Has Sweden’s Coronavirus Gamble Paid Off?

In March, as the world closed down, Sweden bucked the trend. What exactly is the country's controversial coronavirus policy, and has it worked?

Oliver Lamb explores the effectiveness of Anders Tegnell's lockdown guidelines, as Swedes' lives remain relatively undisturbed compared to a vast proportion of the world. While the government was initially confident in their unique approach, recent statistics are beginning to suggest that the method has its flaws. Political tensions are rising, and the public are becoming increasingly sceptical of their leader's reliability.

Contrary to popular perception, it is not business as usual in Sweden. Gatherings of more than 50 people are banned; schools are closed for over-16s; social distancing measures are in place. Yet shops, restaurants and gyms are still open. Many of the curbs on daily life that are compulsory elsewhere, like avoiding non-essential travel and self-isolating if you show symptoms of the virus, are merely requested. This is a strategy that relies heavily on trust: the public’s trust in their leaders and the science, and the government’s trust in the public. For the most part, that trust has proved well-founded. Travel in Stockholm approximately halved at its lowest point, less than in other major cities (London, for example, saw a drop in travel of around 80%) but still significant.

What was the rationale behind this light-touch approach? Anders Tegnell, Sweden’s state epidemiologist and the architect of the strategy, would flip the question. What was the rationale behind the lockdowns imposed in other countries? They may suppress the virus in the short term, but they cannot be sustained without doing incalculable economic and societal damage. Once they are eased, the virus will rebound unless a vaccine has been developed – which, Tegnell points out, is not guaranteed. Sweden’s strategy is designed to slow, not suppress, the spread of the disease, so the health system is not overwhelmed. Eventually, in theory, enough people will have been infected that herd immunity brings a natural end to the epidemic. Tegnell denies that herd immunity is his intention – merely a happy side-effect of the strategy.

As the pandemic loosens its grip on Europe, the results of Sweden’s gamble are coming in. They do not look good. 4694 deaths have been registered, equating to 465 per million people. Compare this to Sweden’s neighbours, Finland and Norway, which have suffered 58 and 44 deaths per million, respectively. (Finland and Norway imposed lockdowns.) As a proportion of its population, Sweden’s toll is on par with those of the worst-hit Western European countries; France, Italy, Spain and the UK have recorded between 448 and 602 deaths per million.

This is despite Sweden having several advantages over those countries. Most importantly, its population density, at 24 people per square kilometre, is an order of magnitude lower than in Western Europe. It helps that Finland and Norway are also sparsely populated. In addition, Sweden had longer to prepare for the pandemic because it has no international hub like London or Paris; an unusually high number of its households (40%) are occupied by a single person; and there is a low level of intergenerational mixing.

Sweden has not even achieved herd immunity. A study conducted by the country’s public health agency revealed that only 7.3% of Stockholm’s population had coronavirus antibodies by the end of April – meaning they have had the disease and are now in theory immune. Models had predicted that 25% would have been infected by the start of May and that the herd-immunity figure of 60% would be reached by mid-June. It is possible that not everybody who recovers from the virus develops antibodies, and scientists say that another part of the immune system, T-cells, may be involved in fighting COVID-19. Nevertheless, for defenders of Sweden’s strategy the antibody study is bad news.

Tegnell himself admitted in a radio interview earlier this month

that too many had died and that, with the benefit of hindsight, he would have done “something in between what Sweden did and what the rest of the world has done.” Despite this, he stands by the broad strategy and insists that it was right given “the knowledge we had then”.

Prime minister Stefan Löfven continues to argue that the high death toll is the result, not of the strategy itself, but of its implementation. In particular he cites the failure to protect care homes, which have seen half the country’s deaths.

After a political truce during the height of the crisis, the public mood is souring. A heated televised debate between party leaders on Sunday saw Sweden’s approach attacked from many sides, and Jimmie Akesson, the leader of the populist Sweden Democrats, called for Tegnell to resign. The much-vaunted trust in authority has also been shaken. Polls show that the public’s confidence in the government’s ability to deal with the virus has fallen to 45% from 63% in April, and confidence in Sweden’s public health agency has dropped to 65% from 73% in April.

What about the economy? The European Commission forecasts that Sweden’s GDP will fall by 6.1% in 2020. The country’s own central bank predicts a 7-10% drop, coupled with a peak unemployment rate of around 10%. These projections are similar to forecasts for countries that did impose a full lockdown. However, some economists argue that Sweden would have fared even worse if it had gone for a hardline approach, pointing out that the country is often distinctly hard-hit by global recessions because its large manufacturing sector relies on foreign parts.

Sweden must also contend with the possibility that its failure to eliminate the virus will prolong its economic pain. For example, a proposed Nordic ‘travel bubble’ might exclude Sweden because of its high infection rate. That could hurt tourism and all the industries that depend on it.

Whether the dubious economic benefits of no-lockdown outweigh the debatable health impacts of that same policy is, in the absence of data, a matter of judgement. Most of the factors that will decide the answer – whether there is a second wave, whether there is a vaccine, how fast the economy recovers – are yet to be seen.

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