LittleLaw Looks At… Sweden’s Coronavirus response
May 25, 2021
14 min read
What’s going on here?
Last year, the world saw the coronavirus spread across the world at rapid speeds. With the virus first appearing in Europe in Northern Italy, we watched as regions, and then the entire country, went into a strict unprecedented lockdown to prevent the spread of the virus and to stop hospitals from being overwhelmed with patients. As the virus spread further within Europe we saw country after country implement similar lockdowns, the UK included. Few countries diverged from this strategy, however, one did and in doing so drew international attention: Sweden.
What was Sweden's coronavirus response?
Unlike other countries, Sweden relied almost solely on citizens’ sense of civic duty to act responsibly through issuing recommendations. The voluntary measures focus primarily on social distancing, for example working from home if possible and practicing good hygiene.
As a result, most schools, businesses and restaurants remained open, and there was no requirement to quarantine for those returning or visiting from abroad. The only ban to come into place in April 2020 was an end to visitors in nursing homes.
Interestingly, the Swedish government also did not recommend wearing masks. They reportedly consider that wearing a mask could give people a false sense of security, and in contrast to the majority of the world’s scientists, the Swedish Health Agency considered there to be insufficient evidence that masks actually worked. Many are critical of this, Dr Elgh a Virology professor considers that of the 170 countries in the world using face masks, Sweden is the only one that thinks there is not enough science backing their use. Consequently, many Swedes do not wear masks on the basis that it is not obligatory and because it has not been recommended by the government.
The recommendations, compared to other countries, indeed seem very light, and some appear to be in stark contrast with other countries. For example, Sweden’s chief epidemiologist Anders Tegnell did not think that keeping children home would control the spread of the virus and as such children of infected parents should not stay home, but should continue to go to school as normal.
As a result of the relatively light measures many have thought Sweden’s strategy to be herd immunity. The state epidemiologist behind the strategy, Anders Tegnell, has however denied this but he acknowledges that the strategy would allow the virus to slowly spread in order to achieve high immunity levels. High levels of immunity, they thought, would be achieved within 6 to 12 months, and as such it was thought initially that the country would suffer relatively little from a second wave, when compared to countries which had locked down.
What’s the reasoning?
The country’s strategy has been driven by its public health agency, as the government reportedly thought it best to leave the science to the scientists. There are a multitude of reasons behind the approach.
Firstly, the government reportedly considered it near impossible to stop the virus completely, and thus the overarching aim was to protect the elderly and at risk groups, and much like the rest of the world sought to flatten the curve to protect healthcare services from being overwhelmed. The government considered that battling the virus was a marathon and not a sprint and therefore has looked for sustainable measures. Thus it was considered that lockdowns were not effective enough to justify the negative impact that they would have on society.
Furthermore, they considered there to be no satisfying evidence that lockdowns were able to reduce long term mortality rates. Instead they thought that a lockdown would simply delay cases until the restrictions were eased. They argued that, if the country could maintain an adequate health care capacity during the crisis, then the only purpose of a lockdown would be to delay deaths, because the curve would equal out over time. It was suggested by a former state epidemiologist in Sweden that if each country looked at their figures one year into the pandemic, they would be similar regardless of what measures were taken. However, a Stockholm University professor who specialises in modeling infectious diseases has pointed out that more stringent quarantine measures could actually prevent deaths among the most vulnerable people because, as time progressed scientists would learn more about the disease and could therefore treat it better. This is something that countries who have imposed stricter lockdowns will benefit from. One year is now fast approaching, and we will soon see which prediction was correct.
In addition, Sweden may also have a cultural advantage in fighting the virus. More than half of Swedish homes are made up of only one resident – the highest proportion in Europe, and experts believed that this living pattern would help slow the spread of the virus when compared to countries like Italy and Spain where it is common for several generations to live together. Sweden is also a culturally “cold” country – it is normal to avoid speaking with or sitting close to others, and thus social distancing was almost inherently part of a Swedes nature even before the pandemic.
Modelling to project the course of the virus has been used by most countries in coming to a decision as to how to tackle it. Sweden is no exception to this and the country’s models predicted less hospitalisations than other countries. Why? Because it was believed that there would be many asymptomatic people who it was considered were not important to the spread of the virus, and this was reflected in the data used.
But if the data used by the Swedish government gave the same result as that which caused Boris Johnson to call for lockdown, then could the Swedish have had a lockdown if it wanted to? That is debatable, as it has been pointed out by some that, unlike many other countries, Sweden does not have the legislation that would allow the government to shut down society in peace time – though some legal experts argue that it does have the authority to take more drastic measures than it has done.
The country does not have emergency legislation that would empower the government to force closures and require a lockdown. That is partially because instead of having one emergency law which is all encompassing, Sweden has emergency clauses embedded into specific laws – stating under which circumstances and to what extent the government may interfere with the rights set out in the law. Klamberg, a professor of international law at Stockholm University, has argued that the government could use these emergency provisions to impose tougher measures. However, where these clauses do not provide sufficient power to the government, then changes must be made to the legislation. To do so the government must follow the ordinary legislative procedure including gaining parliamentary approval.
Some believe that such changes are not needed, and the government already has the power to make such closures, for example the Act on Communicable Disease Control at Chapter 9 reads (translated):
Section 4: “the government or whatever agency the government empowers can issue the further ordinances required for appropriate protection from infection as well as the protection of individuals”.
Section 6: “The government can issue special ordinances on protection from contagion according to this law, if in a peacetime crisis this has a significant impact on the possibility of maintaining effective infection control, there is a need for coordinated national measures, or from a national perspective, requires other special initiatives regarding infection control.:
Klamberg however argues that traditionally, Swedish law is interpreted by looking to the intention of those who created it, so the real question becomes whether or not the writers had intended the government to have such powers.
In response to recently escalating cases, the government has begun preparing a new temporary one-year “pandemic law” which aims to be in place by March 2021. This would give the government the power to restrict opening hours or shut down businesses, as well as limit the number of people in public spaces. However, notably, a similar law was in place over the summer of 2020, but it was never used because opposition amendments to the law, which required that any decisions gained parliamentary approval, left it unworkable.
Further, Article 2 of Sweden’s constitution enshrines basic rights which includes the right of public access and the right to travel freely, as well as the right of businesses to trade. Furthermore, the ECHR was incorporated into Swedish law in 1995, and this has protected freedom of movement. As a result, these laws prevent the most coercive measures which have been imposed by other countries such as travel bans, curfews and forced closures. However Klamberg, has pointed out that most of the protections provided by the ECHR would also have granted similar rights in other EU countries which nonetheless have imposed lockdowns.
Regardless of the reasoning behind the strategy, it has drawn both criticism and praise within Sweden and abroad. It is a potentially more business friendly and sustainable model, however the Swedish Left-Centre government is now under pressure over its handling of the pandemic. A commission recently found that the government had not done enough to protect the elderly during the spring.
Has it worked?
Early on it looked as if the strategy had worked. In March the number of positive cases in the country was similar to that of neighbouring Norway, yet Sweden has twice the population. While this may sound promising, the reason for the reported low rate of infections at that time was the low rate of testing in Sweden, so it was impossible to know the true spread of the virus. In June and July the infection rate in Stockholm was dropping, and many wondered whether Sweden had managed to strike the right balance between managing a health crisis and economic impacts.
Unfortunately, things weren’t quite as successful as they may have seemed. As early as May the government admitted that it had failed to protect the elderly in nursing homes – where the majority of deaths were recorded. Further, a Public Health Agency model estimated that about 20-25% of the Stockholm population would have been infected by the end of April, but results from antibody tests in May suggested that less than 8% of people had antibodies. Antibody tests taken in June and July found that only 15% of the population had them. The country’s high number of cases at that time led Neighbouring countries Norway and Denmark to exclude Sweden from their travel bubble.
In the Autumn things took a turn for the worse with the arrival of a second wave, and the government has made a slow retreat from its no-lockdown stance as it struggled to stop the spread of the virus.
In November the PM made an address to the nation saying that things were moving in the wrong direction, however at the time of the address, the country’s chief epidemiologist Anders Tegnell said that the strategy would not change. Later in that same month the PM stated that they had been forced to introduce stricter recommendations because Swedes had not been behaving responsibly (ie had not been following the recommendations) and with this many began to sense a split between the government and the public health agency over the approach.
There was a record number of infections almost every week in November and December. The death rate in Sweden is nearly 6 times the combined number in the neighbouring countries of Norway, Finland, Denmark and Iceland all of which adopted strict measures, but have similar cultures (experts consider Sweden’s strategy is best compared to these neighbouring countries due to their similar demographics, cultures and political systems). More widely, the death rate per capita is one of the highest in the world. The number is however lower than the UK which has opted to lockdown.
The situation is not helped by the fact that nurses have been leaving their jobs in high numbers since the start of the pandemic – 3000 left in the first 10 months. In December the head of the health service in Stockholm pleaded with the government for help as the city’s hospitals became overwhelmed with patients, and are fast approaching double the number of patients than intensive care beds. Staff have been moved from the children’s hospital to help with the strain, but there are fears that the situation will get even worse in the coming weeks.
On December 15 an independent commission found that the government had not done enough to protect the elderly – people that the strategy had intended to protect. To many, this is proof that the strategy had failed, but the architect of the strategy, Tegnell, maintains that the overall strategy had not failed. Regardless of whether or not the strategy is working, a recent poll in newspaper Dagens Nyheter shows peoples trust in the strategy to be falling, with only 34% having high confidence in the authorities and 52% having confidence in the public health agency – the lowest figures since the start of the pandemic.
The crisis has become so bad that the King of Sweden made a rare comment on public affairs, stating that the country’s tactic had failed. A recent OECD study showed Sweden consistently ranked among the hardest hit European nations, and a study published in the Journal of the American Medical Association found that Sweden had been one of the least effective at containing the virus.
How has this affected the economy?
The authorities have denied that economic protection was part of their strategy, however, it is a positive byproduct. Like many other countries in the world, the Swedish economy has taken a hit during the pandemic, in the April-June period it shrunk 8.6% which is the largest quarterly fall for 40 years. Countries that took harsher measures have however suffered more– the EU overall saw a contraction of 11.9% in the same period, while Spain saw a whopping 18.5% contraction with France and Italy not far behind. However, Sweden’s economic damage is still greater than that of its nordic neighbours who did lockdown (Finland was down only 3.2% and Denmark 7.4%).
Given that things have largely remained open, a smaller economic impact could be expected, but stores have still seen reduced footfall as a result of the recommendations. In addition, Sweden’s economy is highly dependent on exports and international trade, and pandemic induced a lack of demand has therefore hit the country. The country has also seen more layoffs than during the GFC as a result of the virus.
Despite these troubles, a December estimate has seen the economy rebound more quickly than expected in the middle of the second wave and has predicted GDP to shrink only 3% for the year – a much better estimate than the earlier predictions noted above. However, Sweden’s Riksbank has noted that a delay in rolling out a vaccine would be very costly for the economy – between 1.78bn to 4.73bn USD per month depending on the severity of the pandemic and measures taken.
What new measures are being brought in?
With the Autumn and Winter surge in cases the government has brought in its toughest measures yet, but the focus remains on voluntary compliance. So what are the changes being made, and how has the situation developed?
- In October it was recommended that adults who live with an infected person should not go to work. Notably, children in such households were able to continue going to school and daycare. That changed in December after much criticism that the health agency has underestimated the potential for asymptomatic transmission of the virus.
- In November the public was urged to cancel social engagements, not go to the gym, shopping centres, or public places, and there was a ban on the sale of alcohol after 10 pm However, shops and gyms were able to remain open.
- In December the ban on the sale of alcohol was moved forward to 8 pm. It was also stated that gyms, pools, and libraries would close until January 24.
- In mid-December, the public health agency made nationwide recommendations. The public was told to avoid public transport and to limit social contact. Schools for 16-18-year-olds were told to move to online classes, and then a week later this was also recommended for schools for 13-15year olds. Primary schools and preschools however remain open as usual. For the first time since the start of the pandemic, they have included the recommendation to wear face masks on public transport when travelling in peak times.
There is however no penalty for breaking these recommendations.
LittleLaw Verdict: A tougher hand is needed
Despite the move to harsher recommendations critics are calling for yet more measures. Tove Fall, a professor of molecular epidemiology at Uppsala University considers that a few weeks of lockdown is needed to get the numbers down, and she notes that other countries are taking much greater precautions when they have lower levels of virus transmission.
With bars, restaurants and shopping centres remaining open, the response still pales in comparison to the rest of Europe. So will these measures be enough to get the numbers down when intensive care is already at 200% capacity? Or is it too little too late? As with most things, time will tell.
Report written by a LittleLaw Reporter
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- Rafaela Lindeberg, “Sweden Sees No Signs So Far Herd Immunity is Stopping Virus” (Bloomberg, 24 November 2020)
- Niclas Rolander, “Swedens Top Epidemiologist Says Herd Immunity Remains a Mystery” (Bloomberg, 1 December 2020)
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