Analysis: Five key questions that the coronavirus crisis raises in Sweden

Analysis: Five key questions that the coronavirus crisis raises in Sweden
People sit in the sun outside the Dramaten theatre in central Stockholm. Photo: Janerik Henriksson/TT
The coronavirus crisis has exposed strengths and weaknesses in every country and community it has affected. Some lessons can already be learned while others will take much longer to be clear, but here's a look at the questions that will need answers in Sweden.

Could the elderly have been better protected?

One of the things we knew about this virus from early on was that older people were most at risk of serious illness, and protecting the elderly was a key part of the Swedish strategy from the start. But politicians and the Swedish Public Health Agency have admitted that the country failed to sufficiently protect the elderly.

By late April, residents of elderly care homes had accounted for around a third of all people who have died with the virus in Sweden, with an even higher rate in Stockholm.

Different theories have been raised as to why that might be: for example, the reliance on low-paid hourly workers in the care sector, a lack of clear routines for preventing the spread of infection, or a lack of sufficient staff and equipment to follow through on those routines.

Sweden's Health and Social Care Inspectorate has already begun inspections of elderly care homes, with the aim of preventing the same spread of infection in other parts of the country. And the Public Health Agency has begun examining why the coronavirus had such a devastating impact on care homes here. If any mistakes can be avoided in parts of the country that have not yet seen a wide spread of infection, there's the possibility to save lives.

 

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Signs outside an elderly care home warn people not to enter; many care homes across the country introduced visitor bans in mid-March. Photo: Anders Wiklund/TT

How can Swedish authorities communicate better?

Sweden has the advantage of strong public trust in its government and institutions, and that trust seems to have only grown during the crisis; a Dagens Nyheter/Ipsos poll this week showed nearly 70 percent had high trust for state epidemiologist Anders Tegnell, while just 11 percent did not trust him. Clearly there is support for the strategy from a majority in society.

But trust is a two-way process. Even among those who instinctively trust the authorities, a democracy requires clear, comprehensible explanations when members of the public are asked to change the way we live – or when we can see that the measures here are different from those in other countries.

The Public Health Agency gives daily press conferences with an update on the latest situation in Sweden and answers to journalists' questions, but still communications have not always been clear. Different authorities have issued different advice on the appropriate distance to keep from others in public. Guidance to pregnant women to be “extra careful” came many weeks later than similar guidance in other countries, and with no explanation of what exactly that meant (when asked for clarification, the Public Health Agency said it simply meant that following the general measures was especially important for pregnant women).


State epidemiologist Anders Tegnell and representatives from other state authorities. Photo: Anders Wiklund/TT

When The Local asked why Sweden introduced social distancing measures so much later than other countries, we were told that the approach has focused on bringing in the right measures at the right time – a common answer given to journalists' questions, but we are rarely given insight into how authorities decided the time was right.

Even with levels of trust around 70 to 80 percent, that still leaves millions of people who do not have that trust. Some of these people may belong to vulnerable groups, and their previous interactions with Swedish authorities may not have done much to build up trust. Some may not speak Swedish to a native level; foreign translations of key advice have tended to come later than the Swedish versions, although multilingual communications have improved during the course of the crisis. This is a lesson that is being learned in real time.

How can Sweden earn the trust of vulnerable groups and better reach them in future crises?

In terms of the coronavirus, vulnerable groups include the elderly and those with underlying symptoms that make them especially at risk of serious illness.

But people who are vulnerable in other ways – being on low incomes, having an insecure job or housing, having a lack of support network – are especially vulnerable to any crisis, including the health and economic crises caused by the coronavirus.

Earning trust among these groups requires better communications, including multilingual awareness campaigns from the earliest stages, something that took several weeks in Sweden and which Deputy Prime Minister Isabella Lövin admitted to The Local happened “too late”. It also needs actions.

The infection spread quickly in some of the country's most socio-economically vulnerable suburbs, and a lack of awareness cannot be solely to blame. These residents are more likely to work in jobs that can't be done from home, and to live in crowded accommodations mixing between generations. Local authorities have since made emergency accommodation available to people in risk groups who share housing with others.

Even in Sweden's other major cities, Malmö and Gothenburg, vulnerable areas were not disproportionately hit in the same way as in Stockholm, so there may be lessons to learn from within the country.

Information signs about the virus in a range of languages in the Tensta suburb of Stockholm. Photo: Anders Wiklund/TT

How many of Sweden's coronavirus deaths could have been prevented, and how?

This is the question that may take longest to get a reliable answer to. At the moment, Sweden's coronavirus death toll is significantly higher than the other Nordic countries, both measured in numbers and per capita. 

Two models published by researchers at the end of April estimate that the total number of deaths in Sweden from the coronavirus will be between 8,000 and 20,000

State epidemiologist Anders Tegnell has said he believes all countries that see the virus spread in society may ultimately experience similar death rates, unless their healthcare systems become overwhelmed making it harder to provide adequate care to all.

But it will be important to look at whether some of the deaths could have been prevented, and how that might have been possible. Routines in the elderly care home sector may be one factor, and this has been the key reason for Sweden's comparatively high death rate cited by the Public Health Agency, but there may also be other lessons to learn that could help save lives in future.


Photo: Fredrik Sandberg/TT

Has Sweden done enough to protect its economy?

Even with the lack of lockdown, it's already clear Sweden's economy will suffer from the crisis.

As in other countries, Sweden has pushed through measures aimed at limiting the number of layoffs and bankruptcies caused by the coronavirus. According to the worst-case scenario presented by the Finance Minister, the Swedish economy could see a 10 percent drop in GDP and unemployment figures soar to 13.5 percent this year if the crisis drags on. Already, more than 300,000 people have been sent home from work with the travel and hospitality industries especially hard hit.

And again, it will be important to ensure that these measures benefit different groups in society as equally as possible. That might mean creating extra support for people here on work permits, which typically require people to find a new job within three months of a layoff, or it might mean increasing access to training schemes, or ensuring support is available to those who were on insecure contracts before the crisis.

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