The 23rd of March feels like such a long time ago, doesn’t it?
Now we’re living through October, a strange time where we await our next orders from politicians, and exist in a minefield of testing capacities, R-rates, excess deaths and government fiascos that many people would have turned a blind eye to previously.
Comparisons to our international neighbours are hard to resist, and as Sweden slips off the UK’s list of countries requiring quarantine, one question continues to loom; was Sweden right?
Here in the UK, we anxiously await a resurgence of the virus in our local areas and the dreaded restrictions that will come with this second wave. Minus the occasional surge in cases, Sweden appears to be enjoying something closer to normality, with less than 20 people in ICU and close to zero fatalities being reported.
That being said, it has not been an easy ride from the typically uncontentious nation. Anders Tegnell, who is effectively Sweden’s version of Professor Whitty, became a somewhat polarising figure when he took a very different approach back in March. He chose to encourage, rather than enforce, social distancing while keeping schools, bars and restaurants open, refused to impose a full lockdown and completely dismissed the need for face coverings. He said, “Face masks are an easy solution, and I’m deeply distrustful of easy solutions to complex problems.”
Despite experiencing widespread popularity at home, internationally he is more contentious. With thousands of early care home deaths and a death rate close to ten times that of its neighbours in Finland and Norway, criticism grew of the ‘inhumane’ approach being taken. Yet, Sweden stuck to its guns and has fallen below us and its Scandinavian neighbours. Cases have fallen rapidly since July and surges have never materialised into more hospitalisations or deaths. Notably, the death rate per capita is lower than the likes of Spain and the UK where widespread lockdowns have been devastating. The rationale behind this method was long-term sustainability and the consideration of public health with coronavirus.
But maybe it is not quite as simple as it seems.
Sweden’s population density lends itself to the approach taken, with a much higher number of single households – 52% of Swedish households are ‘single person households’ – meaning the virus naturally cannot spread as easily.
Then comes the fact that Sweden is set apart in its governance. Here in the UK, like most countries, groups like SAGE inform the Prime Minister, First Ministers and their respective Cabinets. In Sweden however, politicians do not take these big decisions, this responsibility lies fully with the public health agency.
A final factor to consider is one of the most controversial notions of the coronavirus emergency – ‘herd immunity’ – whereby enough people have had coronavirus that they become immune and it struggles to spread too easily. This approach was widely criticised and abandoned early doors in the UK and although Sweden assert their goal was not widespread death and extensive population exposure, they admit that this immunity is an important part of their long-term response. Anders Tegnell himself describes the second spike a lot of Europe is suffering right now: “They [other countries] are likely to be more vulnerable to these kind of spikes. Those kind of things will most likely be bigger when you don’t have a level of immunity that can sort of put the bake on it.”
I am certainly not envious of the job that world leaders and their medical leads are faced with. This is a hugely complex crisis battling between clinical and economic outcomes. What is hard to understand, but hugely important nonetheless, is the impact on broader public health, rather than just the narrow view of Covid-19 deaths. It is this wider public health consideration that Sweden’s approach was predicated on. A true evaluation must consider the widespread impact of the pandemic on mental health, suicide deaths, deaths from non-communicable diseases such as cancers, poverty-related deaths and childhood education to name but a few. It is with a heavy heart I worry about such issues in the UK, particularly as the rate of male suicide reaches its highest level for twenty years.
Without doubt, Britain and Sweden are very different countries, but more and more we are seeing European leaders edging closer and closer to the Swedish approach, even if they do not admit it. Perhaps this is simply because Western economies and the people who rely upon them simply cannot live with such crushing and prolonged abnormality for much longer.
Although it is easy to criticise any approach to tackling the outbreak from the comfort of our own homes, time will tell whether Sweden really has been victorious over the virus and whether the price was worth paying. I am certainly no expert on the topic and will never claim to be, but whatever happens in the coming months, Sweden must be praised for its consistency in approach that sets its apart from its European counterparts.
With not a single change to the rules, Sweden seems like the place to go if you are looking for a taste of the “old normal”.