Sweden's
Relaxed Approach to the Coronavirus Could Already Be Backfiring
When Chloe
Fu, 24, went for a run on Monday evening, the streets of Stockholm were filled
with people drinking on restaurant patios, enjoying the first warm day of
sunshine after a long winter.
“When you
walk around, there is a total and utter absence of panic,” Fu says, who moved
to Sweden from the United States last year. “The streets are just as busy as
they would have been last spring.”
As many public spaces
throughout Europe empty out—with citizens only leaving home for essential
groceries or medication—life in Sweden is carrying on, mostly as usual.
Children walk to school
while adults meet up for dinner at their local bar.
Only the vulnerable have
been advised to isolate and some are working from home.
Yet in Sweden, where there are 9,141 confirmed cases
and 793 people have died, experts worry weaker measures may be leading to a
more severe outbreak in the country of just 10 million citizens.
Sweden has a relatively high
case fatality rate: as of April 8, 7.68% of the Swedes who have tested positive
for COVID-19 have died of the virus.
Neighboring countries,
like Norway and Denmark, have case fatality rates of 1.46% and 3.85%
respectively.
(The U.S. case fatality
rate is 3.21%.)
While Sweden’s elevated
case fatality rate could be a result of its low testing rates compared to its
neighbors, experts say Sweden’s laissez-faire approach could also be to blame.
The Swedish government
continues to advocate for relaxed measures.
The Swedish Public Health Agency cautions citizens to
cover their mouths when they cough or sneeze and wash hands regularly but does
not call for lockdown measures.
On March 11, the
government cut down the size of permitted gatherings to 500, and only lowered
that down to 50 on March 29.
Other countries, like
Germany and Australia, have prohibited gathering in groups larger than two.
On Monday, Sweden
declared that domestic flights would continue running, despite the risks
domestic travel poses for spreading the disease.
Anders
Tegnell, Sweden’s chief epidemiologist overseeing the government’s response to
COVID-19 has said the government should allow the virus to spread slowly
through the population, an approach initially employed by the United Kingdom
and the Netherlands before both countries rapidly changed strategy amid
mounting evidence that this approach would still overburden health care
systems. Tegnell told Swedish TV on April 5
that COVID-19 could be stopped by “herd immunity or a combination of immunity
and vaccination.” (A vaccine for COVID-19 is likely at least 14 months away.)
But many
experts throughout Sweden say the current strategy is dangerous.
“Herd immunity doesn’t make
sense because we don’t know whether or not you can become immune,” says Nele
Brusselaers, an associate professor of clinical epidemiology. She added, “this
is a virus that can kill anybody.”
At the end of March, 2,300
doctors, scientists and academics signed an open letter to the government
calling for stricter measures.
“We think there is no
scientific evidence for their strategy,” says Cecilia Söderberg-Nauclér, an
expert in microbial pathogenesis who signed the letter.
She says the government
has been reluctant to share its data with scientists, leading her to believe
that the government’s strategy is “not based on evidence.”
Carina King, an infectious
diseases epidemiologist, agrees that the government’s lack of transparency
makes it “really hard to give proper scientific thoughts on their approach
because they haven’t released their science.”
She added that the
government has made no concrete efforts to test, contact trace and
quarantine—as South Korea did—which is standard protocol to stop localized
spread at the beginning of an outbreak.
Nevertheless, she says Sweden
could be a rare case where a nationwide lockdown may not be necessary.
“Sweden is unique,” she
says. “It doesn’t have many intergenerational households. It is a country where
you could have a mixed approach.”
Though interpersonal distance
is valued in Swedish culture and 40% of Swedish households are single-person
households without children, other experts say that COVID-19 can still spread
rapidly and widely in these conditions.
Sweden has the second
lowest number of critical care beds in Europe after Portugal, with only 5 beds
for every 100,000 inhabitants.
The healthcare system
would likely be unable to handle a severe COVID-19 outbreak.
Currently, experts say the
Swedish government is not following the World Health Organization’s (WHO)
guidelines, which advise countries with COVID-19 outbreaks to contact trace
where possible and to adopt strict self-isolation measures.
“I’m surprised and
frustrated that they still have not taken any action or listened to the advice
of organizations like WHO,” says Brusselaers.
“They disregard any
prediction model that has been published by experts in the field and they don’t
even give a defense.”
A head doctor at a major
hospital in Sweden says the current approach will “probably end in a historical
massacre.”
He says healthcare
workers at his hospital who have tested positive for the virus but are asymptomatic
have been advised to continue working.
He asked to remain
anonymous because “it is frowned upon to speak of the epidemic or to go against
the official vision” but said he felt a need to speak out from an “ethical and
medical point of view.”
The Swedish legislature will
meet this week to discuss whether tougher measures restricting business and
travel should be implemented.
Söderberg-Nauclér says
it’s already too late to prevent chaos in Stockholm but that preventative
lockdown measures could still be taken throughout other parts of the country.
“If they are right and we are
wrong, I will open a bottle of champagne,” Söderberg-Nauclér says.
She notes that, based on
the modeling she’s seen, the healthcare system in Sweden will collapse if
stricter measures are not adopted immediately.
“But I will not give up
the fight until the government shows us evidence for their strategy.”
While experts may be taking
issue with the government’s approach, many Swedes seem to be in favor of it.
Opinion polls show that
citizens trust the Public Health Authority, with 48% saying they have very high
or high confidence in the institution.
“It’s rare for Swedish
society to loudly disapprove of the government,” says Fu.
“Even though people are
concerned about losing loved ones, they also trust that the government is doing
the right thing.”
And Swedes have above-average
confidence in their politicians, who in turn, trust citizens to follow their
advice.
“In Sweden, the approach
has always been to make suggestions and let the public decide,” says Johan Erik
Lallerstedt, a 23-year-old filmmaker living in Stockholm.
“Whatever guidelines the
government may give are just that: suggestions. Nothing is enforced.”
But Söderberg-Nauclér believes
this outbreak could bring an end to a long history of public trust in
government.
“If you put people’s
lives at risk in democratic society and then you do not help them, how will
society trust politicians?” she says. “I don’t want to live in a society that
treats people like this.”
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