Sweden’s relaxed policy for the containment of the Covid-19 virus has been an outlier amongst the hard lockdowns that happened in Europe and across the globe. Although hard lockdowns have been shown to be very effective in controlling the pandemic, they have also caused massive losses to businesses. In contrast, Sweden predicted that through their softer approach of allowing businesses to stay open and not having a lockdown, their economy would suffer much less.
Sweden’s method of not imposing a lockdown, though, has been heavily criticized for being negligent in allowing Covid-19 to run rampant through the country. The truth is murkier. While it is true that the cumulative death rates per capita due to Covid-19 were higher in Sweden than in the neighboring countries, the death rates per capita were less there than in some other European countries such as the United Kingdom and Italy.
And in terms of controlling Covid-19, Sweden did manage to flatten the curve and the numbers of infections now are much lower than in previous months, so in a manner of speaking, one might call Sweden’s approach successful. Thus, I pose the question: could the United States have used the Swedish model to control the coronavirus instead of using a hard lockdown?
The Misconception of Herd Immunity
To dive into this question, there is a misconception that needs to be ironed out. Herd immunity had nothing to do with Sweden’s decision not to lockdown. Sweden’s foreign minister, Ann Linde, dismissed the claim as a factual error. Furthermore, Dr. Angers Tegnell, the State Epidemiologist of the Public Health Agency of Sweden, in an interview with Trevor Noah stated unequivocally that he did not think herd immunity was possible. He also admitted that Sweden was not as successful for the death toll of the elderly as it had wished. Sweden is concerned about their deaths, he said.
However, the decision to not lockdown was not a decision at all. The Constitution of Sweden guarantees its people freedom of movement in peacetime, thus making it technically illegal to order a lockdown. Simply speaking, Sweden’s government did not allow a hard lockdown.
Also, Sweden’s pandemic response did not involve politics. In fact, the Swedish Constitution prohibits ‘ministerial rule’, in other words, the interference of the government on a public agency. Thus, Sweden’s Public Health Agency had a lot of power to dictate policy, and they set many guidelines. They encouraged social distancing. Restaurants and bars restricted capacity to the number of people who could sit and socially distance. Universities and secondary schools closed. Sweden restricted travel within its borders. Groups of more than 50 were prohibited. Companies encouraged sick people to stay home, even if they were just a little sick. Rivisions to sick leave rules allowed workers to stay home for 21 days without a doctor’s note. Elderly isolated in retirement homes. And in June, contact tracing restarted. However, these guidelines came in the form of recommendations. Enforcement did not occur on a large scale. Sweden’s soft approach centered on personal responsibility. Sweden relied on people acting for their own and society’s good.
Control of the Pandemic?
Has Sweden’s soft approach of not having a lockdown controlled the pandemic? The numbers do suggest this is true. From July 3 to 9, four months after setting its guidelines, Sweden had a weekly total of 2245 Covid cases and 22 deaths. These counts were much smaller than the weekly case counts it was having in March. At the end of April, Sweden’s Public Health Agency reported that the reproduction number of the virus went below one, which means that the number of daily infections in Sweden have been decreasing since April. Thus, it is fair to say that Sweden controlled the virus without a lockdown.
Questions of Sweden’s wisdom arise, though, when Sweden’s approach is compared with the approaches of other countries. For the week of July 3 to 9, Sweden’s EU neighbors had much fewer Covid numbers and fewer deaths. Norway had 44 cases and 3 deaths. Denmark had 84 cases and 3 deaths. Finland had 31 cases and 0 deaths. When taken cumulatively, Sweden’s numbers are also several times more than its EU neighbors. According to John Hopkins, by July 9 Sweden had 5482 deaths or 53.83 deaths per 100,000 people. The highest numbers any of its neighbors had was Denmark with 609 deaths or 10.52 deaths per 100,000 people. Because Sweden’s numbers are so comparably high, the EU has largely criticized Sweden’s strategy for containing the virus. And although EU borders have begun to open between member countries, Denmark’s, Norway’s, and Finland’s borders with Sweden remain closed.
One of the assumptions of the Swedish strategy was that by not locking down, they could save their economy. Analyzing the veracity of this claim is more complicated. Hard lockdowns can do a devastating hit on the economy, but if the lockdowns control the problem, rapid recoveries can occur, which has happened with Sweden’s neighbors. Denmark, Norway, and Finland are now relaxing guidelines and allowing inter-country travel. As of the end of July, Sweden, on the other hand, still had to deal with hundreds of cases of Covid each day.
A recent New York Times article by Peter S. Goodman analyzed the economic impact of Sweden’s decision. The decision staved off an economic contraction in the first quarter. However, Sweden’s Central Bank has projected the economy to contract by 4.5% for the year. Global trade suffered a hit, despite not locking down, Sweden’s manufacturing shut down when everyone else shut down because of supply-chain issues. In comparison, Norway’s Central Bank has predicted a 3.9% contraction, and Denmark has predicted a 4.1% contraction. It appears that Sweden’s economy is no better or worse off than that of its neighbors.
A lack of long-term economic benefits coupled with a larger death toll makes Sweden’s strategy lose its luster. Even when compared to America, Sweden had more Covid deaths per capita by July 9th, 53.83 deaths per 100,000 people as opposed to America’s 40.44 deaths per 100,000 people. Even with the high death rates, Sweden appears to be far from herd immunity, so that argument for taking their strategy also fails.
A lot of research now suggests that lockdowns saved millions of lives globally. Certainly, if the United States had not gone into lockdown, more lives would have been lost. However, the question posed in this article is not should the U.S. have used Sweden’s model but could the U.S. have used Sweden’s model.
Flattening of the Curve
In terms of flattening the curve, Sweden is actually doing better than America. While Sweden had 2245 known cases and 22 deaths from July 3rd to July 9th, the U.S. had 383,600 cases and 3748 deaths, and the daily numbers in the U.S. crept even higher in the weeks following. The U.S. has approximately 30 times the population of Sweden. Even when taking its larger population into consideration, the U.S. is doing much worse. Whereas Sweden’s daily numbers are declining, the American numbers continue to push towards new records. Unfortunately, at the end of the pandemic, America’s deaths per capita will certainly be higher, even after we had a lockdown in most states.
The fact is that America failed to control the pandemic even after a lockdown while Sweden managed to control it with non-enforced guidelines. But Sweden is not America. Some stark differences between our countries allowed their strategy to work for them whereas it would most likely have ended up in disaster for us.
The U.S. Is Not Sweden
Population density matters. Sweden has 64 people per square mile as opposed to America’s 93 people, while still including Alaska. Outside of Sweden’s capital, Stockholm, towns are spread far apart and social distancing is par for the course. New York City, on the other hand, which has the same population as Sweden, has 27,000 people crammed into one square mile. A higher population density allows for more vectors of transmission.
Similarly, the size of the country matters. Sweden is the size of California. When the outbreak happened, Sweden closed its borders. Additionally, inside itself, Sweden requested citizens not to travel. It would be next to impossible for one state in the United States to close its borders. New York has recently tried to require travelers from other states to quarantine for two weeks, but there are open questions on how enforceable the new rules are. More travelers moving around means more transmission vectors. Thus, in the United States, we still cross-transmit the disease between states.
Leadership matters. The head of the pandemic response in the United States is none other than our President, who has downplayed the threats of the coronavirus. Politics tempered our response. Dr. Fauci, the director of the National Institute of Health has been largely sidelined of late. Although Sweden’s guidelines were relaxed, the Public Health Agency was in charge of the response and a non-political message was consistently given to the people.
Belief in Science
Our mentalities are also different. Northern Europe has the highest trust in science in the world. People in Sweden are also generally more trusting than Americans. When responding to a survey about whether most people can be trusted, Sweden replied with a high 63.76% while Americans answered with a much lower 38.17%. This trust in general also connects to trust in the government. Whereas most Swedes did practice the recommended governmentatl guidelines, many Americans would likely snub their noses at non-enforced recommendations. Even with mask guidelines that carry fines, many Americans are not wearing masks.
As Americans debate how we handled the pandemic, there is a faction of Americans who push the narrative that the lockdowns were not necessary. The evidence points elsewhere. I shall not condemn Sweden. Their Constitution reined in the pandemic response, but there was a human price they paid for their refusal to lockdown and the economic benefits were few. That being said, they are controlling the virus better than us. The fact is, though, we are not Swedes. If our government had followed the Swedish model, it would likely have been disastrous.
Should we have followed the Swedish model?
Could we have followed the Swedish model?