Four things to know about Sweden’s Covid-19 strategy

Like other countries around the world, Sweden has adjusted its coronavirus strategy in recent weeks amid a second wave of the virus, but has retained its focus on non-coercive measures. Here are four key points to understand.

Four things to know about Sweden's Covid-19 strategy
A government press conference in early December. Photo: Henrik Montgomery/TT

What is the Swedish strategy?

Judging it nearly impossible to stop the virus completely, Sweden's authorities aimed to protect the elderly and risk groups. The goal was to 'flatten the curve' or curb the spread of the virus so that it wouldn't overwhelm healthcare services.

They neither imposed lockdowns nor closed schools for under-16s, and have always advised social distancing over mask-wearing. Frequent hand-washing, working from home and staying home at the first sign of symptoms were also highlighted in calls on citizens to act “responsibly”.

April brought one of the only bans, ending visits to nursing homes at first nationally and later regionally as needed.

As the second wave took hold in October, the Public Health Agency and the government began issuing stricter recommendations, first in hard-hit regions and then nationwide as of December 14th.

These include calls to avoid public transport and crowded stores, as well as limiting social interactions to single households or people already in regular contact. 

In November, the government banned alcohol sales after 10 pm until February, and reduced the limit on public events from 50 to eight people. Prime Minister Stefan Löfven has urged people to cancel all social engagements, and not go to the gym, library, shopping centres or other public places. But this has caused some accusations of mixed messages as these businesses remained open in many areas.

The government also ordered upper secondary schools (for 16-18 year olds) to conduct classes online from December 7th until January 6th. Many municipalities have also switched school for younger children to distance learning ahead of the Christmas holidays, to reduce the risk of children picking up the virus at school and spreading it among their families over the break.

A sign in Helsingborg says 'be extra considerate this Christmas'. Photo: Johan Nilsson/TT

Why did it adopt this strategy?

Public health authorities have insisted that battling the pandemic is “a marathon, not a sprint”, and measures have to be sustainable for the long haul. In general, Swedes also have a high level of trust in authorities, and the government in turn greatly relies on expert agencies.

This trust appears to be falling however, with a recent poll in Dagens Nyheter showing only 34 percent had “high confidence” in the authorities in general and 52 percent for the Public Health Agency, the lowest figures since the start of the pandemic.

The strategy has been guided by the Public Health Agency. It argued that draconian lockdown measures are not effective enough to justify the negative impact on society. And unlike most other countries, Sweden does not have legislation that allows the government to shut down society in peacetime — though some legal experts argue it does have authority to take more drastic measures than those in place.

The government is instead preparing a temporary, one-year “pandemic law” it aims to have in place by March 2021. It would empower the government to limit the number of people in public places and regulate businesses and services by restricting opening hours, or even shutting them down.

A similar law was in place over summer but never used, with the government saying amendments pushed through by opposition parties left it “unworkable”.

How well has the strategy worked?

The effectiveness of the strategy has been fiercely debated, at home and abroad.

Sweden's Covid-19 death toll is nearly six times the combined number in neighbouring Denmark, Norway and Finland as well as Iceland, all of which adopted stricter measures.

However, many other European countries that imposed lockdowns, such as France, Italy, Spain and Britain, have fared worse than Sweden's 772.5 deaths per million inhabitants.

The government in May admitted it had “failed” to protect the elderly in nursing homes, where nearly half of deaths have been recorded. On December 15th, an independent commission concluded Sweden had failed in its effort to protect the elderly, though it also noted that some of this failure related to systematic flaws already present before the pandemic.

Prime Minister Stefan Löfven and Public Health Agency director-general Johan Carlson. Photo: Jessica Gow/TT

Outside nursing homes, Sweden's recommendations have not always had the desired effect.

A December survey by the Civil Contingencies Agency showed nine of ten Swedes said they were good at following the recommendations but a third were sceptical of others' diligence — and the government has expressed frustration with those who don't.

Prime Minister Löfven, who held a rare address to the nation in November after being accused of being absent in the crisis, said his government had been forced to step in and impose stricter recommendations during the second wave as Swedes were not behaving as responsibly as they had before.

Surveys carried out by The Local have suggested that the country's international residents are critical of the government and agencies' handling of the crisis to a greater extent, with the majority also sceptical that the population was following the guidelines.

Did Sweden pursue herd immunity?

Early on it was widely reported that Sweden's goal was “herd immunity”, when a significant portion of the population has had the virus and developed antibodies, thereby stopping community transmission. Swedish authorities have robustly denied this.

“No it's never been a part of the strategy,” state epidemiologist Anders Tegnell told AFP in September.

However, allowing the virus to spread slowly leads to high immunity levels, he acknowledged.

“It's good to have high immunity in the population… We are seeing the effects,” he told AFP in June when cases were in decline.

Emails between the Public Health Agency's top officials obtained the by media have revealed however that the issue of herd immunity arose early on in their discussions on Sweden's strategy.

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Covid deaths in Sweden ‘set to rise in coming weeks’

The Public Health Agency of Sweden has warned that the number of weekly Covid deaths is set to rise, after the number of people testing positive for the virus rose for the sixth week running.

Covid deaths in Sweden 'set to rise in coming weeks'

According to the agency, an average of 27 people have died with or from the virus a week over the past three weeks. 

“According to our analyses, the number who died in week 27 (July 4th-July 11th), is more than died in week 26 and we expect this to continue to grow,” the agency wrote in a report issued on Thursday. 

In the week ending July 17th (week 28), 4,700 new cases of Covid-19 were registered, a 22 percent rise on the previous week. 

“We are seeing rising infection levels of Covid-19 which means that there will be more people admitted to hospital, and even more who die with Covid-19,”  said Anneli Carlander, a unit chief at the agency. “The levels we are seeing now are higher than they were last summer, but we haven’t reached the same level we saw last winter when omicron was spreading for the first time.” 

While 27 deaths a week with for from Covid-19 is a rise on the low levels seen this spring, it is well below the peak death rate Sweden saw in April 2020, when more than 100 people were dying a day. 

The number of Covid deaths recorded each week this summer. Source. Public Health Agency of Sweden
A graph of Covid deaths per day since the start of the pandemic shows that the current death rate, while alarming, remains low. Photo: Public Health Agency of Sweden

Carlander said that cases were rising among those in sheltered accommodation for the elderly, and also elderly people given support in their own homes, groups which are recommended to get tested for the virus if they display symptoms. The infection rate among those given support in their homes has risen 40 percent on last week. 

This week there were also 12 new patients admitted to intensive care units with Covid-19 in Sweden’s hospitals.  

The increase has come due to the new BA.5 variant of omicron, which is better able to infect people who have been vaccinated or already fallen ill with Covid-19. Vaccination or a past infection does, however, give protection against serious illness and death.