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‘Like generals fighting the last war’: How Sweden got Covid-19 wrong

The assumptions Sweden's Public Health Agency made at the start of the Covid-19 pandemic were "fundamentally wrong", and Prime Minister Stefan Löfven should have shown "true leadership" and ordered the agency to change course, the chair of Sweden's Covid-19 inquiry has told The Local.

'Like generals fighting the last war': How Sweden got Covid-19 wrong
The chair of the Coronavirus Commission, Mats Melin, submits his final report at the end of February. Photo. TT

Mats Melin, the former judge who led Sweden’s Corona Commission, told The Local that Johan Carlson and Anders Tegnell, respectively director general and state epidemiologist at the Swedish Public Health Agency, had stuck to a strategy developed to combat a flu pandemic, and had failed to adjust it even as they saw other countries’ public health authorities take a different approach. 

“It was like generals fighting the last war,” he said. “They were fundamentally relying on science and, in Swedish, beprövad erfarenhet — proven prior experience. And for this virus, there was no science and prior experience at hand. It was at hand for the flu virus, and that helps to understand why they relied on old knowledge and did not realise: ‘this is something new, we need to take another approach’.” 

According to Melin, this led the pair and their supporting experts to make assumptions about the virus that turned out to be catastrophic misjudgements. 

“They fundamentally believed, at least in March and into April at least, that most people would get only very mild symptoms. And that they would recover after a few days or weeks,” he said.

“Of course, they realised, and that was very clear, that the elderly were particularly vulnerable,” he continued. “The problem, in our assessment, is that there was no plan in place for how to protect the particular vulnerable, and thus, the assumption that you did not actually need to take intrusive measures to limit the general spread of the virus was fundamentally wrong.” 

In its final report, published at the end of last month, Melin’s Corona Commission concluded that the Swedish authorities’ decision to rely primarily on voluntary measures and recommendations had been largely correct. 

But Melin told The Local that he believed that the authorities should have temporarily put this principle aside at the start of the pandemic and followed the example of Denmark and Norway, who temporarily closed down shops, pubs, restaurants, sports facilities and other places where people meet indoors.

The only measure other Nordic countries took that Sweden was right to avoid, he argues, was the decision to close schools.

“Our impression, having spoken to experts is that, had we been able to slow down the spread of the pandemic in the initial phase, then the spread of the virus into the care homes for the elderly, would also have been slowed down. And that, we are convinced, would have saved at least some lives in the spring of 2020.” 

State Epidemiologist Anders Tegnell speaks at one of the weekly press conferences of the Public Health Agency. Photo: TT

Melin said that in the early stages, the Public Health Agency had seen a certain level of spread of the virus was unavoidable. 

“We are not claiming that the Public Health Agency deliberately abstained from any possible measures in order to achieve immunity among the population,” he said. “But our firm impression is that they found the wide spread of the virus to be practically unavoidable, and that we would have a large immunity later on, which was fundamentally a good thing.” 

But for Melin, the chief responsibility for Sweden’s failures during the pandemic lies with the then Prime Minister, Stefan Löfven, who, he believes, should have intervened in March and April, when he saw that the approach being taken by the Public Health Agency differed so much from those being taken by other countries in Europe. 

“The reluctance of the government to take the lead in a large crisis that involved large segments of society, that was what surprised me the most,” he said of his nearly two-year inquiry. 

“The Prime Minister has a special role to play in giving instructions to the cabinet, and thus, the Prime Minister bears personal responsibility for not ordering or taking initiatives in spring of 2020 to order, or give directives, to the Public Health Agency to change its course.” 

He rejected the argument that Sweden’s system – which combined relatively streamlined ministries, with powerful, semi-independent agencies – had prevented Löfven from doing this. 

“Under the Swedish system, the government has some has more difficulties in actually leading than in other constitutional systems. That is true. But we say that those difficulties could have been overcome. The government could very well, in March 2020, have ordered the Public Health Agency to change its fundamental course in fighting the pandemic.” 

Prime Minister Stefan Löfven announces his decision to stand down from his position. Photo: Anders Wiklund/TT

He said that until around October 2020, the government had made shockingly little effort to consult experts critical of the Public Health Agency’s approach. 

“During the first wave, they relied heavily, and almost exclusively, on the advice given by the Public Health Authority,” he said. 

The efforts that were made to seek outside advice were wholly inadequate, he argued. 

“They made some, almost private, outreach to scientists to get advice from outside sources, there were some initiatives, both from within the Department for Health, and even more so from within the Minister for Finance, but those were very odd, very few and not systematic at all. We conclude that the government should, early on, have reached out and tried to improve its own ability to evaluate advice given by its expert authority.” 

Even though, Melin believes the government should have overcome any structural barriers and assumed a leadership role, he said that Sweden’s government still needed reform to make it perform better in future crises. 

It was wrong, he said, to have a Public Health Agency which was itself tasked with weighing up the actions necessary to control a pandemic against other public health concerns.

“The [Public Health Agency’s] director general needs to make that evaluation before advising the government on what to do to combat the virus, and that is not a good order of things,” Melin said. 

He also called for reforms giving the government and Prime Minister a greater role in peacetime crises. 

“We need to organise a structure that enables the government more clearly to take a leading role in a health crisis or any other crisis,” he said. “We need to change the constitution to make it possible in a very severe peacetime crisis for the government to take certain decisions that otherwise need to be taken by Parliament.” 

Asked whether his three reports would change anything, or whether they, like so many other enquiries in Sweden, would simply be left to gather dust, Melin said he believed actions needed to be taken.  

“I certainly hope so. Anything else would be almost unthinkable,” he said. “The standpoint of many experts, not least the World Health Organisation, is that this was really a sort of general rehearsal before the next, more severe, pandemic will hit the world.” 

“So from that perspective, it is of fundamental importance to learn from this experience and be better prepared next time.”

Member comments

  1. There’s a stark contradiction here. The headline says “How Sweden got Covid-19 wrong”, while in the column to the right of the article it says “Sweden’s pandemic strategy fundamentally correct: Coronavirus Commission” …

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Covid face mask rule on flights in Europe set to be eased

The mandatory EU-wide mask requirement for air travel is set to be dropped from Monday, May 16th, but airlines may still require passengers to wear masks on some or all flights

Covid face mask rule on flights in Europe set to be eased

Europe-wide facemask rules on flights are set to be ditched as early as next week in light of new recommendations from health and air safety experts.

The European Union Aviation Safety Agency (EASA) and European Centre for Disease Prevention and Control (ECDC) dropped recommendations for mandatory mask-wearing in airports and during flights in updated Covid-19 safety measures for travel issued on Wednesday, May 11th.

The new rules are expected to be rolled out from Monday, May 16th, but airlines may still continue to require the wearing of masks on some or all of flights. And the updated health safety measures still say that wearing a face mask remains one of the best ways to protect against the transmission of the virus.

The joint EASA/ECDC statement reminded travellers that masks may still be required on flights to destinations in certain countries that still require the wearing of masks on public transport and in transport hubs.

It also recommends that vulnerable passengers should continue to wear a face mask regardless of the rules, ideally an FFP2/N95/KN95 type mask which offers a higher level of protection than a standard surgical mask.

“From next week, face masks will no longer need to be mandatory in air travel in all cases, broadly aligning with the changing requirements of national authorities across Europe for public transport,” EASA executive director Patrick Ky said in the statement. 

“For passengers and air crews, this is a big step forward in the normalisation of air travel. Passengers should however behave responsibly and respect the choices of others around them. And a passenger who is coughing and sneezing should strongly consider wearing a face mask, for the reassurance of those seated nearby.”  

ECDC director Andrea Ammon added: “The development and continuous updates to the Aviation Health Safety Protocol in light of the ongoing Covid-19 pandemic have given travellers and aviation personnel better knowledge of the risks of transmission of SARS-CoV-2 and its variants. 

“While risks do remain, we have seen that non-pharmaceutical interventions and vaccines have allowed our lives to begin to return to normal. 

“While mandatory mask-wearing in all situations is no longer recommended, it is important to be mindful that together with physical distancing and good hand hygiene it is one of the best methods of reducing transmission. 

“The rules and requirements of departure and destination states should be respected and applied consistently, and travel operators should take care to inform passengers of any required measures in a timely manner.”