The Good and Bad Lessons From Sweden

The Good and Bad Lessons From Sweden

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A rising mortality rate suggests the more lax model means more death

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A funny thing happened in late April: Sweden ? 70% marginal tax rate, safety net replete Sweden ? briefly became the darling of the American right wing.

The cause of the fandom was the country?s approach to mitigating the coronavirus pandemic?s effects on its population: Unlike most nations, including its Scandinavian counterparts, Sweden did not shut down its economy or schools. Instead, the country?s leaders asked its people to take responsibility for social distancing themselves and banned only gatherings larger than 50 people, allowing schools and businesses, including bars and restaurants, to stay open. (Officials advised people to work from home when possible and avoid nonessential travel, and on March 31, the country issued a ban on visits to elder care homes.)

Sweden?s Covid-19 daily death rate has consistently been among Western Europe?s highest. And while daily numbers of confirmed Covid-19 cases are trending downward in many parts of Europe, in Sweden, they have plateaued, and are trending upward.

Be careful of assumptions

Sweden?s approach relied on several assumptions, some more overt than others. One was that the country?s entire population would and could, without punishment or incentive, maintain the social distancing needed to protect themselves and each other from disease transmission. Another assumption was that infection with the coronavirus eventually leads to protection ? both from repeat infection and onward transmission to others ? and that its high transmissibility meant many people would quickly become infected and thus protected. And a third was that the country?s relatively low population density would be protective for everyone.

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The goal of Sweden?s strategy was to avoid the financial collapse facing countries whose near-universal shutdowns have led to severe economic contractions, while simultaneously slowing disease transmission to avoid health care system overload. But the strategy seems to be resulting in more deaths: Sweden?s daily per capita Covid-19 mortality rate, already high in late April, is currently higher than any other European country?and an order of magnitude higher than that of its neighbors Finland and Norway.

Despite the country?s ban on care home visits, Covid-19, the disease caused by the SARS-CoV-2 coronavirus, ravaged the largely older populations living in these homes: Nearly half of the country?s deaths from the virus occurred in care home residents. This pattern suggests that even in a country with low population density, ?once the virus gets into congregate living facilities, it?s extremely hard to control,? says Eric Schneider, senior vice president for policy and research at the Commonwealth Fund, an independent health care research organization. Sweden?s liberal approach invited this problem ?because you?re allowing a certain level of cases in the community ? and eventually, through workers, usually, or visitors, or other mechanisms, the virus will make it into those residential facilities,? he says.

Widespread infections means more death

Additionally, the assumption that Sweden?s population would achieve broad protection as a consequence of infection, often called herd immunity by public health specialists, did not play out. Sweden?s leaders did not specifically identify herd immunity as a goal ? and they have denied that it?s part of the country?s strategy ? but in early May, the epidemiologist who formulated the country?s no-lockdown strategy estimated that 40% of Stockholm?s population would be immune to the virus by the end of the month. Recently published antibody survey results, however, suggest that only 7% of the city?s residents had been exposed to the virus by late April, and the question of how much protection antibodies confer is still a very murky one. In Sweden ? as in the rest of the world ? population-level protection as a consequence of infection is still a mirage.

Some Swedes did voluntarily stay home when advised by their government to do so, but not nearly as many as in the rest of Scandinavia. According to Google mobility reports, retail and transit activity are down 16% to 17% in Sweden, while similar activity took deeper and more sustained dives in Norway, Finland, and Denmark.

To Schneider, the Swedish model is an intriguing experiment in relying on the voluntary efforts of citizens to change their behaviors without severe mandates ? and it is not going well. Things might have turned out differently if the country had taken special steps to protect older residents in facilities, he says, but it?s hard to know. Swedish?s top epidemiologist, Anders Tegnell, said in an interview with Swedish Radio that the country made some mistakes. ?If we were to encounter the same illness with the same knowledge that we have today, I think our response would land somewhere in between what Sweden did and what the rest of the world has done,? he said.

In any case, the most instructive phase of Sweden?s approach may lie ahead: ?It will be interesting to find out whether they can respond now, or whether they?re going to keep going with a strategy that seems like it?s not working,? says Schneider.

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