Opinion: An American perspective on the Swedish coronavirus strategy

Opinion: An American perspective on the Swedish coronavirus strategy
Sweden's strategy has relied partly on voluntary measures. Photo: Ali Lorestani/TT
How do we measure the human and social costs of our countries' coronavirus strategies, ask Stockholm-based researchers Andrea M Voyer and Jason J Czarnezki.

As Americans living in Sweden, we have found it is impossible not to notice how President Trump, the media, and scientists have criticized Sweden's coronavirus response. Even though we are so early in the Covid-19 crisis, the desire to declare which countries have winning and losing strategies for protecting their citizens appears to be a common and powerful sentiment among experts and laypeople alike.

But is it really possible to talk about victory in the face of such loss of life? The American president's description of Sweden as “suffering” applies to every country in the world, noted both Swedish Foreign Minister Ann Linde and Swedish state epidemiologist Anders Tegnell.

As American songwriter and Swedish nobel laureate Bob Dylan famously sang, “Don't criticize what you can't understand.” These words caution us not to rush to judgment and to instead base our conclusions on careful and detailed analysis.

There remains a fundamental misunderstanding of the Swedish strategy to Covid-19, especially when compared to the United States. Exploring this misunderstanding illustrates why we should be careful in our comparisons of national responses to Covid-19.

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Tensta, a suburb north of Stockholm, is one of the areas overrepresented in Sweden's infection statistics. Photo: Anders Wiklund/TT

To get it out of the way, the primary misconception is that Sweden is taking an experimental approach by doing nothing and letting the virus spread rapidly in the desire to build immunity. Swedish officials have repeatedly stated that the country is not pursuing a herd immunity strategy. Sweden's goal now, like many other countries, is to flatten the curve (i.e. lowering the rate of infection so that the need for hospital beds and ICU units does not overwhelm the healthcare system).

However, while the goal is the same (again, to flatten the curve), the Swedish method of achieving this goal is clearly different from the countries that rely upon a “lockdown” strategy enforced by police and the military, or that have limited movement to “essential” workers.

Instead, while it has relied on some formal legal tools like bans and closures, Sweden's response has also relied upon voluntary compliance with the Public Health Authority's evolving set of “recommendations” that are not optional and individuals are obligated to follow, despite the lack of punishment or fines for any failure to follow them.

Events over 50 people have been banned. Swedes have been told to work from home if possible, avoid travel, limit their social contacts, and especially avoid having contact with people at greatest risk for coronavirus complications. Restaurants and bars remain open with new requirements to reduce the threat of Covid spread. In contrast to many countries, Sweden's preschools and grade schools also remain open while its high schools and universities have moved to distanced learning. Social distansering (social distancing) is the effective law of the land during this coronatiden (time of the coronavirus).

Two people relaxing on a bench in Stockholm. Photo: Fredrik Sandberg/TT

In our corner of busy and well-off central Stockholm, life has slowed to a calm and quiet pace; an endless parade of weekend afternoons. “No, it's not business as usual in Sweden,” noted Swedish Health Minister Lena Hallengren.

The evidence shows that social distancing has already led to an early end to this year's flu season, and travel over the Easter holiday decreased significantly as requested by the Swedish Public Health Agency and King Carl XVI Gustaf who, in a prime time speech on the eve of what we Americans call “spring break,” noted the significance of the request that people give up their holiday plans:

“For me, and for many people in our country, this is an important celebration and one we look forward to. It is a time when we are keen to travel and perhaps spend time with family and friends. Many go to church. But, this Easter, some of this will not be possible. We have to accept this. We have to rethink, prepare ourselves for staying home.”

As noted by others, several characteristics of Sweden and Swedish life account for this strategic difference between outright bans and closures and voluntary compliance – higher social trust, a general preference for social distancing in everyday life, high rates of people living alone, most parents of small children are working parents, a strong legal commitment to democratic values, and a constitutional commitment to physical freedom of movement. It is not the goal of Sweden to stand out with a novel Covid-19 approach, but nor is it the way of Sweden to give in to pressure to conform to a one-size-fits-all international strategy.

You cannot use the same approach when fighting a crisis in different landscapes. Under one view, the Swedish corona strategy began in 1946 with the rise of the Swedish social welfare state.

The United States government was built on the idea of separation – protecting private actors and entities from government authority and limiting state power over civil society. In contrast, the Swedish model emphasizes solidarity, commonality, and the construction of a state that encompassed all aspects of civic life–unions, the church, and economic interests were incorporated into the Swedish welfare state, which was dubbed “the people's home”.

Expanding participation in the welfare state through employment, paying taxes, and using one's benefits is a stated goal of the Swedish system; a goal perhaps only shared in the US during the New Deal following the Great Depression. In pursuit of this goal, the Swedish welfare state ensures that residents have rights to healthcare, unemployment insurance, paid sick leave, and family leave. Swedes generally see “the economy as an engine of the welfare state”. This is not the landscape in the US.

People outside a job centre in the US earlier in April. Photo: AP Photo/Nam Y Huh

That the same virus may have very different impacts in different social landscapes does not come as a surprise. For example, Sweden has a healthier population than the US based on obesity and life expectancy. Despite sharp contrasts, however, in both countries coronavirus is a mirror that reflects social inequalities and injustices by highlighting them with numbers in the form of race, class, and ethnic disparities in death rates, affected neighborhoods, jobless claims, and the ability to limit risk by working from home.

Sweden has failed its minority population, with many groups, in particular those Somalian, Turkish, Syrian communities, significantly overrepresented in coronavirus cases and deaths. The Swedish elderly are suffering as well. The privatization of old age facilities in Stockholm, staffed by low paid hourly workers who did not skip work when sick due to a law (now repealed) making the first day of sick leave unpaid, may have facilitated spread in many elderly communities seeing increased death rates.

In the US, persistent racism, and social and economic disadvantage produces a “weathering effect” eroding physical health above and beyond the race and class disparities in access to healthcare, and quality of care received. The virus is projected to claim the lives of a disproportionate share of America's large incarcerated population, also predominantly poor and non-white, as well as the over 50,000 immigrants and asylum seekers held in detention as a result of draconian immigrant policies implemented in 2018.

Swedish newspaper DN on Sunday had nine pages of obituaries, compared to a normal average of four. Photo: Jonas Ekströmer/TT

How do we measure the human and social costs of any particular strategy to Covid-19?

Should it be measured by how fast we start national economies? Should we simply measure the death toll when some countries may be engaged in systematic undercounting of Covid deaths, while others evaluate each death as a potential Covid-19 death? Should we consider the long-term impacts of quarantine, lockdown, and decreased social relations on mental health and quality of life?

How do we value the lost educational attainment of students? What are the secondary effects that could arise as a result of the pandemic such as lack of access to other necessary medical care and increase in non-Covid deaths? What are the health impacts of long-term unemployment and economic decline?

National differences in risk assessment and rebuilding strategies do not just provide insight into how countries will be compared when coronatiden is done; they highlight the unique factors every country is considering in its response to Covid-19. There are no winners here.

Friends and family lose parents and grandparents. School children lose class time and even their teachers. High school and college students lose their final semester and coming-of-age rituals. Businesses lose customers. Workers lose jobs. Parents lose alone time. Healthcare workers lose their sense of security and sometimes their lives.

Again, there is no winning here; only the question of how we will take stock of our losses.

Andrea M Voyer is an Associate Professor of Sociology at Stockholm University.

Jason J Czarnezki is the Olof Palme Visiting Professor at Stockholm University (Sweden) and Kerlin Distinguished Professor of Environmental Law at the Elisabeth Haub School of Law at Pace University (New York).

Member comments

  1. And the most recent report finds that over 60% support by 60+ for the Swedish strategy…the highest of any age group.

  2. Covid is simply bringing forward the soon to die 70+ in elderly homes. Over a 5 year time period the average death rate would be nearly the same as if Covid 19 never happened. Sorry to be so blunt but it’s looking at the facts…90% of deaths in Sweden are 70+ with pre-existing conditions.

  3. Stock up the loses??? The comparison between the U.S. strategy or lack there of makes your opinion alarming and ill informed at best and I am weary of Americans in Sweden doing that because I a American myself..yes yes we know Sweden is better than the US…for you not all. …how about compare Sweden with a U.S. state with the same demographic and population size OR with all the other Scandenavian countries. I am not a Trump supporter but for once he is right…especially the elderly.

    But you are right only time will tell if this strategy has been a disaster or not. In the meantime, the government should be held accountable for not protecting the very people they claimed they would protect, as Lena has rightfully stated:

    Lena Einhorn, a virologist who has been one of the leading domestic critics of Sweden’s coronavirus policy, told the Observer that the government and the health agency were still resisting the most obvious explanations.

    “They have to admit that it’s a huge failure, since they have said the whole time that their main aim has been to protect the elderly,” she said. “But what is really strange is that they still do not acknowledge the likely route. They say it’s very unfortunate, that they are investigating, and that it’s a matter of the training personnel, but they will not acknowledge that presymptomatic or asymptomatic spread is a factor.”

    The agency’s advice to those managing and working at nursing homes, like its policy towards coronavirus in general, has been based on its judgment that the “spread from those without symptoms is responsible for a very limited share” of those who get infected.

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