On Sweden – Mallory Pickett in The New Yorker:
‘While lockdowns, curfews, and travel bans were being rolled out across the rest of the world, Swedish restaurants, stores, bars, museums, day cares, and elementary schools all remained open. People were encouraged to work from home and to reduce travel, but both were optional. Masks were not recommended and remained rare. Households could mix; until the end of March, even parties of up to five hundred people were allowed. The man behind Sweden’s coronavirus response is Anders Tegnell, the country’s head epidemiologist. Tegnell worked in Zaire during the 1995 Ebola epidemic, and then served as an expert on infectious diseases for the European Union before being hired by the Swedish public-health agency, in 2013.
The Swedish constitution gives government agencies extraordinary independence, so Tegnell and the public-health agency have led much of the coronavirus response, and, constitutionally, the government has little power to impose restrictions. Tegnell, who is sixty-four and tall, with round glasses, has often said that lockdowns are not supported by science and that the evidence for mask-wearing is “weak.” His stance is a startling departure from the scientific consensus, but he maintains that if other countries were led by experts rather than politicians, more nations would have policies like Sweden’s. The world has been left gawking. American liberals were shocked that the country of Greta Thunbergcould seem so scientifically backward. Right-wing activists in Minnesota held up signs during anti-lockdown protests reading “Be Like Sweden.” Within the country, Tegnell has become an icon of Swedish exceptionalism, believed to be excessively reasonable, levelheaded, and rational. Supporters praised him for not giving in to political panic. Wearing a mask in Sweden was sometimes seen as a signifier of being anti-science.’
‘Tegnell introduced the country’s light-touch approach to the pandemic in March, as cases were mounting. Internal e-mails obtained by the freelance journalist Emanuel Karlsten show that the government at least considered whether the strategy might lead to more widespread immunity. In an e-mail exchange between Tegnell and the head of the Finnish public-health agency, on March 14th and 15th, Tegnell suggested that keeping the schools open could help the young and healthy develop immunity sooner. His Finnish colleagues noted that their models found that closing schools would decrease the infection rate among the elderly by ten per cent. Tegnell responded, “Ten percent might be worth it?” However, Sweden seems to have settled on its final strategy primarily through a mix of unorthodox scientific conclusions, pragmatism, and folkvett, a particularly Swedish notion of common sense. No epidemiologists thought that self-isolation should be a long-term solution. “Lockdown is a temporary measure that you do to buy you time,” David Nabarro, a long-time United Nations adviser and one of the World Health Organization’s special envoys on covid-19, told me. But most countries were unable to get the virus under control and decided to leave lockdowns in place until a vaccine became available. This seemed unsustainable to Tegnell. He also shirked masks. A year ago, there were few studies that directly measured the impact of masks on viral-particle emissions and community spread of the virus, and controlled experiments were difficult to conduct, for logistical and ethical reasons. Over the course of the pandemic, evidence supporting masks has piled up. An analysis of mask mandates in German towns found that they may have reduced covid-19 infections by about forty-five per cent. Another study examined U.S. states with mask mandates, and found that the daily growth of infections was two per cent lower in states where a mask mandate had been in place for a few weeks. By April, 2020, the W.H.O., the Centers for Disease Control, and other groups decided that there was enough evidence, and recommended face coverings. The C.D.C. now firmly concludes that “experimental and epidemiological data support community masking to reduce the spread of sars-CoV-2.” Yet Tegnell remained unsatisfied. In April, 2020, he wrote a letter to the European Center for Disease Control urging against a mask recommendation, saying, “The argument for and evidence for an effect of face covering to limit the spread from asymptomatic persons is not clear. . . . The arguments against are at least as convincing.”’
‘Sweden is a country of ten million people, about the size of Los Angeles County, and almost twenty per cent of Swedes live in Stockholm, the largest city. In April, 2020, a widely-circulated pre-print version of a paper by researchers at Uppsala University, adapting the Imperial College model, predicted that, under the Swedish strategy, fifty per cent of susceptible Swedes would be infected within thirty days, resulting in over eighty thousand deaths by July. That spring, the virus began spreading unchecked in Sweden. “It just kept adding up,” Tegnell said. “I mean, you’re always kind of hopeful and think that, O.K., this is something that’s going to pass over.” Soon, the per-capita death toll was among the highest in Europe. Slight modifications were made to the Swedish advice: visitors to nursing homes were banned on March 30th; people were not allowed to gather in groups larger than fifty. Tegnell told me that the death toll weighed on him. “I think this was a big frustration and feeling of failure for us,” he said. But he remained steadfast, often saying, in interviews, “Judge me in a year.”’
‘This summer, case counts began to drop in Sweden. When I spoke to Tegnell at the end of August, he felt that the worst was behind him. Just a few weeks later, he and other international experts had a special audience with Boris Johnson, to give advice on how Sweden had brought numbers down with their light-touch approach. “I think we are reasonably optimistic,” he said. “Our prognosis is, No, we don’t really see a huge second wave coming on.” This did not last. By December, cases and hospitalizations were higher than they’d been since the earliest days of the pandemic. Intensive-care units in Stockholm and Malmö, the country’s third biggest city, were full. “It was just this development we did not want to see,” Björn Eriksson, Stockholm’s director of health and medical care, said during a press conference. Confidence in the public-health agency had fallen from sixty-eight per cent in October, to fifty-two per cent in December. The government appointed an independent commission to investigate the Swedish response to the pandemic, and passed a new law temporarily allowing the state to close businesses as needed.
Tegnell’s prediction of a tapering epidemic curve and quickly-attained immunity never came to pass. Sweden’s per-capita case counts and death rates have been many times higher than any of its Nordic neighbors, all of which imposed lockdowns, travel bans, and limited gatherings early on. Over all in Sweden, thirteen thousand people have died from covid-19. In Norway, which has a population that is half the size of Sweden’s, and where stricter lockdowns were enforced, about seven hundred people have died. It’s likely that some simple policy changes—especially shutting down visitations to nursing homes sooner, and providing more P.P.E. and testing to nursing-home staff—would have saved lives. And the strategy doesn’t seem to have helped the economy much: the Swedish G.D.P. fell by around three per cent, better than the European average, but similar to the drop in other Nordic countries.
Fredrik Elgh, a virologist at Umeå University and one of Tegnell’s former bosses, wishes that Sweden had implemented restrictions like those used by other countries in the region. “Why don’t they go the same route as our neighbors that have been so successful?” he said. “We could have done that, too, if we had followed their path.” The fatalities in the elder homes, which account for about fifty per cent of the covid-19 deaths in Sweden, seem especially needless; if visits to these facilities had been banned sooner, if their workers had been advised to wear masks and get tested frequently, it’s possible that thousands of lives could have been saved. People from both pro- and anti-Tegnell camps believe that this was an unnecessary tragedy. (Tegnell agrees, although he does not think that the responsibility lies solely with the health agency.)’
‘But, although the outcome in Sweden was a black spot in Scandinavia, “compared to other countries in Europe, it’s not the worst off,” Patrick Heuveline, a professor of sociology at U.C.L.A. who studies pandemic mortality rates, told me. “It’s not as bad as Italy, Spain, the U.K., and Belgium for example.” Tegnell holds up this statistic when defending his strategy, claiming that sparsely-populated Norway and Finland are the outliers, and that Sweden should be compared to the rest of Europe. Sweden has a larger foreign-born population than other Nordic countries, and its population is more concentrated in urban areas, Tegnell claims. Other experts are skeptical of this argument. “I find no correlation between proportion of foreign-born and Covid death rate,” Heuveline wrote, in an e-mail. “Norway has a higher proportion of foreign-born than Denmark, which has about the same proportion as Italy (about 10%), but Covid-19 mortality is much higher in Italy than in Denmark, and higher in Denmark than in Norway.” Over all, Elgh, Heuveline and other experts argue, Sweden’s population is more similar to the other Nordic countries. Its first infections also came later than in other parts of Europe, giving its government more time to warn its citizens of the virus’ severity. For these reasons, comparisons to the rest of Scandinavia, which are less favorable to Sweden, may be more apt.’
‘In a recent piece for this magazine, Siddhartha Mukherjee noted that, while some countries were ravaged by the pandemic, others had far lower death rates than expected. The reasons for this, he noted, remain an “epidemiological mystery.” It may be, for example, that the Swedish policies appeared more different than they actually were. Small liberties were allowed—restaurants, bars, parties—which made Sweden seem wildly permissive. Lone Simonsen, an epidemiologist at Roskilde University, in Denmark, told me that, in the late spring and early summer, Danes would sometimes take a short trip to Sweden to enjoy a reprieve from lockdown. “If you just went to Malmö, which is right across from Copenhagen here, you would see two completely different societies when we were in lockdown,” she said. But most high schools and universities in Sweden went online. Staying at home was optional rather than mandatory, but mobility data from cell phones show that Swedes did significantly reduce their movement. Simonsen believes that two of Sweden’s simplest restrictions—limiting the sizes of gatherings and regulating visits to nursing homes—did much of the work to limit spread. “Most countries do a bunch of things at the same time, and you really can’t find the effect of the individual ones,” she said. She also points out that Sweden’s restrictions, while relatively relaxed, also remained fairly steady. “They didn’t fluctuate like we did in other countries,” Simonsen said. “We’ve been on a yo-yo diet with covid over here. The numbers went down, we opened up, and then they went up.” There may also be factors that we’re not yet aware of. “We’ve just got to be humble about what we know and what we don’t know. And we still don’t know a lot,” Howard Forman, a professor of public-health and management at Yale, told me. Protections that seemed important may turn out, after long-term study, to have been less effective than we thought. “If you, one day, come to me and say that masks only reduce spread by fifteen per cent or even ten per cent, I’d be like, O.K., well, that’s within range. It’s not a total shock. And, by the way, I would still say it was worth wearing the masks.” Huevelin added, of the virus’s first wave, “I remember we were given all these reasons why Germany kind of dodged the bullet: they had great hospitals, they had an excess of I.C.U. hospitals, they had redundancies in their hospital system.” But, now, Germany is doing no better than its neighbors, and it’s not clear why.’
‘Days after this new rule was passed, I asked Tegnell whether he still thought the evidence for masks was “sketchy.” “Yes,” he responded. “Unfortunately, there is not much new evidence in place.” But he told me that he had decided that it was better not to take chances. “Due to the developments we see, we need to use even measures where evidence and effect is low,” he said. Swedes are slowly making masks a part of their pandemic routines. My mother-in-law has bought some masks to wear on buses and trams. She and my father-in-law continue to see a small circle of friends, but they celebrated Christmas alone, seeing their grandchildren only on small screens.’
Read the article here.
Besides the obvious, there are a few interesting things here.
Luck does play a role, we think we can outwit luck or fate or whatever you want to call it, not always.
Why was Germany thought of an example a year ago, a shining city on the hill and why is it now considered as gloomy as most of Western-Europe?
And should we compare Sweden to Denmark of to Italy or Belgium? And why did Belgium, with severe lockdowns, didn’t do better than Sweden, maybe even worse?
Also, the question is not economy versus health.
The question is civil liberties versus risk avoidance.
How far should the state limit personal liberties in order to keep its population healthy? We can see the same discussion about the vaccine passport. Zero covid might be an appealing idea, but maybe less so if you think about the role of the state that is needed in order to get this result.
Zero crime might be a desirable goal as well, but maybe less so if you think about it longer than 60 seconds. I.e. do you want to live in a police state?
The final verdict is not out yet, but I would say that’s too easy and too early to ridicule the Swedish approach.
When it comes to fighting crime, the right is the champion of the state.
When it comes to fighting viruses, the left appears to be the champion of state action.
In both cases, I can only repeat that a state that is too weak is as dangerous as a state that is too strong.
The lofty ideal of total control should always be undermined.