Sweden is the country that has chosen a completely different attitude towards COVID-19 pandemic. The uniqueness of Swedish culture and the social environment mirrored measures and steps to slow the spread of the virus.
The first case came to Sweden on 31st March due to the woman returning from Wuhan. 9th March was the beginning of community transmission in Stockholm. Despite the threat of coronavirus, Sweden did not apply lockdown nor strict restrictions of the normal life. Sweden is a liberal, social and innovative country. As per its tradition of freedom, Sweden is also well known for its culture of willingness, compliant citizens, consensus culture, and community responsibility. It is the country of high tax rates with 90% of tax compliance.
All the measures Sweden posed are voluntary. As the Swedish constitution limits the power of government agencies and prohibits ministerial rules, during the time of pandemic main power and decision-making was entrusted to the Public Health Agency (PHA) independent on politicians. In accordance with Swedish law, the Public Health Agency initiated all actions to prevent the spread of the virus. Swedish strategy against pandemic was cooperation and the common decision of The Public Health Agency and National Pandemic Group consisting of 4 other agencies. As apparent Swedish strategy included all levels of administrative bodies and experts on the matter of infectious diseases.
According to the John Hopkins Centre of Health Security was Sweden considered to be one of the most prepared according to the Global HS Index 2019 to handle the pandemic crisis. As in the terms of prevention, detection of an epidemic and low-risk environment. Although the Healthcare System is not sufficient enough for the scenario of the heavy spread of the disease with low hospital capacities per capita. Even though a sparsely populated country Sweden has only 2.2 beds per 1,000 people, 5.8 intensive care beds per 100,000 people.
Sweden did not accept the testing strategy as a magical tool towards the end of the crisis. Tested are mainly people essential to society as police, firemen, health and care workers. They were able to test up to 100,000 people per week. Sweden was also targeting symptomatic people. PHA decided to test specifically for COVID-19 and did not give much priority to the testing of antibodies as there is no scientific data for antibody influence on the herd immunity yet. In time Immunity testing shall be added. In meantime repeated testing of essential personnel will be the cover for less of the serological immunity dataset.
The prime figure of Swedish crisis management epidemiologist Anders Tegnell proposed recommendations for the public and several bans. Tegnell declared the public responsibility not to spread disease anywhere. The goal was to slow down the spread of coronavirus and keep the hospital capacity available instead of exhausted. As for 6th May, Sweden has almost 24,000 confirmed cases, 2,941 deaths, and 4,000 recovered per 10.23 million population. Despite the voluntary measures, Sweden has a better rate of controlling the spread of disease than the United Kingdom, Italy, or Spain. But it has worse statistics than neighbouring countries.
Among few bans, Sweden issued there is the limiting of the freedom of assembly, ban of gatherings of more than 50 people, ban of big sports events, ban of visits to nursing homes, closure of museums as well as the closure of secondary schools and universities. However, primary, special and nursery schools remained open in order to avoid the problem of healthcare workers staying at home with their children. There are no limits on public transport, sports activities, cosmetic studios, etc.
Sweden decided to go with the recommendations instead of restrictions. The main recommendations for people are to work from home if possible, avoid unnecessary travels, maintain social distancing. At the same time, they asked the elderly to stay at home as well as all asymptomatic people. To provide help for keeping up with these recommendations state prolonged paid sick leave from 7 to 21 days. People were asked to monitor themselves, avoid crowds and be responsible. Keep up a strict hygienic routine and a positive mindset.
The Swedish nation is traditionally ruled by the mindset of safety, good manners, sense of social responsibility, and mutual trust between government and people. It is based on the Swedish national attitude. Swedish has a special word for this FOLKVETT which in translation means “good manners”. It depicts the fact that Swedish people act appropriately and follow social rules. If not, society responds to public shame and judgment. Therefore, Sweden is the only country stricken by pandemic where restaurants, bars, pubs, hairdressers, primary schools remained open the whole time. People wearing face masks are scarce. People are encouraged to go outdoors for nature and sport, a clear head, and fresh air to keep strong and healthy. Sweden perceives isolation and indoor lockdown as serious dangers for the mental health of the population.
Even in this atmosphere of shared responsibility and voluntary measures, the Public Health Agency was addressed with several protests against too relaxed attitude and lack of restrictions. Swedish nursing homes were hit hard with the COVID-19 and lead to the high death rate of 12.3% overcoming even Italian and Spanish numbers. It is true that prevention of spread to the nursery homes was underestimated with late closure of visits and lack of protective equipment. However, it is important to take into consideration that nursing homes in Sweden are occupied only by seriously ill and incapacitated elderly patients. The majority of the older population remains to live on their own with regular attendance of social and healthcare workers. Due to Swedish social benefits and state support systems, elderly citizens are not forced to leave their homes for nursery accommodation for financial or social reasons. Then nursing homes are the last option for severe illnesses and vulnerable targets for the epidemic.
Swedes were recommended to keep in mind these important rules.
- We do this together
- We get along and get over this soon
- Do not think to be special
- Be responsible and selfless
- We all have the obligation to society
Sweden values the rights of the people and claims that to maintain physical and also mental health people need their time, space or the possibility to work. Sweden did not restrict the movement, did not enact lockdown and isolation for another reason. As Tengell explains they want to avoid collateral damage which occurs in other countries as for example mental health conditions, the rising rate of drug and alcohol abuse, the rising rate of domestic violence as well as economic impacts. The Public Health Agency signifies the importance of mental health as well as physical health.
Despite all prognosis and criticism Swedish strategy seems to be working. Swedish hospitals are not filled with infected people, nor are abused of other cases, home hygiene among people is great, social distancing is working in practice, there are no penalties, no movement restrictions, and not heavy economic losses. Sweden applied the rule of science and experts of all concerned parties above politics.
Although the economic activities in Sweden were not mitigated due to government measures the unemployment is expected to rise up to 10% during the summer as a result of the Swedish export economy. The Swedish economy has been impacted by the global shutdown and border closings of other states. Sweden did not close its border during the crisis though.
Export-depending Swedish economy will be influenced by the global situation. The government prepared relief measures worth USD 9.9 billion. Swedish businesses were influenced by the drop of the customers but were running for the whole time thanks to no restrictions. The Swedish economy has already failed this year by 7%. SMEs were less affected than bigger companies.
European Commission approved SEK 100 billion aid scheme to support the Swedish State Aid Temporary Framework to support its economy. State aid worth EUR 9.1 billion shall help businesses to cover immediate liquidity needs and to continue and enables them to continue in their economic activities. As well new loans will be granted by commercial banks as another supportive tool for companies and SMEs. The loans are of a limited amount to cover only liquidity needs. The state will provide guarantees until the end of September 2020. Guarantees will be limited to 3 years, exceptionally another 3 years prolongment. The state will cover risk maximal to a high of 70%.
Swedish aid scheme consists of several other types of measures. Except for the loans, the state will provide grants, selective tax advantages, and advance payments, subsidized public loans for companies, safeguards for banks channelled to state aid, short-term credit insurance. All these tools will be in place until December 2020.
The relaxed attitude was also a tool to gain herd immunity. The PHA was heavily criticized for these decisions and was accused of sacrificing old and vulnerable. Sweden is concerned with the danger of asymptomatic carriers and the risk of resumption of the crisis. But the need for getting the services and economy running is overcoming the fear. Fight against the pandemic is a tough task even in Sweden. Even the relaxed plan does not work exactly the way the government expected. Since the very beginning, Sweden was inclined to adopt the long-term solution which could not have consist of strict measures. As the case of other states show, the problematic step has not been to issue restrictions but to get on the way back to normal. The lifting of strict restrictions will be the real test of anti-COVID policies all around the world. In this matter, Sweden could be the inspiration world needs. Many states watch the Swedish public health experiment with careful curiosity and seek the guideline on how to re-open the country to the world.
Written by Lenka Martínková, April 2020.