Emma Frans is a senior research specialist at the C8 department for medical epidemiology and biostatistics, Karolinska Institutet.
But almost two and a half years after the pandemic began, what can we say today about the results of this “experiment”?
Let us first summarize what Sweden’s strategy looked like. The country largely held its own pandemic plan, originally developed for use in the event of an influenza pandemic. Instead of lockdowns, the goal was to achieve social distancing through public health recommendations.
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Swedes were encouraged to work from home if possible and limit travel within the country. Also, people 70 years or older were asked to limit social contact, and people with Covid symptoms was asked to self-isolate.
The goal was to protect the elderly and other high-risk groups and at the same time slow the spread of the virus so that the healthcare system would not be overwhelmed.
As the number of cases increased, certain restrictions were introduced. Public events were limited to one maximum 50 people in March 2020 and eight people in November 2020. Visit to nursing homes were forbidden and high schools closed. However, primary schools remained open throughout the pandemic.
Face masks were not recommended for the public during the first wave, and only in certain situations later during the pandemic.
In the spring of 2020, the reported death toll for Covid in Sweden was among those highest in the world. Neighboring countries that implemented quick lockdown measures, such as Norway and Denmark, fared much better and Sweden got harsh criticism for his relaxed approach.
But defenders of the Swedish strategy argued that it would pay off in the long run, arguing that draconian measures were not sustainable and that the pandemic was a marathonnot a sprint.
So did Sweden’s approach pay off?
Let’s look at excess mortality as a key example. This measure takes the total number of deaths and compares this number to pre-pandemic levels, capturing the wider effects of the pandemic and accounting for misreporting of Covid deaths.
The decision to keep primary schools open also paid off. The incidence of severe acute Covid in children has been lowand a recent study showed that Swedish children were not affected by this learning loss seen in many other countries.
In this light, the Swedish strategy has gone from being called “a disaster” and “cautionary tale” to one “Scandinavian success“. But in order to draw some relevant conclusions, it is crucial that we dig a little further into how Swedes navigated the pandemic.
It is noteworthy that all perceptions that people in Sweden continued with their everyday lives during the pandemic as if nothing had changed are untrue.
In a survey from the Public Health Agency from spring 2020, more than 80% of Swedes reported that they had adapted their behaviour, for example by practicing social distancing, avoiding crowds and public transport and working from home. Aggregated mobile data confirmed that Swedes reduced their travel and mobility during the pandemic.
Swedes did not have to take measures against the spread of the virus, but they did it anyway. This voluntary approach might not have worked everywhere, but Sweden has a history of high trust in authorities and people tend to follow with public health recommendations.
It is also difficult to compare Sweden’s results with countries outside of Scandinavia, which have very different social and demographic conditions.
Strengths and weaknesses
Despite the benefits of avoiding lockdown, the Swedish response was not flawless. At the end of 2020, the Corona Commission, an independent committee appointed by the government to evaluate the Swedish pandemic response, evaluated was found the government and the Public Health Authority had largely failed in their ambition to protect the elderly.
At the time, almost 90% of those who had died of Covid in Sweden were 70 years or older. Half of these people lived in a nursing home and just under 30% received home care.
The fact is that many problems in elderly care in Sweden became apparent during the pandemic. Structural deficiencies such as insufficient staffing left nursing homes unprepared and ill-equipped to handle the situation.
In its final report on the fight against the pandemic, the Corona Commission concluded that tougher measures should have been taken early in the pandemicsuch as quarantine for those returning from high-risk areas and a temporary ban on entry to Sweden.
However, the commission found that the no-lockdown strategy was fundamentally reasonable and that the state should never interfere with the rights and freedoms of its citizens more than absolutely necessary. The commission also supported the decision to keep primary schools open.
By comparison, the Corona Commission in Norway, one of the few countries in Europe with a lower excess mortality than Sweden, concluded that although the handling of the pandemic in Norway was generally good, children hit hard through lockdowns and the authorities did not protect them sufficiently.
The focus of Sweden’s strategy was to reduce the spread of the virus, but also to consider other aspects of public health and protect freedom and fundamental rights. Although the Swedish strategy is still controversial, most countries today have a similar approach to the continuing pandemic.
In retrospect, it seems a little unfair that the country that followed its pre-pandemic plan was the country accused of conducting an experiment on its population. Perhaps Sweden should instead be considered the control group, while the rest of the world underwent an experiment.