, Sweden is sparsely populated outside Stockholm, the capital, and 45 percent of all households consist of a single person, so it is not expected to have much effect. Regarding measures being voluntary, public-health campaigns have a long history of success in the country, with one of the world’s highest vaccination rates as one example.

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The most interesting feature of Sweden’s response to Covid-19 is arguably the decision to keep kindergartens and primary schools open amid the pandemic, done so far more widely than in the other Nordic countries. Here, the Swedish public-health officials boldly relied on limited, initial data, suggesting that children developed mild or no symptoms and transmitted the disease far less than adults. Not all parents were prepared to accept that early assessment by the authorities, so some kept their children at home for several weeks. A July report of the National Public Health Authority comparing Sweden’s experience with Finland, a country that closed down all schools for two months, found virtually no difference in the number of infected schoolchildren.

Today, as minor outbreaks erupt in many European countries, Sweden is still experiencing a slow downward trend from a previously high level, and some commentators are once again reappraising Sweden’s strategy, pointing out that its economy is one of a few that suffered only a single-digit drop in GDP during the second quarter of this year. Yet whether this is a sign that Sweden’s approach, comparatively speaking, is more sustainable or just another twist in the broader story of a global pandemic poised to last for many months (or years), remains to be seen. Sweden continues to be an outlier in its pandemic response, and it is unclear if its strategy — in many respects shaped by happenstance — will ultimately generate more or less pain than that of neighbors or countries farther away.

Crucially, though, the consistent drop in new infections from mid-April to mid-August suggests one of two major things: either Sweden’s heavy reliance on voluntary social distancing (without mask-wearing) is an exceptionally effective nonmedical form of intervention, or Sweden’s mitigation strategy has actually yielded a significant level of immunity in the population. That level is unlikely to justify lifting most restrictions and recommendations in the short term but might be enough to thwart major new outbreaks.

If the latter proves to be the case, previously hard-hit locations, such as New York City, London, Delhi and northern Italy, are probably also less susceptible to a large second wave.

This essay is part of a series of people who work in international affairs or global health relating their experiences during the pandemic from across the globe: Vienna, Chicago, Singapore, Madrid, Beirut, Geneva, Santiago, Chile, Lilongwe, Malawi, Panama City, Panama, Auxerre, France, Whitchurch, England and Buffalo, N.Y. 

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Kjell Engelbrekt is a professor of political science in the Department of Security, Strategy and Leadership at the Swedish Defence University, Stockholm.

4 thoughts on “Sweden Is Not a Model in Managing Covid-19 but a Special Case”

  1. The Libertarian International Organization (LIO) was aware from Chinese libertarians in Wuhan that something was going extremely wrong in November, 2019, and contrary to media accounts recommended an aggressive approach focused on health provider discipline and mask measures on medical indication on January 1st to its fans while all health organizations were still in denial. It immediately understood based on recommendations of libertarian physicians across the globe that the purpose was to flatten the curve so all got the best care possible and protect the most vulnerable (or prevent it entering a country in the first place) while positioning for herd immunity (which was originally feared unlikely by some researchers), and not a quixotic attempt to stamp out the problem absent a vaccine or border containment from the beginning. In addition, libertarian physicians understood the major vector was poor discipline by physicians and hospitals, and the politicians. The media has grudgingly produced admissions of health facility lack of handwashing, masks, segregating serious cases from the unaffected, etc. and politicians promoting ‘hug a Chinese to show you’re for socialism and against racism’ as unhelpful.

    It has also said there was nothing ‘libertarian’ about the Swedish approach in their Facebook groups, which a responsible researcher should know. When the Libertarians themselves say the Swedish approach is not a particularly libertarian one would think this would be noted, but the international media claims the reverse of the truth.

    North American libertarians and Swedish libertarians are aware of this, the Swedish Defence University apparently not. Libertarian fans and the LIO were aware that the major spreader of the problem were inept coercively socialized health care systems run by far-left ideologues, starting with China, Iran, Italy, and New York City.

    The rates in Sweden and the US are about the same as far as death rates as of today (August 29, 2020). The US voluntary approach in Florida is lower than the rest of similar US and Sweden given the heightened medical/mask discipline from libertarian influence and adjusting for both far better US statistical collection, far superior health care compared to Europe, and the older Florida demographic. The far-left or far-right press likes to smear L/libertarians as do-nothings, but it was unsung libertarians who campaigned for the proactive medical institutions and health practices by common citizens that we enjoy today. Swedish health workers have certainly been proactive and responsive with what they have, not simply ignoring the problem as the international media pretends. Sweden by taking a more relaxed approach to business shutdowns has it seems helped its economy and the data may also prove has minimized deaths from people simply not venturing out for care or other economic impacts, but at the moment the data suggests as far as death rates it is like most Northern countries. Sweden is not saving more lives because that was not the focus, and apparent differences between the US, Sweden, and advanced countries may be statistical reporting issues–as mentioned, death rates are generally the same. The Libertarian approach is in contrast targeted saving of lives as far as possible by removing barriers to health care access (or in cases as Mongolia and Uruguay, mostly preventing and slowing disease entry) creating some pockets of best practices pending a vaccine/herd immunity.

    Libertarian 6-Sigma open management techniques have, finally, been very important in minimizing COVID impacts, as have their efforts to remove backfiring regulations especially in the US that limited testing and respirators. It has contributed to the rise of the internet, a great tool for immediate sharing by researchers. This actual Libertarian approach, but again, is ignored by media and political ‘experts.’ The Libertarian community is undramatic and focuses on scientific method, community/self-help, best practices, and pro-active common sense respectful of rights: That’s makes for boring news stories and academic articles that get peer-rejected as ho-hum trivial (or embarrassing, such as libertarian articles on iatrogenesis)–but good medicine.

    Reply
  2. I’ve read the entire article and no reasons were given why Sweden is a special case as you say and why this model won’t work in other countries.. If you say it’s a special case then write explicitly what make it so special!

    Reply
    • A combination of peculiar circumstances shaped the Swedish response to Covid-19 in the first place. For instance, freedom of movement is a constitutional right in Sweden, so restricting it through a full-scale lockdown would have been illegal, as would subjecting the expert-led National Public Health Authority to political-party considerations. As to mask-wearing, Sweden is sparsely populated outside Stockholm, the capital, and 45 percent of all households consist of a single person, so it is not expected to have much effect. Regarding measures being voluntary, public-health campaigns have a long history of success in the country, with one of the world’s highest vaccination rates as one example.

      The most interesting feature of Sweden’s response to Covid-19 is arguably the decision to keep kindergartens and primary schools open amid the pandemic, done so far more widely than in the other Nordic countries. Here, the Swedish public-health officials boldly relied on limited, initial data, suggesting that children developed mild or no symptoms and transmitted the disease far less than adults. Not all parents were prepared to accept that early assessment by the authorities, so some kept their children at home for several weeks. A July report of the National Public Health Authority comparing Sweden’s experience with Finland, a country that closed down all schools for two months, found virtually no difference in the number of infected schoolchildren.

      Reply
    • Here is a good video. We are the only country where mitigation actually mattered, neighbouring countries had no spread and other countries locked down when they were already through their peak. This guy have a few other podcasts if you want a bit more nuanced perspective of Covid-19.

      https://youtu.be/cSKjcltDkng

      Reply

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