August 27, 2020

COVID-19 Policy in Sweden: Disaster or Object of Admiration?

TT/Scanpix
Sweden’s chief epidemiologist, Anders Tegnell, speaking to journalists in July.
Sweden’s chief epidemiologist, Anders Tegnell, speaking to journalists in July.

Due to the coronavirus pandemic, Sweden may be facing an identity crisis.

As fate would have it, I experienced the height of COVID-19 in Sweden. I wrote down, day by day, what went on in Gothenburg. I later turned my corona diary covering 40 days into a book.1 Now, three months later, it is time to discuss what the Swedes did right and what they got wrong. Can the world learn anything from the Swedish experience?

Swimming Upstream

In mid-March, European countries closed their borders one after the other. Soon, almost every country on every continent was in lockdown. Governments forced their citizens to stay indoors. Freedom of movement was restricted according to the severity of the situation. The free movement of people, one of the fundamental principles of the European Union, was swept under the table based on the consensus of the member states’ governments. In Italy, Spain, France and soon the UK, extremely strict rules forced people to stay within four walls. International TV channels broadcast the development of the pandemic in dramatic detail.

The view in Sweden’s cities was different from the rest of the world. Life went on as it had before. Granted, while there were many happy old people on the streets and in the malls in March, the numbers reduced by the end of April. The fact that the elderly were much more vulnerable to COVID-19 forced them into voluntary self-isolation.

Masks were a rare sight in March, and in later months. Gyms, spas and restaurants stayed open. You could order a drink at the bar, but patrons were no longer allowed to sit and stand side by side at the counter. Walking in parks, sitting on benches and having a picnic when the weather got warmer was never prohibited.

The maximum number of people allowed at a gathering stood at 500 in March but was lowered to 50 by the government with the approval of the Riksdag (Swedish parliament) in early April. The same 50-person limit stands to this day. Cinemas closed their doors in March, and by mid-July there was still no sign of them opening again. Kindergartens and middle schools stayed open until the summer holidays. High school and university students had classes online, as they did in Estonia.

The question of why the schools stayed open has quite a simple answer: Swedish law states that children under the age of 12 cannot be home alone without supervision. As the board of every business could decide on lockdown individually, most companies and institutions therefore continued to operate as usual. Parents had to go to work and children could not be left at home on their own. So there was no other option than for middle schools to stay open. Furthermore, statistics confirmed that COVID-19 was not fatal for young people. The generation of their middle-aged parents could also relax and breathe easy. The situation was more serious for the grandparents.

Grandmothers or the Economy?

This commonly asked question is somewhat cynical, not to say inadequate. Every one of us would love to spend their retirement in Sweden, given the country’s social welfare and general social policy. However, Sweden was late in providing safety measures in retirement homes, just like the rest of the world. Unfortunately, testing was not the primary concern during the height of the pandemic. As in the rest of Europe, COVID-19 got into retirement homes through their employees.

If an elderly person lived alone and had someone hired by the local government to keep an eye on them regularly, they could catch the illness in their own home. In April, the Swedish media brought the subject of the elderly contracting the virus to the public eye in full force. The stark facts showed that, as local governments were low on workforce, anyone could apply and get a job taking care of the elderly.

The grim reaper wreaked havoc amongst Swedish pensioners, as in other countries. This resulted in a 25% increase in deaths amongst people aged 60 and over compared to 2019, and a 50% increase amongst those 80 and above. Half of the deaths from coronavirus in Sweden are connected to retirement homes.

In six weeks during March and April 2020, the number of deaths increased by 67% in the UK, 60% in Spain, 50% in Belgium and the Netherlands, 49% in Italy and 44% in France. At 27%, Sweden was in seventh place. However, the largest country in Scandinavia is well ahead of its neighbours in every aspect of coronavirus statistics.

In actual fact, the month with the most deaths in Sweden’s recent history is not April 2020, but rather December 1993 and January 2000, when thousands of Swedes died due to the flu. The Swedish media did not keep track of the deaths like CNN, which permanently carried statistics from the world and the US on the right-hand side of the screen.

As for the economy, the Swedish government gave no instructions to business owners on what they were required to do. Media enterprises received compensation from the state for lost advertising revenue. Small businesses got substantial support. For example, hair salons were recommended to keep their employees on for 40% of the time, while the state covered the rest (57%, to be precise) of the hairdressers’ salaries. Overall, people spent less time at work. In Gothenburg, for example, Volvo sent their 20,000 or so employees on furlough.

The Government’s Hands Are Tied

Sweden has admitted its mistakes. The greatest of these might have been sticking to the herd immunity plan. Neither Johan Giesecke, the former chief epidemiologist, nor Anders Tegnell, his successor and Sweden’s COVID-19 strategist, has admitted to trying to achieve this goal. Although it was never explicitly stated in Sweden that the objective was to achieve herd immunity, published statistics often indicated this might be the case. For example, at the beginning of May, 20–25% of the 2.4 million people living in the Greater Stockholm area had immunity. It was hoped that this number would reach 50% by mid-June. But statistics do not support this wishful thinking.

I discuss in my book how journalists and politicians received a strong boost during the pandemic. The extraordinary times brought special opportunities. The media got the chance to cover non-stop the battle with COVID-19. To cast light on the heroes. To serve on the front line. Similarly, politicians could show they cared for their people, while ruthlessly battling the invisible enemy and imposing restrictions on citizens in the spirit of statesmanship.

The reason why the Swedish government could not take control like others around the world is really simple: the Swedish Constitution is several hundred years old and does not foresee a plan of action for a pandemic. In peacetime, Sweden cannot declare a state of emergency like Estonia could. In other words, the Swedish government did not have the authority to restrict people’s freedom of movement.

The problem goes further. Governing Sweden is based on administrative dualism. Several institutions stand beyond the reach of ministries’ authority and have the freedom to shape their actions regardless of the government’s wishes. Thus, the Public Health Agency of Sweden (Folkhälsomyndigheten) had more say during the pandemic than did the government.

Formally, the government is not required to follow the agency’s directions, but in reality there was no other choice than to obediently fall into line. That is why Swedes ate up every word spoken by Anders Tegnell, while prime minister Stefan Löfven proved to be of less importance at the height of the pandemic. Even King Carl XVI Gustaf appeared on television once, recommending that people should stay at home and not attend church at Easter.

Another obstacle restricting the government is local authority. Kommunalt självstyre, the local government units, have extensive authority in the municipalities. In addition, the regions are like small states within a state. Healthcare and social welfare institutions report to county authorities (landstingen). Overall, the government in Stockholm has little power over the local authorities in West or South Sweden.

In respect of COVID-19, the government could only issue a call to action. During the pandemic, it could highlight the importance of washing hands and keeping a safe distance, as well as regulating gatherings in public places. As mentioned earlier, this was done, but in order to reduce the maximum number of people in restaurants and increase the distance between tables, the government needed a mandate from the Riksdag. The Minister of Internal Affairs admitted it was not the government’s business to control and close restaurants. Every landsting had to decide separately how strict the rules should be in each county. Generally, restaurants in Sweden were not closed en masse, but some places here and there were required to keep their doors shut for a while.

Trust

Sweden provides another lesson for other European countries: Swedes trust the politicians they have elected. The voting turnout in Sweden is comparable only to that of Belgium. However, in Belgium voting numbers are as high as they are only because the right to vote has been turned into an obligation. In Sweden, people vote of their own free will, and the turnout is the highest in the EU, and one of the highest in the Western world.

Asked whether they trusted other people, 67% of Swedes answered “yes”. I am not familiar with the latest statistics on how Estonians would answer such a question, but for some reason, I am inclined to think that we would side with the US, where only 30% of people have trust in their fellow citizens.

The Swedish government explained why Sweden’s actions in the pandemic were different from the rest of the world. The country’s population density of only 25 per square kilometre means less exposure to fellow citizens. Sweden comes first amongst OECD countries in terms of the number of one-person households, which account for 57% of all households in the country. Another important factor is that only 6.9% of Swedes have diabetes, a chronic illness that is a risk factor in contracting the coronavirus. Research suggests that only 13% of the population being overweight should also keep the of COVID-19 fatality rate low.

At the government’s recommendation, Swedes dined out less and avoided public transport. SAS grounded almost all of its flights and in April and May only flew from Stockholm to Visby, Gotland and Umeå in northern Sweden. There was no flight connection between the capital and Gothenburg, the second-largest city. In early June, Gothenburg Landvetter Airport only had three flights per day, none of which were domestic flights connected to SAS. In late July, the number of flights from Landvetter reached a dozen, three of these being SAS flights taking travellers to the capital.

The Ministry of Foreign Affairs has warned people not to rush into travelling; it has not been stated explicitly that people from Sweden are not welcome abroad, but sensible Swedes understand that this is the price to be paid for their freedom of movement during the coronavirus crisis. However, the Swedish spirit is crushed in a sense. The Swedes have come to see that the world does not understand them. The attitude of other Scandinavian countries has been the most hurtful. While all Danes can travel freely to Sweden across the famous Öresund bridge, movement in the other direction is only allowed for people whose registered address is in the municipalities of Skåne, Blekinge or Halland.

For the first time, people are feeling that being a Swede is not as good as it was made out to be. Some diplomats have even called the current situation an identity crisis for Sweden. At the same time, trust in the government has not been shaken. Nevertheless, an independent committee of inquiry has been created, tasked with giving a final verdict on tackling COVID-19 in Sweden.

Last but not least, on one hand Sweden’s historical constitution restricted the government, but on the other we must remember that Sweden is one of the few countries where there hasn’t been a war for more than two centuries. Unlike their neighbours, the long peace may prevent Swedes from fully understanding the threat to Swedish society.

In an interview with Swedish public broadcaster SVT over Easter, pastor Camilla Lif said that, although we were vulnerable, this was not the first time in the history of humankind. Swedes have no other option than to endure this period. Interest amongst high school graduates in Sweden in pursuing a career in nursing is up by a third this year compared to last year.

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1 Kroon kuningriigis. Eestlase märkmed pandeemia ajal Rootsis (The crown of the kingdom: An Estonian’s notes from Sweden during the pandemic). Tallinn: Ühinenud Ajakirjad, 2020.

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