The case for “doing a Sweden” runs out of steam

21 Dec

From the start of the Coronavirus crisis, Sweden’s approach to managing the virus has sparked huge debate. While its Nordic neighbours, and many others, enforced strict lockdowns, Sweden took a more libertarian route, leaving most schools, businesses and restaurants open throughout the pandemic.

Sweden soon became known as an “experiment” in whether lockdowns work, with Covid “hawks” and “doves” closely monitoring it over the last year to see who would be proved right. Did the experiment pay off? Unfortunately, the answer now seems to be no.

Sweden has struggled immensely with the pressures of the second wave, with one Stockholm region recently reporting that 99 per cent of its intensive care beds were full, and the country recording its highest new case count yet (9,659) last Thursday. Sweden has had more deaths than the rest of Nordic countries combined (8,000 have died in Sweden compared to 400 in Norway), and even its King, Carl XVI Gustaf, claimed it had “failed” to manage Coronavirus.

The severity of the situation is most obvious from the fact that Stefan Löfven, Sweden’s Prime Minister, has increasingly intervened on pandemic policy. In other countries, having a leader do this would not be such a strange occurrence, but the Swedish Public Health Agency typically presides over such decisions. Löfven’s intervention has thus been taken as a sign he disapproves of its past strategy (as does the public – apparently – with support for Anders Tegnell, Sweden’s leading epidemiologist, dropping by 13 points in a recent poll, and support for its public health agency dropping from 68 per cent in October to 52 per cent.).

On Friday, Löfven announced the strictest measures yet for Sweden, with the government lowering the limit at restaurants to four people per group and banning alcohol sales past 8pm. It has also asked citizens to wear face masks on public transport at certain times.

The measures still show Sweden cares greatly about freedom. It has not made face masks compulsory, for instance, and shops are responsible for deciding the number of people who can enter them at one time. Unlike in other parts of the world, there are no penalties for breaking the recommendations, and Löfven also still believes full lockdown was not the right choice for the country. However, he has said that if these measures do not have the planned effect, “the government will also plan to close those businesses”, so it remains to be seen how far Sweden will venture from its original Covid response.

Whatever the case, it is clear that there will be big implications for Sweden in the future in terms of its governance, with Tegnell said to be increasingly sidelined. Does the government want to continue letting the Public Health Agency take charge of health policy after the events of this year?

Some of the Sweden “experiment” is more complex than is sometimes made out. It still has a lower death rate than other countries, a higher population to the Nordic countries it is frequently compared with, and its GDP has not been as badly hit as other nations’, which will in turn have an impact on health.

But it’s still clear that the case for “doing a Sweden” will struggle after this point. While the Covid Recovery Group hasn’t called for a “Sweden” exactly, it has been deeply sceptical about the tiered system. With the current second wave situation, and Löfven’s intervention, it will find its arguments for reopening the economy increasingly hard to make. Not even the country that invented the “anti-lockdown” policy can now sell this approach.

Sweden – an experiment gone terribly wrong?

30 Nov

Ever since Anders Tegnell, Chief Epidemiologist of Sweden’s public health agency, shunned the idea of a national lockdown to fight Covid-19, his country has been the subject of intense debate.

“Should we have done a Sweden?” fast became one of the most controversial questions to ask in the UK (and no doubt other countries). Sweden provoked opinions as divided as those on Brexit. Some felt that it had been dangerously relaxed about Covid-19, whereas others idolised its policy.

You only had to go to an anti-lockdown protest to see how fanatical some had become about Sweden. I observed one in London, where I photographed a young woman with a placard reading “SWEDEN DID IT RIGHT!” I wondered how my picture of her would age. Would she be vindicated as a brave revolutionary? Or proved wrong?

Right now, many would say the latter. Sweden has shown troublesome trends in its fight with Coronavirus. While its death rate (6,681) is low compared to many countries, the statistics are almost certainly going in the wrong direction, with cases and deaths steadily increasing. Shockingly, the European Centre for Disease Prevention says that in December, Sweden will surpass the peak death rates it suffered in April, with between 100 and 140 projected to die of the virus each day.

Furthermore, Sweden doesn’t compare well to its neighbours, which Tegnell once said would end up with lower levels of immunity. Whereas Sweden has seen 630 deaths this month so far, Norway, registered 30 deaths between October 28 and November 25.

Although Norway’s population is around half the size of Sweden’s, the difference is still stark, and in pursuing a more hawkish approach, Sweden doesn’t seem to have gained much economic benefit. Its GDP slumped 8.6 per cent in Q2, which was sharper than that of Denmark, Finland and Norway.

All of this has led many to conclude that Sweden has failed, and that someone is responsible for said failure. Newspapers are quick to point the finger at Tegnell, whom they suggest is being sidelined by the government because of his errors.

It certainly would seem that Stefan Löfven, the Swedish Prime Minister, wants more control over the pandemic. Sweden is unique in that its health agency, as opposed to the government, is in charge of health policies. But who knows for much longer…

In the fourth ever broadcast by a Swedish PM, showing just how urgent matters have become, Löfven warned that the Covid situation would get worse before it got better, and asked Swedes to call off, cancel or postpone non-essential meetings. The government has also banned public gatherings of more than eight people.

But does this make Tegnell and the whole of Sweden’s approach a disaster? It’s easy to say yes, but the reality – like everything in Covid-19 – is more complicated than headlines suggest.

For one, Sweden has never been as radical as made out, and actually had restrictions at the beginning of the Coronavirus outbreak. High schools and universities were closed, gatherings of more than 50 people were banned and the health authorities advised those over 70, as well as people who felt ill, to stay home.

Two, there are more favourable comparisons on which to place Sweden – only they do not always get the same media traction:

And three, not all of Sweden’s initial policies are thought of as incorrect by other governments. It kept schools for pupils up to 16 open throughout the crisis, in a decision that has now followed.)

The reality is that Sweden, like many other countries, has simply evolved its strategy in line with new data. In October, for instance, I wrote about the fact Sweden’s regional authorities would soon have their own ability to issue Covid-19 guidance, similar to Germany’s localised system. At a national level, the health authorities became more cautious – warning people to avoid shops, restaurants and public transport. Tegnell was especially vigilant about the elderly, as a large number of Covid-19 fatalities in the first wave of the crisis were care home deaths.

Far from being callous, which Sweden is often presented as, its initial system was always based around trust. It asked citizens to distance from one another, and to be careful, but it did not seek to legislate around their movements. There were also some logistical points Tegnell took into account when deciding Sweden’s policy, such as the fact it has a low number of multi-generational households compared to other nations.

And so, these nuances have to be taken in when assessing Sweden. Now that the vaccine has arrived, it’s tempting to decide what country “did best”, and to believe the “sit tight and wait for a vaccine” policy was correct.

But there remain so many unknowns, from whether the vaccine will work (we still don’t have approval) to the scale of the economic damage, to how every little decision will play out over years and decades. We are missing complex data, too, around population density, hospital capacity and other factors central to assessing a country’s performance. In short, the answer to the question “should we have done a Sweden?” is “who knows.”

Sweden. Once the outlier. But a new localised approach brings it closer to other countries.

14 Oct

Throughout the Coronavirus crisis, it could be said that Sweden has been the biggest outlier in terms of its pandemic strategy. While many countries quickly introduced lockdowns at the outbreak, and others implemented already-developed test and trace systems, Sweden pushed to keep society open as much as possible. 

Johan Carlson, head of its public health agency, justified this approach by saying that Sweden couldn’t take “draconian measures that have a limited impact on the epidemic but knock out the functions of society.” These words stunned members of the lockdown-loving press, as did the confidence of Anders Tegnell, chief epidemiologist, who refused to apologise for taking such a radical approach.

Hawkish Britons looked on with jealousy. As shoppers in this country were photographed frantically stockpiling Andrex, Sweden had more tranquil scenes of people going about their day. Bars and restaurants – as well as events of under 500 people were allowed to run. Seven months later, the debate still rages on about whether Britain “should have done a Sweden”.

There’s a libertarian romanticisation of it, and those with more interventionist instincts demonise it. It has become the axis on which people place arguments on whether to reopen, or close, the economy further.

The curious thing, though, is that the Swedish approach has actually changed a fair bit, making it not quite the radical experiment newspapers would have us all believe. It has, in fact, recently become closer to systems such as Germany’s, whereby local authorities get to decide what measures should apply to their area.

Indeed, next week Sweden will grant regional authorities the ability to introduce guidelines in their area to curb specific outbreaks of Covid-19. The National Board of Health and Welfare has set out what some of these could be, such as avoiding public transport; avoiding unnecessary travel; avoiding visiting people in a risk group, like elderly care homes, and avoiding physical contact with people who do not belong to your household. It remains to be seen how much councils will take up these instructions.

Furthermore, at a national level, Sweden has actually been quite cautious in many ways. Its health authorities encourage people to work from home if they can, avoid large social gatherings and keep a distance, as well as asking vulnerable people and over 70s to avoid shops, restaurants and public transport. 

Maybe the crucial difference about Sweden is that it has been a more consensual model than others’. Instead of introducing Emergency Powers, it has relied on people’s sense of personal responsibility to achieve a balance between keeping the economy open, and saving lives. 

Some of the more cautious move towards regional powers also reflects Tegnell’s fears about care homes – and his regret that they were not protected enough initially. It has been shown that a large number of the country’s 5,899 fatalities took place in such settings in spring, and he has since urged these places to “test staff very generously”.

In spite of Sweden’s evolving Covid strategy, the press still very much likes to sensationalise it. TIMES magazine recently called it a “disaster”, and focussed upon rising cases (never mind that daily deaths are relatively low and stable – as seen above).

But as with many other countries, the Swedish approach is changing. Perhaps that’s the biggest lesson from it. Nothing is known about this virus, not least how a government might – in future – choose to deal with it.

Daniel Hannan: Sweden settled in for the long haul, and now doesn’t need to worry about a second surge

5 Aug

Daniel Hannan is a writer and columnist. He was a Conservative MEP from 1999 to 2020, and is now President of the Initiative for Free Trade.

You know who isn’t worried about a second wave? Sweden. Covid cases may be rising worldwide but, in that stolid, sensible monarchy, they are down nearly 90 per cent from peak. “I think to a great extent it’s been a success,” says Anders Tegnell, the country’s chief epidemiologist. “We are now seeing rapidly falling cases, we have continuously had healthcare that has been working, there have been free beds at any given time, never any crowding in the hospitals, we have been able to keep schools open which we think is extremely important, and society fairly open.”

Uncomplicatedly good news, you might think. Yet the overseas media coverage of Sweden is brutal. Its fatality rate is endlessly compared to the lower rates in Norway and Finland (never the higher rates in Italy or Britain). Many commentators sound affronted, as though Sweden were deliberately mocking the harsher prohibitions imposed in most of the world.

The nature of their criticism is telling. To condemn Sweden for its relatively high number of deaths per capita suggests a worrying inability, even after five months, to grasp what “flattening the curve” means. In the absence of a cure or vaccine, an epidemic will end up reaching roughly the same number of people. That number may differ from country to country for all sorts of possible reasons: age profile, weather, family living patterns, openness to international travel, incidence of obesity, past exposure to different coronaviruses, differing levels of genetic immunity.

But it won’t be much affected by lockdown measures. To put it at its simplest, flattening the curve doesn’t alter the area underneath the curve. No country can immobilise its population indefinitely; so all we are doing, in the absence of a medical breakthrough, is buying time.

The UK lockdown was intended to string things out while we built our capacity. “It’s vital to slow the spread of the disease,” said the PM in his televised address of March 23. “Because that is the way we reduce the number of people needing hospital treatment at any one time, so we can protect the NHS’s ability to cope – and save more lives.”

Sweden judged that it could manage to keep its hospitals functioning with only relatively minor restrictions – and it was right. With hindsight, it seems likely that the UK could have got away with a similar approach. Not only did our Nightingale hospitals stand largely empty throughout; so did many of our existing hospital beds. The expected tidal wave, mercifully, did not come – probably because the rate of infection, worldwide, turned out to be lower than was first feared.

No one should blame public health officials for erring on the side of caution. Still, it ought to have been clear by late May that we could start easing restrictions. We knew, by then, that the infection rate had peaked on our around March 18 – that is, five days before the lockdown was imposed.

But, alarmingly, liberty turns out to be more easily taken than restored. The easing of the lockdown was achieved in the face of public opposition: British voters were global outliers in their backing for longer and stronger closures. The media, never having internalised what flattening the curve meant, failed to distinguish between preventable deaths and deaths per se.

In March, according to the official minute, “Sage was unanimous that measures seeking to completely suppress the spread of Covid-19 will cause a second peak.” As far as I can tell, it has never rescinded that view. The question is not whether there will be some post-lockdown uptick in infection rates – releasing an entire population from house arrest is bound to lead to an increase in all sorts of medical problems, from common colds to car crashes. The question, rather, is still the one we faced in March, namely can we be certain that our healthcare capacity will not be overwhelmed.

Given what we can see in Sweden – and, indeed, in developing nations which lack the capacity to isolate their teeming populations – it seems pretty clear that we can.

Yet the original rationale for the closures has somehow got lost. Commentators now demand the “defeat” of the disease, and hold up league tables of fatality rates as if that were the only gauge by which to measure the performance of different countries. Covid, like everything else, has been dragged into our culture wars, so that one side revels in excessive caution, ticking people off for the tiniest lockdown infractions, while the other argues that lockdowns don’t work at all.

The case against the lockdown is not that it was useless, but that it was disproportionate and had served its purpose long before it was eased. Confining an entire population is bound to have some impact on slowing a disease – any disease. The question is how high a price we should be prepared to pay.

Sweden seems to have got it right. It banned large meetings and urged people to stay home where possible. But, beyond one or two targeted closures, it broadly trusted people to use their nous. Because it judged coolly at the outset that there would be no immediate vaccine, it never got into the ridiculous position of being unable to restore normality in the absence of one. It settled in for the long haul, understanding that the disease would be around for a while, and that acquired immunity would be part of the eventual solution.

The figures for Q2 growth are published later today. Yes, Sweden will have suffered. The distancing measures taken by most Swedes, and the global downturn, will have taken their toll. Still, my guess – judging from retail figures, credit card activity, employment rates and other extant data – is that Sweden will comfortably have outperformed most European countries, as well as avoiding the costs of furlough schemes and massive borrowing.

It may turn out, when all is said and done, that the international variable was not the eventual death toll so much as the price exacted from the survivors.