New Delhi: Sweden was lauded for its ‘low-scale’ lockdown Covid-19 strategy, which relies heavily on voluntary social distancing, but it is now discovering that being counterintuitive may not be the best approach in matters of public health.
When most of its neighbours were shutting down schools, businesses and restaurants, and asking people to stay at home and avoid gatherings, Sweden took a different route — it let life continue as before with social distancing guidelines but no stringent measures.
The country decided that rather than shutting down and reopening suddenly, which may see a sudden spike in cases, a “low-scaled” lockdown that kept it running may be a better option.
Anders Wallensten, Sweden’s deputy chief epidemiologist, described the strategy as a slow spread of infection to ensure health services are not overwhelmed, arguing that it was important for a part of the population to acquire immunity.
The strategy relies on the epidemiological concept of herd immunity, which means if enough members of a certain population are infected with the virus, it offers protection to other vulnerable members and keeps the disease in check.
The country of 10.2 million population depended on its robust healthcare system to protect it if the cases do rise.
Over the past week, however, the number of Covid-19 cases in Sweden have been rising with 700 new cases reported just on 24 April.
In all, as of 24 April, Sweden has 17, 567 cases with 2,156 deaths.
This is over double the cases and more than 20 times the deaths recorded by its nordic neighbours such as Norway (7401 cases, 195 deaths) and Finland (4395, 177), both of whom implemented stringent lockdowns. Finland is, in fact, in the process of easing lockdown measures as its cases have been reducing.
The deaths per million in Sweden is now 198, higher than Germany (67) and even the United States (152), the worst affected country in the world right now.
It also begs the question — Did Sweden’s gamble backfire?
There are sharp differences in COVD19 strategists between the Nordic countries. And also a distinct difference in results as measured in deaths. pic.twitter.com/Egw51K02Xk
— Carl Bildt (@carlbildt) April 16, 2020
Self-restraint and choice
At the heart of the Swedish approach is the country’s emphasis on individual freedom as well as self restraint.
In an interview with The New York Times in March, state epidemiologist Angus Tegnel said, “That’s the way we work in Sweden. Our whole system for communicable disease control is based on voluntary action. The immunization system is completely voluntary and there is 98 percent coverage.”
Hence while the public messaging focussed on social distancing, hand washing and keeping those above the age of 70 years safe, the Swedish government did not close primary and secondary schools and allowed restaurants, salons and markets to run.
Even gatherings up to 500 people were allowed in the early phase. Only high schools were shut and people were advised to work from home.
Swedes even though they approved of the government’s decision to not order a lockdown, kept away from public life — public transport saw a 60 per cent drop and ski resorts lay empty.
The strategy, however, did not take into consideration the asymptomatic carriers of the disease, the high number of elderly population and the fact that self-reliance may not work in a public health crisis, wrote Hans Berstorm, member of Royal Swedish Academy of Engineering Sciences.
By April, the number of Covid-19 cases began rising rapidly, especially in nursing homes for the elderly. It was estimated that almost one third of the nursing had at least one case of coronavirus.
Number of ICU admissions due to Covid-19 has doubled since March in Sweden and as of 24 April, nearly 1,244 patients are in intensive care units.
The death toll is highest among immigrant families who live with more intergenerational families and senior citizens.
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Experts urge the government to reconsider
The Swedish government has responded by posing new restrictions, such as not allowing more than 50 people to gather at one time, advising spacing measures in restaurants, banning international travel and visits to nursing homes.
But a section of experts think it is a matter of too little too late.
In March, a petition by 2,000 experts and academicians initiated by six professors at Karolinska Institutet, its apex research body, urged the government to reconsider its stand on lockdowns.
Countries that depended on herd immunity such as the United Kingdom and Netherlands have already changed course as cases and deaths have risen.
“We still have some time to react and suppress the virus. Our nation should not be the exception in Europe. We request that our government takes action now!” wrote the academicians.
Tegnell, the country’s chief epidemiologist, is defiant. He claims the strategy is working and the numbers are stable: “We will see the impact of the herd immunity kick off soon in a couple of weeks.”
Sweden’s Prime Minister Stefan Löfven has, however, warned that the coronavirus strategy may have slowed down the number of cases but they will see more seriously ill patients needing intensive care. “We count the dead in thousands,” he said.
Also read: 30 days in lockdown, India has been able to control rate of Covid-19 infections, says govt
Also, Sweden counts Corona deaths as people who died while infected, even if Corona wasn’t the primary cause. Sweden also counts deaths in nursing homes as well as in private people’s homes. In a report it shows that of all deaths, Sweden has counted 72% as Corona deaths, whereas Norway counted 6% as Corona. Get your statistics straight please! It’s very easy to make your own truths with a base of “statistics”. To make it correct, you have to use fair comparisons.
A poorly researched article with a potpourri of data picked up from the internet. There are interviews available where Andrew Tegnell explains the strategy. Yes, some mistakes were made in not providing enough protection for the elderly and the high risk group. In the long run, Sweden will be best positioned to come out of this with the economy in decent shape to boot , and avoiding second / third wave of attacks. Lockdowns are not a solution as it only buys you time to get your act right to handle it. Most of the countries that have locked down have done very little with it. Look at Singapore now, unable to handle second wave of attacks.
So, spend more time to do additional research and come up with a better article .
Hello
The article seems more as opinion (I am not blaming the author here) not facts. The narrative voiced in this article is a summary of some pockets of criticism. If you see the actual daily reported figures on c19.se – it is evident that the strategy adopted by Sweden is paying off in terms of flattening the load curve on the medical care system
Ofcourse, I do not personally advocate this stratgey. That is partly, as I am not adequately qualified on epidimiology; but moreover due to the fact that demographics in Sweden are unique aspects
I hope this article is revisited to include the opinion of voices in support of the implemented strategy in Sweden as well
Deaths per 1M population in Sweden, currently at 225, is higher than Norway/Denmark but much lower than Belgium (622), Spain (503), Italy (446), France (350) and UK (305), all of whom did impose lockdowns. Swedish claim is that the virus will eventually spread to everyone as lockdowns are not perfect. So, those who are going to die, will die. Only a small number of deaths can be avoided by medical intervention. As long as the cases stay low enough for hospital capacity, those who can be saved will be saved. The death rate in Norway / Denmark is lower than Sweden now, but the Swedes think that by year end, that difference may disappear as people in Norway / Denmark will die later when the infection will eventually spread there as well. Later, because lockdown has slowed the spread now but it will eventually spread anyway.
You are just comparing the deaths per million as of date but Sweden’s point is that those deaths are bound to increase in the coming months even in places that have lockdowns imposed. And by the time those deaths increase in countries with lockdown Sweden would have gained herd immunity and would be functioning normally.
I am in SWEDEN for past 3 years and I believe the strategy is working. Look at more statistics : average age in Sweden 40.5 years. Deaths for people over 60 as of today 27 April is 2000 people. 1/3 of cases in Sweden are in Stockholm. Schools for kids are open as all health care workers with kids need some support. In Sweden unlike india grand parents don’t live with their kids and kids kids. So schools have to be open.
Sweden constitution did not give powers to the government to do a lock down. They have to follow public health agency recommendation.
With new powers given to them on 18 April valid until 30 June, still they don’t want a lockdown as they trust even if they go for lockdown numbers won’t go down. Whenever a country opens up after lockdown the numbers go up again. with social distancing Sweden believes to carry this new normal for long rather than having lockdown and open and then lockdown and so on and so forth
Sweden will be out of this mess first. All their neighbours who locked down have the worst to come, and a broken economy to boot.
The only mistake Sweden made was to not protect old peoples’ homes better, but the numbers show their decision to stay open was the right one. Norway, Finland and Denmark will still be hiding under the bed-covers long after Sweden returns to normal.
Where do you get journalists like this? Read a bit, there is plenty on the internet about what they are doing. There is an hour plus interview of Anders Tegnell on youtube. Swedish population by and large support his policy. They have done social distancing, shut offices etc. Again, read a bit more about the specifics of Sweden- single households, two cities with high population and rest scattered around. They have admitted two mistakes – which are cross linked. One is elderly homes, they did not protect that well. Secondly, high death rates in their immigrant Somali population and many of them work in care homes. Other than that the population by and large voluntarily follow social distancing. Please research, they will not back down. It is a marathon not a sprint. Slow spread of disease while managing economy. Their ICU capacity has been underutilised.
Be safe rather than sorry