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The Swedish COVID-19 Response Is a Catastrophe. It Shouldn’t Be a Mannequin for the Remainder of the World

The Swedish COVID-19 Response Is a Disaster. It Shouldn’t Be a Model for the Rest of the World


The Swedish COVID-19 experiment of not implementing early and robust measures to safeguard the inhabitants has been hotly debated around the globe, however at this level we are able to predict it’s nearly sure to end in a internet failure by way of demise and struggling. As of Oct. 13, Sweden’s per capita demise price is 58.Four per 100,000 individuals, in keeping with Johns Hopkins College information, 12th highest on this planet (not together with tiny Andorra and San Marino). However maybe extra putting are the findings of a research printed Oct. 12 within the Journal of the American Medical Affiliation, which identified that, of the nations the researchers investigated, Sweden and the U.S. primarily make up a class of two: they’re the one nations with excessive total mortality charges which have didn’t quickly cut back these numbers because the pandemic has progressed.

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But the architects of the Swedish plan are promoting it as a hit to the remainder of the world. And officers in different nations, together with on the prime degree of the U.S. authorities, are discussing the technique as one to emulate—regardless of the truth that doing so will nearly definitely enhance the charges of demise and distress.

Nations that locked down early and/or used in depth check and tracing—together with Denmark, Finland, Norway, South Korea, Japan, Taiwan, Vietnam and New Zealand—saved lives and restricted injury to their economies. Nations that locked down late, got here out of lock down too early, didn’t successfully check and quarantine, or solely used a partial lockdown—together with Brazil, Mexico, Netherlands, Peru, Spain, Sweden, the U.S. and the U.Okay.—have nearly uniformly performed worse in charges of an infection and demise.

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Regardless of this, Sweden’s Public Well being Company director Johan Carlson has claimed that “the Swedish state of affairs stays favorable,” and that the nation’s response has been “constant and sustainable.” The information, nevertheless, present that the case price in Sweden, as elsewhere in Europe, is at present rising.

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Common day by day circumstances rose 173% nationwide from Sept. 2-Eight to Sept. 30-Oct. 6 and in Stockholm that quantity elevated 405% for a similar interval. Although some have argued that rising case numbers may be attributed to elevated testing, a latest research of Stockholm’s wastewater printed Oct. 5 by the Swedish Royal Institute of Expertise (KTH) argues in any other case. An elevated focus of the virus in wastewater, the KTH researchers write, reveals an increase of the virus within the inhabitants of the larger Stockholm space (the place a big proportion of the nation’s inhabitants stay) in a method that’s completely impartial of testing. But even with this rise in circumstances, the federal government is easing the few restrictions it had in place.


From early on, the Swedish authorities appeared to deal with it as a foregone conclusion that many individuals would die. The nation’s Prime Minister Stefan Löfven advised the Swedish newspaper Dagens Nyheter on April 3, “We should rely the lifeless in 1000’s. It’s simply as nicely that we put together for it.” In July, because the demise rely reached 5,500, Löfven mentioned that the “technique is true, I’m fully satisfied of that.” In September, Dr. Anders Tegnell, the Public Well being Company epidemiologist answerable for the nation’s COVID-19 response reiterated the social gathering line {that a} rising demise rely did “not imply that the technique itself has gone mistaken.” There was an absence of written communication between the Prime Minister and the Public Well being Authority: when the authors requested all emails and paperwork between the Prime Minister’s workplace and the Public Well being Authority for the interval Jan. 1—Sept. 14, the Prime Minister’s Registrar replied on Sept. 17 that none existed.

Regardless of the Public Well being Company’s insistence on the contrary, the core of this technique is broadly understood to have been about constructing pure “herd immunity”—primarily, letting sufficient members of a inhabitants (the herd) get contaminated, get better, after which develop an immune system response to the virus that it will in the end cease spreading. Each the company and Prime Minister Löfven have characterised the strategy as “widespread sense“ trust-based suggestions moderately than strict measures, resembling lockdowns, which they are saying are unsustainable over an prolonged time frame—and that herd immunity was only a fascinating facet impact. Nevertheless, inside authorities communications counsel in any other case.

Emails obtained by one of many authors via Freedom of Info legal guidelines (referred to as offentlighetsprincipen, or “Openness Precept,” in Swedish) between nationwide and regional authorities companies, together with the Swedish Public Well being Authority, in addition to these obtained by different journalists, counsel that the purpose was all alongside actually to develop herd immunity. We’ve additionally acquired info via sources who made comparable requests or who corresponded instantly with authorities companies that again up this conclusion. For the sake of transparency, we created a web site the place we’ve posted a few of these paperwork.

One instance exhibiting clearly that authorities officers had been excited about herd immunity from early on is a March 15 electronic mail despatched from a retired physician to Tegnell, the epidemiologist and architect of the Swedish plan, which he forwarded to his Finnish counterpart, Mika Salminen. In it, the retired physician really helpful permitting wholesome individuals to be contaminated in managed settings as a approach to battle the epidemic. “One level could be to maintain faculties open to achieve herd immunity quicker,” Tegnell famous on the prime of the forwarded electronic mail.

Salminen responded that the Finnish Well being Company had thought-about this however determined in opposition to it, as a result of “over time, the kids are nonetheless going to unfold the an infection to different age teams.” Moreover, the Finnish mannequin confirmed that closing faculties would cut back “the assault price of the illness on the aged” by 10%. Tegnell responded:10 p.c could be value it?”

Nearly all of the remainder of Sweden’s policymakers appeared to have agreed: the nation by no means closed daycare or faculties for kids below the age of 16, and faculty attendance is obligatory below Swedish legislation, with no choice for distance studying or house education, even for relations in excessive danger teams. Policymakers primarily determined to make use of kids and faculties as contributors in an experiment to see if herd immunity to a pandemic could possibly be reached. A number of outbreaks at faculties occurred in each the spring and autumn.

At this level, whether or not herd immunity was the “purpose” or a “byproduct” of the Swedish plan is semantics, as a result of it merely hasn’t labored. In April, the Public Well being Company predicted that 40% of the Stockholm inhabitants would have the illness and purchase protecting antibodies by Could. Based on the company’s personal antibody research printed Sept. Three for samples collected up till late June, the precise determine for random testing of antibodies is barely 11.4% for Stockholm, 6.3% for Gothenburg and seven.1% throughout Sweden. As of mid-August, herd immunity was nonetheless “nowhere in sight,” in keeping with a Journal of the Royal Society of Medication research. That shouldn’t have been a shock. In any case, herd immunity to an infectious illness has by no means been achieved with no vaccine.


Löfven, his authorities, and the Public Well being Company all say that the excessive COVID-19 demise price in Sweden may be attributed to the truth that a big portion of those deaths occurred in nursing houses, as a result of shortcomings in aged care.

Nevertheless, the excessive an infection price throughout the nation was the underlying issue that led to a excessive variety of these turning into contaminated in care houses. Many sick aged weren’t seen by a physician as a result of the nation’s hospitals have been implementing a triage system that, in keeping with a research printed July 1 within the journal Medical Infectious Illnesses, appeared to have factored in age and predicted prognosis. “This probably diminished [intensive care unit] load at the price of extra high-risk sufferers”—like aged individuals with confirmed an infection—dying outdoors the ICU.” Solely 13% of the aged residents who died with COVID-19 throughout the spring acquired hospital care, in keeping with preliminary statistics from the Nationwide Board of Well being and Welfare launched Aug.

In a single case which appears consultant of how seniors have been handled, affected person Reza Sedghi was not seen by a physician the day he died from COVID-19 at a care house in Stockholm. A nurse advised Sedghi’s daughter Lili Perspolisi that her father was given a shot of morphine earlier than he handed away, that no oxygen was administered and employees didn’t name an ambulance. “Nobody was there and he died alone,” Perspolisi says.

As a way to be admitted for hospital care, sufferers wanted to have respiration issues and even then, many have been reportedly denied care. Regional healthcare managers in every of Sweden’s 21 areas, who’re accountable for care at hospitals in addition to implementing Public Well being Company pointers, have claimed that no sufferers have been denied care throughout the pandemic. However inside native authorities paperwork from April from a few of Sweden’s areas—together with these masking the most important cities of Stockholm, Gothenburg and Malmö—additionally present directives for the way some sufferers together with these receiving house care, these dwelling at nursing houses and assisted dwelling amenities, and people with particular wants couldn’t obtain oxygen or hospitalization in some conditions. Dagens Nyheter printed an investigation on Oct. 13 exhibiting that sufferers in Stockholm have been denied care on account of these pointers. Additional, a September investigation by Sveriges Radio, Sweden’s nationwide public broadcaster, discovered that greater than 100 individuals reported to the Swedish Well being and Care Inspectorate that their kinfolk with COVID-19 both didn’t obtain oxygen or nutrient drops or that they weren’t allowed to return to hospital.

These points don’t solely have an effect on the aged or those that had COVID-19. The Nationwide Board of Well being and Welfare’s pointers for intensive care in extraordinary circumstances all through Sweden state that precedence ought to be given to sufferers primarily based on organic, not chronological, age. Sörmlands Media, in an investigation printed Could 13, cited a lot of sources saying that, in lots of components of the nation, the well being care system was already working in a method such that individuals have been being denied the kind of inpatient care they’d have acquired in regular occasions. Regional well being companies have been utilizing a Medical Frailty Scale, an evaluation software designed to foretell the necessity for care in a nursing house or hospital, and the life expectancy of older individuals by estimating their fragility, to find out whether or not somebody ought to obtain hospital care and was utilized to choices relating to all types of remedy, not just for COVID-19. These pointers led to many individuals with well being care wants unrelated to COVID-19 not getting the care they want, with some even dying consequently—collateral injury of Sweden’s COVID-19 technique.

Dr. Michael Broomé, the chief doctor at Stockholm’s Karolinska Hospital’s Intensive Care Unit, says his division’s affected person load tripled throughout the spring. His employees, he says, “have usually felt powerless and insufficient. We’ve misplaced a number of younger, beforehand wholesome, sufferers with notably critical illness programs. We’ve additionally repeatedly been compelled to say no to sufferers we might usually have accepted as a result of an absence of skilled employees, appropriate amenities and gear.”

In June, Dagens Nyheter reported a narrative of 1 case exhibiting how disastrous such a state of affairs may be. Yanina Lucero had been ailing for a number of weeks in March with extreme respiration issues, fever and diarrhea, but COVID-19 checks weren’t obtainable on the time apart from these getting back from excessive danger areas who displayed signs, these admitted to the hospital, and people working in well being care. Yanina was solely 39 years outdated and had no underlying diseases. Her husband Cristian introduced her to an unnamed hospital in Stockholm, however have been advised it was full and despatched house, the place Lucero’s well being deteriorated. After a number of days when she might barely stroll, an ambulance arrived and Lucero was taken to Huddinge hospital, the place she was sedated and placed on a ventilator. She died on April 15 with out receiving a COVID-19 check in hospital.


Sweden did strive some issues to guard residents from the pandemic. On March 12 the federal government restricted public gatherings to 500 individuals and the following day the Public Well being Company issued a press launch telling individuals with doable COVID-19 signs to remain house. On March 17, the Public Well being Company requested employers within the Stockholm space to let staff make money working from home if they might. The federal government additional restricted public gatherings to 50 individuals on March 29. But there have been no suggestions on personal occasions and the 50-person restrict doesn’t apply to varsities, libraries, company occasions, swimming swimming pools, procuring malls or many different conditions. Beginning April 1, the federal government restricted visits to retirement houses (which reopened to guests on Oct. 1 with out masks really helpful for guests or employees). However all these suggestions got here later than within the different Nordic nations. Within the interim, establishments have been compelled to make their very own choices; some excessive faculties and universities modified to on-line educating and eating places and bars went to desk seating with distance, and a few firms instituted guidelines about carrying masks on web site and inspiring staff to make money working from home.

In the meantime Sweden constructed neither the testing nor the contact-tracing capability that different rich European nations did. Till the top of Could (and once more in August), Sweden examined 20% the variety of individuals per capita in contrast with Denmark, and fewer than each Norway and Finland; Sweden has usually had among the many lowest check charges in Europe. Even with elevated testing within the fall, Sweden nonetheless solely checks solely about one-fourth that of Denmark.

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Sweden by no means quarantined these arriving from high-risk areas overseas nor did it shut most companies, together with eating places and bars. Relations of those that check optimistic for COVID-19 should attend faculty in particular person, not like in lots of different nations the place if one particular person in a family checks optimistic your complete household quarantines, often for 14 days. Staff should additionally report back to work as standard except in addition they have signs of COVID-19, an settlement with their employer for a depart of absence or a physician recommends that they isolate at house.

On Oct. 1, the Public Well being Authority issued non-binding “guidelines of conduct” that open the chance for medical doctors to have the ability to advocate that sure people keep house for seven days if a family member checks optimistic for COVID-19. However there are main holes in these guidelines: they don’t apply to kids (of all ages, from start to age 16, the yr one begins highschool), individuals within the family who beforehand have a optimistic PCR or antibody check or, individuals with socially essential professions, resembling well being care employees (below sure circumstances).

There’s additionally no date for when the rule would go into impact. “It might not occur immediately, Stockholm will begin shortly however some areas may have extra time to get all of it in place,” Tegnell mentioned at a Oct. 1 press convention. In the meantime, in keeping with present Public Well being Company pointers issued Could 15 and nonetheless in place, those that check optimistic for COVID-19 are anticipated to attend work and faculty with delicate signs as long as they’re seven days post-onset of signs and fever free for 48 hours.

Johan Nilsson—TT/Sipa Individuals on a crowded seashore in Lomma, Sweden on Aug. 16, 2020.

Sweden truly recommends in opposition to masks in all places besides in locations the place well being care employees are treating COVID-19 sufferers (some areas increase that to well being care employees treating suspected sufferers as nicely). Autumn corona outbreaks in Dalarna, Jönköping, Luleå, Malmö, Stockholm and Uppsala hospitals are affecting each hospital employees and sufferers. In an electronic mail on April 5, Tegnell wrote to Mike Catchpole, the chief scientist on the European Heart for Illness Management and Prevention (ECDC): “We’re fairly nervous concerning the assertion ECDC has been getting ready about masks.” Tegnell connected a doc by which he expresses concern that ECDC recommending facemasks would “suggest that the unfold is airborne which might critically hurt additional communication and belief among the many inhabitants and well being care employees” and concludes “we wish to warn in opposition to the publication of this recommendation.” Regardless of this, on April Eight ECDC really helpful masks and on June Eight the World Well being Group up to date its stance to advocate masks.

Sweden’s authorities officers caught to their social gathering line. Karin Tegmark Wisell of the Public Well being Company mentioned at a press convention on July 14 that “we see around the globe that masks are utilized in a method so that you simply moderately enhance the unfold of an infection.” Two weeks later, Lena Hallengren, the Minister of Well being and Social Affairs, spoke about masks at a press convention on July 29 and mentioned, “We don’t have that custom or tradition” and that the federal government “wouldn’t overview the Public Well being Company’s determination to not advocate masks.”

All of this creates a state of affairs which leaves academics, bus drivers, medical employees and care house employees extra uncovered, with out face masks at a time when the remainder of the world is clearly endorsing widespread masks carrying.

On Aug. 13, Tegnell mentioned that to advocate masks to the general public “numerous assets are required. There’s fairly some huge cash that will be spent if you’re going to have masks.” Certainly, emails between Tegnell and colleagues on the Public Well being Company and Andreas Johansson of the Ministry of Well being and Social Affairs present that the coverage issues of the well being authority have been influenced by monetary pursuits, together with the business issues of Sweden’s airports.

Swedavia, the proprietor of the nation’s largest airport, Stockholm Arlanda, advised staff throughout the spring and early summer time they might not put on masks or gloves to work. One worker advised Upsala Nya Tidning newspaper on Aug. 24 “Many people have been sick throughout the starting of the pandemic and two colleagues have died because of the virus. I’d estimate that 60%-80% of the employees on the safety checks have had the an infection.”

“Our union representatives fought for us to have masks at work,” the worker mentioned, “however the airport’s response was that we have been an authority that will not unfold worry, however we might present that the virus was not so harmful.” Swedavia’s reply was that they’d launched the an infection management measures really helpful by the authorities. On July 1, the corporate modified its coverage, recommending masks for everybody who involves Arlanda—that, in keeping with a Swedavia spokesperson, was not on account of “an an infection management measure advocated by Swedish authorities,” however moderately, as a result of a joint European Union Aviation Security Company and ECDC suggestion for all of Europe.

As early as January, the Public Well being Company was warning the federal government about prices. In a Jan. 31 communique, Public Well being Company Director Johan Carlsson (appointed by Löfven) and Normal Counsel Bitte Bråstad wrote to the Ministry of Well being and Social Affairs, cautioning the federal government about prices related to classifying COVID-19 as a socially harmful illness: “After a choice on quarantine, prices for it [include] compensation which in keeping with the Act, should be paid to those that, because of the quarantine determination, should chorus from gainful employment. The uncertainty elements are many even when calculating these prices. Society can even undergo a lack of manufacturing as a result of being quarantined [and] prevented from performing gainful employment which they’d in any other case have carried out.” Sweden by no means applied quarantine in society, not even for these getting back from journey overseas or relations of those that check optimistic for COVID-19.

Not solely did these lack of measures probably end in extra infections and deaths, nevertheless it didn’t even assist the economic system: Sweden has fared worse economically than different Nordic nations all through the pandemic.


The Swedish method has yielded little however demise and distress. And, this case has not been actually portrayed to the Swedish individuals or to the remainder of the world.

A Public Well being Company report printed July 7 included information for academics in main faculties working on-site in addition to for secondary faculty academics who switched to distance instruction on-line. Within the report, they mixed the 2 information sources and in contrast the outcome to the final inhabitants, stating that academics weren’t at larger danger and implying that faculties have been protected. However actually, the an infection price of these educating in school rooms was 60% increased than these educating on-line—fully undermining the conclusion of the report.

Refrigeration containers to be used on standby as makeshift morgues to store people who have died from COVID-19 set up behind Karolinska University Hospital in Huddinge, Sweden on March 26, 2020.
IBL/ShutterstockRefrigeration containers for use on standby as makeshift morgues to retailer individuals who have died from COVID-19 arrange behind Karolinska College Hospital in Huddinge, Sweden on March 26, 2020.

The report additionally compares Sweden to Finland for March via the top of Could and wrongly concludes that the ”closing of faculties had no measurable impact on the variety of circumstances of COVID-19 amongst kids.” As testing amongst kids in Sweden was nearly non-existent at the moment in comparison with Finland, these information have been misrepresented; a greater method to have a look at it will be to think about the truth that Sweden had seven occasions as many kids per capita handled within the ICU throughout that point interval.

When pressed about discrepancies within the report, Public Well being Company epidemiologist Jerker Jonsson replied on Aug. 21 through electronic mail: “The title is a bit deceptive. It isn’t a direct comparability of the state of affairs in Finland to the state of affairs in Sweden. That is only a report and never a peer-reviewed scientific research. This was only a fast state of affairs report and nothing extra.” Nevertheless the Public Well being Company and Minister of Schooling proceed to reference this report as justification to maintain faculties open, and different nations cite it for example.

This isn’t the one case the place Swedish officers have misrepresented information in an effort to make the state of affairs appear extra below management than it truly is. In April, a gaggle of 22 scientists and physicians criticized Sweden’s authorities for the 105 deaths per day the nation was seeing on the time, and Tegnell and the Public Well being Company responded by saying the true quantity was simply 60 deaths per day. Revised authorities figures now present Tegnell was incorrect and the critics have been proper. The Public Well being Company says the discrepancy was as a result of a backlog in accounting for deaths, however they’ve backlogged deaths all through the pandemic, making it troublesome to trace and gauge the precise demise toll in actual time.


Sweden by no means went into an official lockdown however an estimated 1.5 million have self-isolated, largely the aged and people in danger teams. This was most likely the biggest consider slowing the unfold of the virus within the nation in the summertime. Nevertheless, latest information counsel that circumstances are but once more spiking within the nation, and there’s no indication that authorities insurance policies will adapt.

Well being care employees, scientists and personal residents have all voiced issues concerning the Swedish strategy. However Sweden is a small nation, happy with its humanitarian picture—a lot in order that we can’t appear to know when now we have violated it. There’s merely no approach to justify the magnitude of misplaced lives, poorer well being and placing danger teams into long-term isolation, particularly not in an effort to achieve an unachievable herd immunity. Nations must take care earlier than adopting the “Swedish method.” It might have tragic penalties for this pandemic or the following.