In the worldwide campaign to stamp out death and illness from the coronavirus pandemic, Sweden is clearly an outlier.
There's no lockdown in Sweden. Its bars, restaurants and even nightclubs have not been closed since COVID-19 first reached its shores on Jan. 31. Elementary and middle schools remain open, though high schools and universities now rely on distance learning.
There are no government orders to wear masks or socially distance, though the latter is recommended and most citizens have voluntarily complied. In fact, voluntary compliance and individual responsibility is at the heart of Sweden's strategy to slow the spread of the virus.
Its approach is not completely hands off, however. Sweden has banned gatherings of 50 or more people and visits to nursing homes, where about half of its COVID-19 deaths have occurred. It has encouraged people to work at home if possible.
The country's soft approach was devised by scientists and backed by the government, even though not all of Sweden's virologists and immunologists are convinced it is on the right path. Although Sweden has been widely condemned around the world for the strategy, its own citizens largely embrace it.
So how are things working out?
The number of COVID-19 cases and related deaths has been higher in Sweden compared to its Nordic neighbors - Norway and Finland, which both imposed complete lockdowns. As of Friday, May 8, Sweden had recorded 25,265 cases of the coronavirus and 3,175 deaths for a population of about 10.2 million. Norway, with about half the population, has 8,055 cases and 218 deaths, while Finland (population 5.5 million) has 5,738 cases and 260 deaths.
Dr. Anders Tegnell, the state epidemiologist who devised the country's coronavirus response, talked about Sweden's experience and the lessons learned during a webinar Friday hosted by the International Center for Journalists. As California and the rest of the nation begin to open up their economies, here are 10 takeaways from Tegnell.
1. Sweden caught the virus early, and started testing early
Tegnell said the Swedish health-care system has not been overwhelmed because it spotted cases early on. Several other countries became overwhelmed, he said, because "they did not see the slow beginning and only noticed when there were already too many cases." Sweden also began testing early on and saw the pandemic coming with spring vacation travel. Spring break was in full swing in Europe back in February, and that's when cases began to surface.
2. Higher infection and fatality rates are cause for concern
Tegnell said one of the main reasons the death rate in Sweden is high is because of the spread of the virus in homes for the elderly. In Sweden, about 70,000 people live in these homes, and the death toll there has accounted for more than 50 percent of all coronavirus-related deaths in Sweden.
3. Achieving 'herd immunity' is not Sweden's goal
The country's goal, Tegnell said, is to keep the level of spread down while society functions. He said that has been accomplished with the exception of the higher death toll among the elderly. The immunity that many have acquired from those infected with the coronavirus, however, will help keep the spread down to a reasonable level until there is a vaccine, which might be at least 12 to 18 months off, he said. When most of a population is immune to an infectious disease, this provides indirect protection or "herd immunity" to those who are not immune to the disease.
4. We don't know how long this immunity will last
Tegnell said that with the coronavirus, the level of antibodies a person has varies from cases to case. So far, he said, not one person from Sweden has had COVID-19 twice. And they know this because Sweden has a strict identification and tracking system. What they don't know, Tegnell said, is how long this immunity will last. Their virologists say this could last for up to six months. But they don't know for sure. That said, Tegnell believes the reason for the slow decline in the number of cases in Stockolm, the epicenter of the outbreak in Sweden, is due to immunity. He believes there is enough immunity in the population to keep the cases down. He also hopes it will hold if there is a second wave of infections in the fall.
5. Wearing masks in public is not mandatory
Tegnell says there are two main reasons why Sweden has not required citizens to wear masks: First, he said, the science behind it is murky - everyone just points to one "very theoretical" study in Hong Kong. In his opinion, there are no studies that clearly show masks are effective when worn in public. Secondly, Tegnell said, the Swedish government does not want sick people to go out in public. He is concerned sick people might be more inclined to go out if masks are encouraged.
6. There is no financial incentive for sick people in Sweden to go to work
Sweden made it possible for sick people to stay home by giving them sick pay from the very first day they miss work. When people get paid for sick days, they have no financial incentive to go to work. This has also helped the country control the spread of the virus, he said.
7. Why younger children still attend school, while high school and college students do not
Tegnell said distance learning works quite well in high schools and universities, allowing students to still get their education. But, he says, there is no evidence of big spreads of the virus among children under 16, and there's no evidence of spread from children to adults. The survival rate among those who come to the ICU has been about 80%, Tegnell said. About 85% to 90% of the death toll nationwide is among people above 80 years of age. The recovery rate among younger people is "very high," he said.
8. The pandemic has disproportionately affected migrant communities
This is mostly because of socioeconomic conditions, Tegnell said. Migrant families tend to live close together and share living quarters among different generations. The disease, he said, also came to those communities early - back in February and early March - and spread quickly before anyone was aware of it.
9. Disinformation has not been a huge problem
Tegnell says there is a high level of trust between the population and governmental agencies. Like other parts of the world, rumors do swirl around in social media, but it doesn't affect the majority of the population who feel they are "well-informed and not afraid," he said, adding that the biggest fear people have is about losing their jobs. Only 5% to 10% actually fear the epidemic in Sweden, based on surveys, Tegnell said. Also, the law in Sweden says anyone who finds a COVID-19 case must report it to the health department within 24 hours, and a lot of people do, he said. There is a high level of public trust and confidence in the government's data, Tegnell said.
10. Physical distancing is a critical part of keeping the economy open
Tegnell says he counts Sweden's approach as a success because people were good about isolating themselves. He warns people against using the Swedish model to argue you can go out anywhere to meet and mingle with anyone. Social distancing, he says, is still the most important thing one can do to prevent spread of the coronavirus.
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