Our departmental webmaster in Łódź asked me to write this piece from 23 April about my impressions of the Swedish response to COVID19. I’m posting it here too.
As I write these lines I have been distancing myself from society for 39 days, since Monday 16 March. Voluntarily, because I live in Sweden. Our government’s approach to containing the pandemic has been discussed quite a lot internationally. Before I go into that, let me describe my personal experience.
The big change for me is not that I work from home. That’s what I’ve done mostly for many years as a research scholar without a university office. Instead, the biggest thing is that my 16-year-old daughter’s high school lessons are now all online, so she is also home all day, five days a week. We get along really well and it’s frankly an improvement of my circumstances. Another change is that I have only been once to central Stockholm and the Academy of Letters’ research library, and currently the library is closed except by special appointment. And I buy groceries for my elderly mother. My father and his wife have stubbornly turned down my offers to shop for them.
My work has continued as planned, without any major frustrations. I have a pretty good library of my own, the most important Swedish archaeology databases have been online for decades, and these days you can get a lot of new journal papers in PDF format online or simply by emailing one of the authors. I’ve submitted three pieces of writing in these quarantine weeks.
When I take walks and cycle in the Erstavik woods nearby I meet more people than usual. We nod and say hi to each other, but we keep our distance. My parents also go out walking a lot. In Sweden, most of us feel that we need to avoid crowds, but not necessarily sit indoors and wait. My boardgaming group still convenes every weekend, but we have moved to my buddy’s house that is better situated for people to reach it on foot or by bicycle. Nobody wants to use public transport much. We figure that us meeting three “unnecessary” people every week won’t change the progress of the pandemic, and it does a lot for our mental well-being.
As for the official Swedish policy, I understand that the main difference to what other countries do is that going out and meeting people isn’t actually forbidden here. It’s just very strongly discouraged, for reasons that are very clearly explained. And events with more than 50 participants are forbidden for the time being. Some important reasons for this policy, as I understand them, are:
- By design, Swedish law makes it really difficult to impose a long-term general curfew with sanctions against those who break it. It’s a civil liberties issue.
- In the long term, we have to build herd immunity to the virus either by infection or by vaccination. We can’t afford to sit around at home until mid-2021 when scientists hope to have a vaccine ready for mass production. You can stop the pot from boiling over temporarily by putting a really heavy lid on it, but sooner or later the lid will fly off. It’s better to turn down the heat and let off the steam a little bit at a time. After a quiet period, there will be a second wave of the pandemic. How high that wave will go depends on herd immunity.
- Swedish people largely trust our government, and our government largely trusts our scientific authorities. So when the government tells us that the scientists think it’s really important to avoid crowds, then most of us act accordingly. We don’t view this as a policy driven by ideology. It’s not a partisan issue. I would go along with it even if I hadn’t voted for the party that currently governs the country.
- If you close daycare centres and schools for young children, then someone has to stay home with those children. That someone will often be their dad who is a nurse, their mother who is a doctor, or their grandmother. This will leave you with insufficient hospital staff and a lot more infected grandmothers in intensive care.
- If you close down your national economy too severely for too long, then even if you don’t suffer many dead during the first wave of the pandemic, everyone will be in extremely poor financial shape when the second wave hits. This can prove lethal in itself.
Of course, there are particular problems in Sweden too. The most important one is that a lot of our very elderly people are in care homes, and the care workers there are generally poorly paid and cannot afford large apartments or cars. So it is a tragic coincidence: the people who run the greatest risk of dying from the virus are cared for by the people who have the greatest difficulty in distancing themselves from crowds: they ride the subway from their crowded homes to work. With predictable results.
A sillier problem is that people have been hoarding goods. First it was pasta and toilet paper, which is ridiculous because Sweden is well supplied with wheat and has one of the world’s largest and most efficient paper industries. The last thing Sweden will ever run out of is toilet paper. But when people calmed down about that, they started hoarding baking yeast. And apparently the one single company that makes yeast in Sweden does not have production capacity enough to capitalise on this sudden enormous rise in demand. But I am OK, I always have a couple of packets of powdered yeast sitting in the cupboard.
Last week was the first one since the pandemic reached Sweden that the number of new intensive care admissions for covid-19 shrank – by 11% . I hope this means that we’re past the crest of the first wave now. We can’t go back completely to normal until after the second wave. And whether our policy is better or worse or indifferent compared to those of other countries, nobody can tell until a couple of years from now.
Update 28 April: ICU admissions have continued to decline: -15% last week. We’re past the crest of the first wave. Phew!
20 thoughts on “A Swedish Perspective on COVID19”
I have seen criticism leveled at Sweden in various MSM by opinionators whose opinions are basically worthless and I usually don’t bother to read it, but I don’t see anything in this account that I could regard as wrong, particularly.
The only things I don’t see here are any mentions of testing and contact tracing, and the wearing of masks in public (or not).
The only thing I would caution is that Sweden is still very far distant from anything that could be regarded as herd immunity. For SARS2 the R0 is actually about 5.6, more than 4x as infectious as seasonal influenza, so herd immunity would require more than 80% of the population to have been infected and to carry the antibodies, and to reach that would result in a very high number of deaths, even if immunity is a certainty, which it appears not to be at this point.
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I have no information about testing and contact tracing, not having read up on that. But I am confident that it is being done at a state-of-the-art level. Few people wear masks.
We know that we haven’t achieved herd immunity yet by far. But there was one encouraging study: 11% of Stockholm’s blood donors were immune 2 or 3 weeks ago. And blood donors are an outlier group in society when it comes to habits that transmit contagion. Their (or our, I’ve been donating for decades) level of immunity is likely way lower than the general population’s.
Yes, even if people who fight off this virus become resistant for years (which is not certain), it seems to be infectious enough that a large majority of the population would have to be infected before the rate of infection slowed down, killing one in several hundred and sending many more to the hospital for weeks. Its also a bad year for influenza, and people who get a flu often decide its coronavirus then feel safe when they recover.
Oops – and of course, travel and border restrictions (or none). Sorry, I realise you are giving your personal perspective and not writing as if you are a de facto member of the government, but I am naturally curious about all of these aspects. The populations of Sweden and Hong Kong are not all that different, after all – 10 million vs 7.5 million; the big difference is that ours is crammed into a land area that is 0.002 times the size of yours.
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Travel and border restrictions have long been in place.
Excellent summary. (i.e. very close to my own view.)
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If I was the Swedish Prime Minister (and Swedes should feel very relieved that I am not, although you could do worse – I could wear a haystack on my head or have orange skin), I think there are three things I would change:
1. A lot more testing. (The antibody testing on blood donors vs the number of known cases suggests that there have been far more people infected, probably asymptomatically or with symptoms too mild to seek medical attention, than reflected in the number of known cases, which means that contact tracing and quarantine have probably been largely ineffective – but this also means that you have got through the initial phase faster, and that the fatality rate has been a lot lower than it appears.)
2. I would encourage citizens to wear masks in public, as now recommended by the World Health Organisation. If possible, I would provide free issue of masks to anyone who wants them, or at least at very low cost.
3. I would provide free personal protective equipment to carers working in aged care facilities.
“Theory predicts that selection for pathogen virulence and horizontal transmission is highest at the onset of an epidemic but decreases thereafter, as the epidemic depletes the pool of susceptible hosts.” I would guess that Sweden is now through this onset phase, given that ICU admissions appear to be dropping. That should be good news for Sweden – let’s hope so; virulence and transmission should both now be dropping.
Why am I so keen on testing/tracing/quarantine and mask wearing? The approaches taken in Sweden and Hong Kong are pretty similar – more alike than different; neither has gone for total shutdown. Population size and age structure are not too different. I need to take account of climate differences, which possibly *could* make a big difference (either directly or indirectly, but no one knows that yet). But HK is doing a lot more testing than Sweden, we have almost zero ‘invisible’ community spread (as evidenced by the fact that we have now had more than a week of zero new known local cases – so either all currently infected people are now asymptomatic, which is not credible, or else they don’t exist), and virtually 100% voluntary mask wearing in public. Deaths in Sweden > 2,000; deaths in HK four. HK has had zero deaths in aged care facilities.
I would be less confident of the above if not for the fact that HK’s experience closely mirrors that of South Korea.
However, I also need to take account of (a) where the different strains have come from, and (b) possible population genetic differences. These are both currently unknowns, but could be factors. Sweden could have received a more virulent strain than HK has – that is looking quite possible, given the findings of the latest genetic tracing coming out of France. And genetic susceptibility – who knows, but if genes account for 50% of severity of symptoms, this could make a big difference on a population scale.
So, having pontificated about all of that, none of which I am competent to spout about, I would round up by saying that I think any international criticism of the approach taken by Sweden is wholly unjustified. Swedes themselves can of course be as critical as they like of their own government, but if I was a Swede, I would not be feeling too discomfited.
Actually, in a direct per capita comparison, Sweden is doing substantially better than Germany, and not too far above South Korea.
MSM journalists and opinionators seem to be going after Sweden because it opted against a full lockdown, but then so did South Korea (which perversely MSM journalists and opinionators are lauding as a great success story), and Hong Kong (where success in defeating the ‘second wave’ introduced by infected HK returnees is very clear, and complete).
Infected HK returnees coming back from UK 403, USA 82. Globally, per capita, the UK is doing the worst of any country – it is going to outstrip Italy, Spain and the USA.
HK is now preparing to bring back 520 HK permanent residents of Indian ancestry from India, where they have been stranded due to travel restrictions.
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A big difference is population density. Apart from countries smaller than, say, Andorra, South Korea or Bangladesh (not sure which) has the highest population density of any country (having overtaken the Netherlands several years ago); the population density in Sweden (larger than Germany in land area but about 12% of the population) is very low.
Bangladesh has the highest population density in the world. But what matters in this context is the population density in cities, particularly Stockholm, so it is not unreasonable to do a direct comparison between Stockholm, a German city, a South Korean city and a territory like Hong Kong.
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The proportion of the population that are ‘invisible’ infected or post-infected, i.e. asymptomatic people, is a real mystery. In Europe, it has been estimated to vary in different countries/populations between 2 and 30%. So if Sweden is at 11%, that puts the Swedish population within that range. I have seen estimates from elsewhere of up to 50% or even higher. In Hong Kong, scientists think it has been only about 1.5%. They are planning to test a random sample of 3,000 people for antibodies to see if they can capture the number of people who have been infected without knowing it, or people who suspected they might have had it, but had such slight symptoms that it just went away again without them feeling the need to get medical attention. And then try to find out what makes those people different.
The most obvious explanation is genetics, but it’s a real mystery. I am not confident that they will be able to solve the mystery with this study. Not confident at all. There are too many variables, which include different strains of the coronavirus, of which by now there could be very many.
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Just a brief comment on the latest mortality statistics. The lag in reporting means individual deaths are not attributed to the statistics for the day they died until a week afterwards.
But as I look back in the last weeks I get the impression the curve is definitely pointing down… but I do obviously not mean 50 deaths a day is “acceptable”.
The curve for hospital admissions is also giving room for optimism.
Other regions than Stockholm are now becoming more prominent in the data.
It will be interesting to see the genetic diversity of the strains, in case most instances came via Stockholm, or directly from abroad.
Some background. The stockpiles that would have been useful in the crisis were sold off after the end of the cold war. No specific party can be blamed above others, there was a lot of optimism and maybe naivity in the zeitgeist.
The pandemic has revealed glaring shortcomings in the elder care facilities and the organisation responsible for their care. This is because the personnel in this actor have been low-paid and their complaints have not had much effect.
25 years ago the then prime minister Göran Persson said the improvement of pay and other conditions for people working in this sector must be a priority ….promises that have been repeated by every government since, left or right.
Everyone have been giving priority to short term and medium term political objectives, I think the Only way to get change would have been if elder care personnel literally had left their work; it would have been less harmful than what we have witnesses the last two months.
-Brits may recognise similar trends in NHS and in elder care facilities; the epidemic cruelly exposes the shortcomings caused by a decade of austerity.
And in USA you see clearly the shortcomings of institutions, and of the whole political system (extending to a lot of Democrats who are happy with the status quo).
Going off on a tangent- I read about “luxury tourists” who are coming to Sweden to enjoy a society that is not in complete shutdown, with shopping and the ability to sit outdoors and go to restaurants . Is this true, or just another internet meme?
For Saturday and onwards the Swedish daily death toll seems to be 50 or lower, but the time lag in record updates is about a week.
My gaming group have gone full-video-conferencing (we normally have one chap who attends via VC anyway, we’re normally physcially present in Cambridge and he’s in Bristol). But part of that is that everyone except one guys needs to travel, it’s a fair bit of distance and if several of the players went to in-person gaming, they’d be in 2-3 different groups each week, and thus (potentially) act as super-spreaders.
So, we do the VC thing. It works pretty well, but in-person is better (more tea, that way).
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About the yeast: you’re not a drinker, Martin. When it gets hard to find proper ale/wine/cider yeasts (the fancy stuff in postage stamp size packets) the Brits, being disgusting and dirty people at the best of times, are known to resort to ordinary bakers’ yeast and (if of a sufficiently Epicurean bent) breed the little fellows up in small batches of different worts to see which best suits their brain-damaging purposes.
Maybe there’s a sudden outbreak of cakery-bakery nonsense in Scandiwegia, but round here it suggests the proles are getting fed-up with the Total Closure of all Pubs,seemingly Forever (I think that’s “Ragnarok”, in your languages?).
TurboCider, ahoy hoy!
Me, I’ve gone for rhubarb. Absolute plague of the stuff. Do it 5/2 with sugar, pot of black tea, bag of raisins, and anything else you fancy (except fungi, I’m not a madman like some).
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Sounds like prison brew!
Very appropriate, since our gov. has had us all under fairly strict house arrest since March.
People are teetering on the edge of a collctive breakdown. Particularly city dwellers in balcony-less, garden-less public housing blocks. Imagine being out of work and jammed into your already inadequate apartment, with the kids going mental all day and night. You’re also supposed to home-educate them somehow. OK if you have a PC and broadband, but not all do.
Tolerable when it was cold, but now the Sun has appeared. I predict a riot.
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