As most of you have probably heard, Sweden went its own way in the COVID pandemic, eschewing the more extreme suppression tactics. It did put in some light-touch restrictions. It banned meetings of more than 50 people and it closed high schools and universities. It encouraged people to physically distance and to wear masks in crowded settings but did not mandate such measures. According to a Statista survey, 84% of Swedes say they never wear a mask.
So, what have been the results of the Swedish laissez-faire approach?
Sweden’s cumulative fatality rate currently stands at about 575 per million population. That ranks it relatively high among the world’s countries. According to this Statista report, it is 16th of the 150 countries that website is tracking. However, its rate is lower than those of Italy, Spain, the UK and the US. Swedish officials have blamed their higher fatality numbers on poor containment in their equivalent of nursing homes, but I have not been able to find any comparable statistics that would confirm that.
Sweden’s experience is frequently compared to its Scandinavian neighbors, whose COVID outbreaks have been much more benign. Norway and Finland have about one-tenth of the fatalities per capita and Denmark is about one-fifth. I think it may be a little unfair to compare Sweden to Norway and Finland because they have much lower population densities and Finland, in particular, does not have the close transportation and commercial ties on the main part of Europe that Sweden does. But its rate is also much higher than some other European countries, like Germany. As a result of its higher fatality counts, Sweden was widely condemned for its approach.
However, more recently, some, including World Health Organization officials, have begun to reconsider whether there may be some merit to it because despite its hands-off approach, Sweden has brought the COVID outbreak in its country to heel. Both fatalities and new cases have fallen to background levels since their peak in late June.
Sweden’s hospitalizations have followed a similar curve. As of September 22, the Sweden Intensive Care Register reported only 19 COVID patients in ICU in the entire country. On a per capita basis, that is about one tenth of the current number of US COVID ICU patients. The peak of Sweden’s ICU COVID hospitalizations was about half that of the US peak. Harris County alone had almost ten times that number on September 22.
Also, Sweden has, at least so far, avoided the “second wave” of COVID cases that is currently affecting many other European countries. In the WHO’s weekly summary last week, Sweden was near the bottom of the list for new cases and fatalities among European countries, even doing marginally better now than its Scandinavian neighbors.
So what conclusion are we to draw from this somewhat mixed picture of Sweden’s experience?
First, we should be cautious in comparing the experiences of different countries. Each country (and regions within large countries like the US) have their own unique characteristics that will affect the course of an epidemic, including such things as cultural practices, the quality of the healthcare system, baseline immunity, age demographics, overall public health and social cohesion.
But Sweden has made it clear that it is possible, at least under the right circumstances, to control COVID without some of the suppression methods so many have argued are indispensable. Those who contend that measures like lockdowns and masks are the only strategies that can control the spread of the virus must explain why Sweden was able to do so without implementing them.
Finally, I would suggest the current increase in cases in Europe is a reminder that the purpose of suppression tactics is to “flatten the curve”, i.e., spread out the infection over time. They were never intended to end the epidemic. It reminds me a little of the old Fram oil filter commercial, “pay me now or pay me later.” It appears that Sweden may now be benefitting from having paid a higher price than its neighbors in the early going. Whether that price ultimately will be justified or not, remains to be seen.