Saturday, June 12, 2021


Scientist behind Sweden's covid-19 strategy suggests it allowed too many deaths

BRUSSELS - For months, the world has watched Sweden's light-touch approach to fighting the coronavirus pandemic, wondering whether it was genius or misguided. On Wednesday, the architect of the strategy said that, in retrospect, he might have pushed something closer to other countries' restrictions.



Swedish authorities have consistently denied they were aiming to achieve full-population immunity by keeping much of their public life humming as usual. They said that if they protected the elderly and other vulnerable groups while allowing others to carry on, the country might be more resilient in the face of a second wave of infections and avoid the economic chaos of a total shutdown.

Deaths in Sweden, though, have been eight times higher than in Denmark and 19 times higher than in Norway, even though Sweden is only double each neighbors' size. The outbreak appears to be continuing to course through their society, even while most other European countries seem to have gotten things under control, at least for now. And because Sweden's economy is tightly bound to the rest of Europe's, it has also suffered, although not as badly as others.

"Should we encounter the same disease, with exactly what we know about it today, I think we would land midway between what Sweden did and what the rest of the world did," Swedish state epidemiologist Anders Tegnell told Swedish Radio on Wednesday.

Tegnell, a gruff, self-confident scientist with a mop of gray hair and an ever-present paper coffee cup in his hand, has turned into an object of fascination both inside Sweden and abroad with his iconoclastic approach to the crisis. He shot down other countries' attempts to close down their societies as a needless overreaction. He was so dismissive of Italy that he twice drew reprimands from the Italian ambassador in Stockholm. He reported to police that he and his family have received death threats by phone, email and on social media.

Through it all, life has continued on the streets of Sweden, where citizens basked in the sunlight, as much of the rest of the world missed spring. 

Swedish public health officials expressed confidence that their citizens would wash their hands and stay apart from each other - and there was no need to impose tougher requirements. 

Most restaurants and cafes have remained open, albeit with social distancing rules. Salons and shops never closed. The biggest change was a ban on gatherings of more than 50 people and an end to big sports events, but most other guidelines have been voluntary and only gently enforced. 

Swedish leaders have also gone against the tide by eschewing face masks, saying they could make things worse, even as other previously skeptical governments have mandated their use. 

"There is a risk of a false sense of security, that you believe that you can't be infected if you wear a face mask," Prime Minister Stefan Löfven told reporters last month.

But on Wednesday, Tegnell appeared rattled by Sweden's rising death toll. Asked whether too many people in Sweden had died, he replied: "Yes, absolutely." 

"There is potential for improvement in what we have done in Sweden, quite clearly," he said in the radio interview. "And it would be good to know more exactly what to shut down to prevent the spread of infection better."

He added that it had been hard to learn what helped and what didn't because most countries shut down everything all at once. Public health officials in Norway and Denmark have come to agree with Sweden's open-door approach to schools, saying that may not have been necessary to close them for children under the age of 14 because of limited evidence that they contribute to the spread of the disease.

Later Wednesday, Tegnell appeared to walk back his comments slightly.

"We basically still think that this is the right strategy for Sweden that we are doing," Tegnell told reporters at a Stockholm news conference, where he was dressed in an olive green sweater and plain brown pants, as though he had just come in from a long hike. "This is a bit like having an ocean liner and trying to steer it, but with a lag of about three or four weeks."


The official Swedish death toll rose to 4,468 people on Wednesday, a toll of 44 per 100,000 residents, according to data from Johns Hopkins University. The United States stood at roughly 33 deaths per 100,000 residents. Britain, Italy, Spain and Belgium are worse-off than Sweden, according to the data. But many Swedes say the best comparison is with their immediate neighbors in Scandinavia, who have been relatively spared, even though they have similar population density, political systems and cultures.

During parts of May, Sweden had the highest death rate in Europe, relative to population. Testing capacity has also lagged far behind other countries in Europe, limiting Sweden's ability to quarantine infected people, conduct contact tracing and fight off a possible second wave in the fall.

In the meantime, Sweden's economy is set to shrink 7 percent this year, the worst contraction since World War II.

The consequences of Sweden's go-it-alone approach seemed to deliver a particular sting last Friday, when Denmark and Norway eased travel restrictions with other countries - but not with Sweden, which under ordinary circumstances is tightly bound to both. Finnish policymakers have also expressed skepticism about allowing travel with Sweden.

Facing the heat from voters, Sweden's center-left government said on Monday that it would appoint a commission to investigate the country's handling of the pandemic.

Swedish public health leaders had initially said that even if they could not eliminate the virus from society, they could still protect the most vulnerable by managing a slow but steady rate of infection among younger, healthier people. A less closed-down approach would get them there, they said. 

But analyses of covid-19 antibodies among the Swedish population have so far proved disappointing. An analysis of 1,104 blood samples taken in late April and early May found that 7.3 percent of residents tested in the Stockholm region had antibodies, a rather limited number given the death toll, scientists said.

Tegnell has said that weeks-old samples would not give an up-to-date picture of antibody levels, and that "20 percent plus" have probably been exposed in the Stockholm region by now.

But as even the hardest-hit countries in Europe such as Britain, Spain and Belgium bend down their numbers and step blinking into the sun, Sweden appears to remain on a different trajectory.

"You look at everyone else's curve, it is typical. You go up, you peak, then you go down on the other side. But in Sweden you have a plateau at a pretty high level," said Björn Olsen, a professor of infectious medicine at Uppsala University and one of Sweden's leading researchers of pandemics, who has been sharply critical of the government's response.

"I know that many countries looked at Sweden as a good example of an open society. We had a relatively low number of cases. And then it started to skyrocket. We understood absolutely nothing," he said.

Olsen said the Swedish approach had been spurred by a mistaken belief that covid-19 behaved like the seasonal flu, which is extremely fast-spreading and contagious. Instead, he said, it appears to concentrate in certain spots and wreak deep devastation.

About half of Sweden's deaths have taken place in homes for the elderly, which is similar to some other European countries but has fueled criticisms in Sweden that policymakers had abandoned the elderly to the virus. After cases inside nursing homes began spiking, the government banned visitors. 

"We must admit that the part that deals with elderly care, in terms of the spread of infection, has not worked. It is obvious. We have too many elderly people who have passed away," Löfven, the prime minister, told the Aftonbladet newspaper on Wednesday. 

In neighboring countries, public health officials say Sweden's situation does indeed look difficult - although they also said so little is understood about how to fight the virus that it may still be too early to tell who has taken the best approach.

"It's a very sad situation with the high number of deaths in Sweden," said Camilla Stoltenberg, the director general of the Norwegian Institute of Public Health, who has advocated a more conventional lockdown approach. "That does make a strong impression. I am grateful that we are not in the same situation. However, we may regard both the Swedish and the Norwegian approaches as experiments, and we will know only in a couple of years which strategy worked best."




Published : June 04, 2020

By : The Washington Post · Michael Birnbaum · WORLD, HEALTH, SCIENCE-ENVIRONMENT, EUROPE