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Lessons from Kronavirus: Is Sweden’s anti-lockdown approach more strategic than it seems?

Scott Young: Sweden's unorthodox strategy has been rightly criticized, but it's too early to condemn an approach that's focused on the long game and public trust

Scott Young (@scottalyoung) is a Canadian citizen living in Sweden. He is the former director of ideas and insights at the Institute for Canadian Citizenship.

Every afternoon, I look up from my home office to watch a group of shrieking kids descend on our local playground. It is a daily reminder my pandemic is not like your pandemic. As a Canadian who relocated recently to Malmö, Sweden, I arrived just in time to witness Sweden’s COVID-19 response firsthand. I live in one of the few places in the world where playgrounds, parks, restaurants and bars never closed.

It is a striking dissonance from Toronto, where I lived until recently, and B.C.’s Lower Mainland, where I grew up. The photographs of deserted streets I am intimately familiar with—Little Italy in Toronto, Gastown in Vancouver—feel as though they are pulled from a nightmare, one my friends and family are all trapped in. While they endure lockdowns, snitch lines and overzealous bylaw enforcement—remember the Ottawa teenager or the new mom in Aurora, Ont., fined hundreds of dollars for shooting hoops or lingering a few seconds too long in a park—my daily life has carried on unimpeded. In the past week, I got a bad haircut, went to the gym, and met friends for lunch, all without fear of censure.

There are moments of stringency here. At the end of April, Lund city council approved a generous helping of chicken manure for its public parks, a pungent and potent deterrent against crowds ahead of the May long weekend (Valborgsmässoafton, the equivalent here of Labour Day). And last weekend, several Stockholm bars were sternly warned, though not fined for breaking social distancing rules. Still, as some restaurants I know and love in Toronto are shutting their doors forever, I am making reservations here for next week.

Much has been written about Sweden’s COVID-19 response: its high case count, and relatively high deaths per capita, by far the highest in Scandinavia. While Sweden’s deaths per capita have not reached the level of Italy, Spain or the United Kingdom, they remain higher than the United States and more than double that of Canada. Its testing rate remains at around 30,000 a week, behind countries like Norway, and Sweden’s more than 26,000 reported cases and 3,200 deaths have attracted attention from around the globe, and the government has been accused of playing Russian roulette with Swedish lives.

However, it may still be too early to prognosticate about the effectiveness of the Swedish strategy, and equally premature to completely disregard it as the wrong one. Dr. Johan Giesecke, the former chief scientist at the European Centre for Disease Prevention and Control who is currently advising the Swedish government, said in a recent interview, “only in a year from now can we know if the Swedish approach has been proven right.” No one would predict the winner of the Stanley Cup on the basis of Game 1 in the first round, so why do so many feel comfortable excoriating Sweden so early in this pandemic?

READ MORE: How prepared was Canada?

The Swedish response has been described as laissez-faire or relaxed. But even as it has been criticized by many experts, outside the country and within, it is not accurate to dismiss it as ad hoc. The strategy relies on deeply engrained social practices and voluntary behavioural changes to flatten the curve over the long term. Unlike the U.S. protesters banging on state legislature doors, or their champion in the White House, Swedish public health officials have consistently denied their objective is to achieve herd immunity or to protect the economy. They are simply betting that a long-term voluntary mitigation strategy will yield better public health outcomes than a short-term coercive containment one.

As the first wave of COVID-19 began to swell in Europe, Sweden’s state epidemiologists recognized it would be impossible to contain the pandemic. In an April 21 interview, Dr. Anders Tegnell, chief epidemiologist of the Public Health Agency of Sweden, skewered lockdowns, border closures and school shutdowns for having no scientific basis whatsoever. Harsh, punitive lockdowns are ineffective, unsustainable long-term, and detrimental to public wellbeing: No one can sprint a marathon. The implication was that lockdowns are the result of a political calculus, not a public health one. Instead, Tegnell and his team have sought to maintain “a slow spread of infection,” allowing Sweden’s public health-care system to maintain a reasonable workload throughout this crisis.

This approach concedes COVID-19 will continue to afflict Sweden for the foreseeable future as we all await a vaccine. Priority has been given, thus, to the development of a sustainable mitigation strategy that also protects the elderly and immunocompromised, though with escalation never off the table.

Meanwhile, Sweden has not exactly underestimated the severity of this crisis. Its public health system has been fully mobilized since the beginning, with daily press briefings leading the news every night. Detailed pandemic data is updated on government websites daily, keeping the population in the loop. Part of Stockholm’s convention centre, the largest in Scandinavia, has been converted into a 600-bed field hospital. Furloughed cabin crew from Scandinavian Airlines have been recruited for three-day crash courses in basic hospital duties. And even as it hoped for the best, Sweden surged its ICU capacity and now has a surplus of several hundred ICU beds at the ready. In less than 24 hours in late March, over 5,000 Stockholmers with medical backgrounds volunteered to step up and serve for when the curve steepened. This is not a country in denial; it is one fighting to maintain its social contract and ensure the greatest number of people survive.

And its approach is led by public health officials. Anders Tegnell’s new public profile illustrates the near total absence of Swedish politicians from the daily press briefings. Compare this with Canada, where federal and provincial politicians are front and centre, jockeying for space alongside Dr. Theresa Tam and her provincial and municipal counterparts. Citizens look to political leaders in times of crisis, who in turn, are often eager to display strong, decisive leadership. But those same leaders bring political baggage.

The updated Edelman Trust Barometer released last week included a question on trustworthy sources of coronavirus information; scientists and health officials unsurprisingly received significantly higher marks than national or local politicians. In a crisis that relies on universal behavioural changes, Justin Trudeau and Jason Kenney can ruffle political feathers even before they open their mouths. In Sweden, that partisan tenor is excised altogether.

That said, not all Swedes are enamoured with their government’s approach. More than 2,300 Swedish academics have signed an open letter imploring the government to take more assertive action. Writer Elisabeth Åsbrink called Sweden a “peace-damaged” country, with two centuries of peaceful non-belligerence metastasizing into complacency and indifference, both fatal qualities in a pandemic. In addition, no one yet understands the risk a second infection might pose to those who have already recovered, a potentially serious flaw in Sweden’s strategy.

Sweden’s Nordic neighbours, who all imposed lockdowns, watch nervously as cross-border commuters, including Swedish health-care workers, flow into their countries daily. The Swedish government has already admitted its failure to adequately protect long-term care homes, where the virus has run rampant with tragic consequences. Last week, Swedish prosecutors announced their first criminal investigation into a Stockholm care home where 35 residents died due to coronavirus. Some immigrant communities have also been disproportionately hit by the virus, underscoring the need to better communicate across language barriers and cultural differences, an underdeveloped muscle here in multicultural Sweden.

These are all legitimate and damning critiques. Yet the divergence between Sweden and its neighbours is smaller than many expected, and still nothing like the worst catastrophes unfolding elsewhere. Swedish public health officials seem to be banking on the idea that in the long run the country’s case count and fatality rate will average out to be lower than they appear now in the pandemic’s first few months.

What explains Sweden’s unorthodox strategy? Demographics are frequently cited as a factor: a relatively low population density and a high proportion of single-person households. With universal high-speed internet access and robust digital infrastructure, the transition to remote work, where possible, has been relatively seamless. Keeping elementary and middle schools open meant many Swedes didn’t have to take time off work, significant in a country with high rates of two working parents. And the fact school closures would have disproportionately affected single-parent households and low-income families was another important consideration. A pandemic is no reason to curtail hard-won advances in gender equality and children’s rights.

Swedes also tend to trust their government, an idea deeply embedded in the political culture. Government agency independence from political interference is enshrined in Sweden’s constitution. Political parachute appointments are rare, and ministers are prohibited from interfering in day-to-day decisions. Even if politicians want to affect change, they are relegated to legislative channels that are subject to parliamentary scrutiny.

The government in turn entrusts residents to act responsibly for the public good. COVID-19 has only reinforced that feedback loop, with a recent poll finding public support for the government and the public health agency jumped 20 points between March and April. Social distancing guidelines, rather than overzealous bans and bylaws, have still seen Swedes largely fall in line. An April 20 poll found 94 per cent of Swedes were maintaining their distance due to COVID-19, up 17 points from one month earlier—though the warmer weather is testing compliance everywhere.

Sweden’s high-trust ethos applies to fellow residents too, where it is tied to radical levels of transparency. Instead of public sector sunshine lists, any Swede can look up any other Swede’s taxable income. Within weeks of my arrival, not only was my birthday, home address and phone number publicly searchable online, but so was the name of my partner, our dog’s age and breed, and the vehicles we own. While this degree of personal disclosure is likely unsettling for many Canadians, it reinforces high levels of social trust, and builds the public-minded civic sense essential for voluntary long-term compliance with public health guidelines.

Sweden also takes crisis readiness very seriously, and did so long before COVID-19. Sweden may have stayed neutral during the Second World War, but it also began building a 500-km line of defensive bunkers along its southern coast in 1939. Starting in 1931, public emergency sirens have been regularly tested, blanketing Sweden for two deafening minutes four times a year. In 2018, the Swedish Civil Contingencies Agency updated its citizen preparedness brochure for the first time since the Cold War, distributing copies to every Swedish household. As a result of that brochure, nearly half the population took concrete steps to prepare for future crises.

COVID-19 will test all of these factors. In a pandemic, no one is neutral. But when looking to Sweden, the takeaway should not be about whether lockdowns are good or bad policy. It should be about whether a coronavirus mitigation strategy is better for long-term effectiveness and sustainability. As of late, interest in the Swedish approach is growing as other governments look to cautiously reopen. The World Health Organization’s emergencies expert Dr. Mike Ryan recently said there are “lessons to be learned” from Sweden, that it “represents a model if we wish to get back to a society in which we don’t have lockdowns.”

Criticism of the Swedish approach will continue—as it should. That is the hallmark of a healthy democratic society. It is not too early to criticize elements of the Swedish strategy, though it is still too early to fully condemn it. Proof of the success or failure of the Swedish strategy will unfold over the coming weeks and months. But the public’s continued trust in their public health experts will continue to give Swedish decision-makers the freedom to focus on the long game and the flexibility to tweak their tactics as new information comes to light.

As Canadians begin to cautiously emerge from lockdowns, the early lesson from Sweden is that citizens, residents, and governments are very much equal partners when it comes to mitigating this pandemic. That partnership requires trust and benefits from transparency. In the end, the only way we will beat this virus is together, as a community of responsible citizens.

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