Europe Versus Coronavirus – Self-Discipline Rather Than Lockdown: The Swedish Strategy

Responsiveness of the health system and the private sector

With the epidemic reaching Sweden later than Asia or Southern European countries, the country had a short but significant time to respond to the danger. Aware of its main weakness in this crisis (of all OECD countries, it has the lowest number of hospital beds, at 2.4 beds per 1,000 inhabitants), the Swedish health system quickly declared a "crisis situation" for hospitals in the capital. It is worth noting that Sweden is among the most generous countries in the European Union in terms of health spending, after Norway, Germany, and Austria. According to a 2017 study by the OECD and the European Commission, 11% of Swedish GDP is dedicated to the health system, compared to a European average of 9.8%.

In the first few days of April, intensive care capacity more than tripled in the Stockholm area, according to TT, the national news agency. The field hospital in Älvsjö, about ten kilometers from Stockholm, with an additional capacity of 140 patients, quickly opened its doors to lighten the capital’s burden.

With regard to healthcare workers, more than 100,000 of them attended online training sessions on combatting the risk of contagion and raising awareness of the protective measures to be taken. At Karolinska University Hospital in Stockholm, nurses were trained over 3 days to work as intensive care assistants.

Unfortunately, these efforts did not succeed in curbing the excess mortality in April. In Stockholm, the morgues quickly filled up and some refrigerated containers were placed outside hospitals in the heart of the capital. The deceased in Sweden are predominantly elderly, with 87% being over 70 years of age (63% over 80 years of age).

For its part, the private sector played its part from the onset of the crisis. Essity, a Swedish company specializing in hygiene products, has manufactured millions of masks since the beginning of April to support the care system and meet the needs of the Swedish people. In another example, to increase the production of ventilators in the country, medical equipment company Getinge has been "loaned" approximately 50 employees from Scania, a Swedish truck manufacturing company owned by Volkswagen. Furthermore, clothing giant H&M has adapted its production at a factory in China to provide long-sleeved protective gowns for healthcare workers.

Meanwhile, Sweden's four largest cities - Stockholm, Gothenburg, Malmö and Uppsala - have agreed to contribute SEK 125 million to ensure the joint purchase of protective and disinfection equipment for their municipalities and the rest of the country.

"National recommendations" rather than strict measures

Much like the rest of the world, Sweden favors social distancing to effectively combat the spread of the epidemic within the country. In the northern city of Luleå, the social distancing scale of choice is that of a "small moose".

These recommendations are made by the government and based on advice of scientists and experts, including Anders Tegnell, the country’s chief epidemiologist, who is invited to news shows almost every night. They are shared with the population through the press, media, and the official government website. Major decisions on the fight against Covid-19 are translated into the languages most spoken by minorities (Polish, Persian, Somali, Finnish, Russian, and Spanish) and posted on the website.

The State and the Public Health Authority also suggested further "preventive measures", to be followed until December 31, 2020. These include staying at home should you show symptoms, washing your hands with soap for at least 20 seconds, respecting social distancing as much as possible and avoiding peak transport hours, avoiding local and family events as well as unnecessary travel, and working from home whenever possible. People aged 70 or over, identified as belonging to the main "at-risk group", are encouraged to self-isolate and stay at home. Municipalities set up systems enabling the purchase of basic necessities for seniors by their neighbors. Primary schools, which have remained open, encourage outdoor teaching and recess as much as possible.

A call for self-discipline and solidarity

Swedes are asked to behave like the "adults" they are, as stated by the Prime Minister in his official speech on March 22. Radio stations throughout the country have been broadcasting factual messages for the past two months: "No need to panic, but better safe than sorry... what if grandma catches it?" or "keep calm... it's going to be okay... it isn’t that different from an ordinary flu, is it?".

As part of these efforts to raise awareness, the government has systematically communicated about the epidemic from both the health and economic perspectives. The Prime Minister has called on every citizen to favor local businesses. The number of hotels and restaurants going out of business has increased by 123% compared to the same period in 2019. Hairdressers, bakeries, cafés, restaurants, and other such businesses have nevertheless remained open all along, provided they comply with the social distancing guidelines (closures have taken place on a case-by-case basis for venues that did not follow these instructions, upon request by citizens), thereby protecting part of the economy. But as Finance Minister Magdalena Andersson pointed out in the New York Times, Sweden is highly dependent on exports and she expects the Swedish economy to drop by 7% this year.

A long-term strategy

In the eyes of the world, Sweden is considered to be one of the few countries that chose herd immunity from the outset. In reality, there is no evidence to suggest that this is the official strategy adopted by the State. For chief epidemiologist Anders Tegnell, who appreciates the need for herd immunity, the government's primary goal is to limit the number of people with symptoms at the same time in order to avoid overwhelming the system. This slow pace can be successful, provided that recommendations for social distancing are followed and extended over time.

Indeed, while most European countries are working towards the end of their lockdown periods this spring, Sweden has asked its population to "live with" the crisis until at least December. The official stance is thus to think in terms of "months" rather than "weeks". Isabela Lövin, Sweden's Deputy Prime Minister, called the crisis a "marathon". At the same time, Minister for Social Affairs Lena Hallengren and Director General of the Public Health Authority Johan Carlsson said that "this is not the time for looser measures, quite the opposite". The country is aware that it is only at the beginning of the crisis.

Is there a way out of this crisis? The country is relying on a potential Covid-19 vaccine. This comes as no surprise to the Swedes, who have among the highest vaccination rates in the world without even needing mandatory vaccination campaigns. In Sweden, vaccination is seen less as a means of individual protection than as a contribution to the country's common good. It is accepted that the objectives of herd immunity are to be achieved collectively. Only segments of the population need to be vaccinated, with these segments varying from one epidemic to another.

A unique approach. Rightfully, so?

While the country hasn’t been seized by panic, there is obviously a lively nationwide debate regarding the government’s approach to the crisis, as is the case in all democracies. On the one hand, there are intellectuals who are shocked by the choices of other countries throughout the world and cannot imagine a world dictated by prohibitions. This is the consensual position among the Swedish elite. Furthermore, business leaders spoke out during the early days of the crisis to remind everyone of the risks of a closed economy.

For its part, the political class has remained astonishingly calm. Even the Sweden Democrats are in line with the overall consensus. Jimmie Åkesson, the leader of this far-right party, did not seize the opportunity to criticize the minority coalition government between the Social Democrats and the Greens. On the contrary, he explains in debates and on social media that protecting the economy and standing together is of the utmost importance. As explained in Politico by Foreign Minister Ann Linde, this support by the Swedish far-right is not an expression of an inclination for libertarianism, but rather a reflection of the fact that the country has managed, in keeping with its history of consensus-reaching, to unite all eight parties represented in Parliament.

Meanwhile, the international community is astounded by Sweden's stance, which is by far a fringe position. A stance which is all the more unexpected, as The Economist points out that, in the 1980s, the country adopted stricter measures overall than its neighbors to combat the spread of AIDS. What explains the adoption of this more lenient strategy for Covid-19?

First, there is the cultural argument brought up by many commentators. The Swedes value their personal space both privately (they don't greet each other with kisses) and publicly. Public transport is rarely crowded. Queues in shops and pharmacies have always followed a ticket-based system. It is worth noting that the Swedes have enough room at their disposal to abide by these customs: indeed, one of Sweden's assets in the face of the pandemic is the low density of its population, which may help to limit the spread of the virus. With 25 people per square kilometer, compared with 120 in France or 206 in Italy, Sweden has one of the lowest population densities in Europe.

If it is indeed a matter of trust, as stated by Cecilia Malmström, a former European Trade Commissioner, during a podcast for the GMF, she also adds that this cultural argument is backed by a crucial legal element: according to Swedish law, the Prime Minister is not authorized to put Stockholm on lockdown.

Conclusion

Sweden hopes to find a way out of the crisis by adopting a long-term strategy. From the very beginning, the government committed to an approach lasting at least until the end of the year, and in the meantime is trying to find solutions to reassure the Swedes. In particular, much is expected of the State with regard to testing. As explained by head of department Karin Tegmark Wisell, the Public Health Authority wants to increase the testing capacity to 100,000 tests per week in the coming weeks. In late April, between 12,000 and 13,000 tests were carried out each week.

Local communities are also looking for ways to make life as easy as possible for the population. For example, in order to avoid problems related to social distancing in public transport, the Skåne Region, in the very south of the country, is launching a new service for users of the local service application to find out the level of congestion on buses and trains by means of sensors in the doors.

However, these are long-term investments. For the time being, Sweden is hurting. While the country is well aware of this, it has chosen to stick to a position that is the total opposite of what the rest of Europe is doing. In particular, it is worth noting that digital tracking solutions, implemented for example in Norway, are not even being considered by the Swedish government. Nevertheless, in order to take into account population movements in the Public Health Authority's daily analyses, the mobile data of Swedes is used as a basis for monitoring. This data is collected by operator Telia from Swedish customers only and is anonymized. From this point of view, science guides the country's strategy.
 
Until a vaccine is developed, the fate of the country will continue to be in the hands of chief epidemiologist Anders Tegnell and his colleagues. With the number of cases continuing to rise, he unsurprisingly stated on April 24 that "this is certainly not over".

Copyright : Anders WIKLUND / TT NEWS AGENCY / AFP