With science and shared values, Sweden charts own pandemic course

With science and shared values, Sweden charts own pandemic course

Why We Wrote This

In discussions over how restrictive the fight against COVID-19 must be, Sweden’s approach to the pandemic comes up frequently. Is Sweden’s communal approach working? And is the public debating that question?

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People buy vegetables amid fences and signage placed to reduce congestion due to the COVID-19 pandemic in the Möllevångstorget market square in Malmö, Sweden, on April 25, 2020

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April 27, 2020

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Sweden’s response to the coronavirus pandemic has focused on citizens taking personal responsibility – a source of pride for many in this Nordic society with a history of both collectivist values and individual freedom. But whether it is working is an open question – one that may not be in sufficient debate.

Decisions made by Swedish authorities have been science-based rather than political. Sweden has allowed businesses to stay open if they follow safety protocols such as placing tables far apart. At-risk populations have been requested to self-quarantine.

So far Sweden has about 19,000 confirmed COVID-19 cases – roughly the same per capita as neighboring Denmark, which has about half the population size and took a much stricter approach to quarantining. But Denmark has registered just under 450 deaths compared with Sweden’s nearly 2,300.

Swedish collectivism may be preventing public debate over whether those figures are low enough. When 22 Swedish experts in infectious diseases and epidemiology demanded that the government change course, they were met with a ferocious backlash.

“Historically in Sweden we have been a success story,” says Goran Rosenberg, a journalist and historian. That “has manifested into an uncritical trust in the authorities and a shaming of critics.”

Stockholm

Sylvia Milchert spends most of her time tending to her blooming garden in a sleepy suburb of Stockholm since the coronavirus hit Sweden. The semi-retired psychologist takes precautions such as having food delivered to her home, but continues to see her grandchildren, albeit only outside, keeping a distance and skipping hugs.

It’s not quite business as usual in the suburb of Vallingby. But people still frequent cafes and the odd person can be seen at the gym. Like most Swedes, Ms. Milchert believes health authorities here have taken the right approach by not responding to the crisis with the strict lockdowns favored in the rest of Europe and trusting the population to do the right thing.

“It’s good to trust people to think for themselves,” she says, although her trust wavers when examining the toll this strategy has taken on older members of the Swedish community. “It’s impossible to accept that so many elderly people have died in such a rich country.”

Editor’s note: As a public service, all our coronavirus coverage is free. No paywall.

As the novel coronavirus tears through the continent, Sweden has been an outlier in its response. It limits gatherings to 50 people but shops, cafes, and other businesses are open on condition that they follow safety protocols such as placing tables far apart. The elderly and at-risk populations have been requested to self-quarantine.


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But whether that approach is working has been the subject of some debate in Swedish society. While the rate of reported infections in Sweden remains on a par with countries that have taken more extreme measures to protect their public, the death toll in Sweden is significantly higher. And some say that the societal norms that Sweden is relying on to ensure the public adheres to the government’s COVID-19 strategy may also be freezing out the kind of debate needed to examine whether the strategy is the right one.

Science over politics

The emphasis of Sweden’s response to the pandemic has been on citizens taking personal responsibility – a source of pride for many in this Nordic society with a history of endorsing both collectivist values and individual freedom.

Sweden promotes itself as being a model society based on values of social justice and human rationality, with a high level of trust between people and trustworthy authorities. This has its origins from the Social Democrat-introduced concept of “Folkhemmet,” or people’s home, where a welfare state cares for all with the proviso that everyone complies with a communal order.

Janerik Henriksson/TT News Agency/Reuters

People enjoy the sun at an outdoor restaurant, despite the COVID-19 pandemic, in Stockholm on March 26, 2020.

“When societies are under stress, national specificities come to the surface and influence decisionmaking,” says Lars Traghdard, a Swedish social historian and co-author of the book “Are Swedes Human?” “In our case, it is to listen to experts and voluntarily comply with their recommendations.”

Dr. Tragdarh says decisions made by Swedish authorities have been science-based rather than political, unlike other countries. Sweden has a unique administrative structure when it comes to certain aspects of governance, one of them being health. It is written into the national constitution that Sweden’s public agencies are independent of the government. This is to ensure that decisions are made based on knowledge and that civil servants are not corrupted by politicking.

The Swedish response to the COVID-19 pandemic stands in sharp contrast with Nordic neighbors Finland and Denmark. Governments there were given similar advice from their health agencies, but they decided to shut down public life anyway.

So far Sweden has about 19,000 confirmed COVID-19 cases – roughly the same per capita as Denmark, which has about half the population size and took a much stricter approach to quarantining. But Denmark has registered just under 450 deaths compared with Sweden’s nearly 2,300. And Finland, which also has half Sweden’s population, has fared even better: less than 5,000 cases and fewer than 200 deaths.

Most of the fatalities have been in Stockholm, with nearly a third occuring in elder-care homes. In a press conference last week, Anders Tegnell, the state epidemiologist who is the mind behind Sweden’s policy, acknowledged “this our big problem area,” especially in light of past statements indicating that the main focus of the strategy was to protect the elderly.

Sylvia Melfeldt, who used to work in elder-care homes as a psychologist in the 1970s, believes that this is the result of the vast neo-liberalization of Sweden in the 1990s, which opened them up to competition between private firms.

“Now if you can afford it, you can get a better quality of private care. But if you can’t, you must make do with what your municipality provides,” says Ms. Melfeldt. “Carers are poorly paid, they have to see multiple people because they are paid by the hour, receive no training, and now have dwindling resources.”

Henrik Montgomery/TT News Agency/Reuters

Youth hang out at a skateboard park in Nacka, Sweden, on April 25, 2020.

The coronavirus pandemic has hit immigrant majority communities particularly hard. Earlier this month, the country’s public health agency reported that people in Sweden with foreign backgrounds are disproportionately represented among those who need hospitalization.

That squares with the experience of Terez Kino, a resident of the city of Södertälje and member of its large population of Assyrian-Syriacs, an ethnic minority scattered across Turkey, Syria, and Iraq. She used to have five carers, all of immigrant background as well, who would come to her home and tend to her needs. Four are now sick at home with virus symptoms. Her elderly sister has also contracted the virus from her carers, and her brother recently died of the virus. Her son is now taking care of her.

“We always did our best here in Sweden, ever since we came in 1974,” says Ms. Kino, “but now we have been left behind.”

Dr. Carina King, an epidemiologist working in the Karolinska Institute who opposes the government policy, says the pandemic has impacted socioeconomic groups differently. “A lot of the strategy is based on cultural norms, the narrative that Swedes will follow the recommendations and trust the authorities.” But she says that does not take into account just how much the make-up of Sweden has changed.

“It’s a very fatalistic view”

It is not completely clear how Swedish society is taking the rising death toll. According to YouGov polls, trust in the public health authorities is now evenly split in Sweden. But other surveys like that of the center-left Aftonbladet newspaper indicates there has been an uptick in confidence in the authorities despite the rising fatalities, with 70% of those polled indicating that they continue to trust the government.

Nonetheless, there have been some vocal critics. Twenty-two Swedish experts in infectious diseases and epidemiology published a commentary in the Swedish newspaper Dagens Nyheter demanding that the government to take a different course of action.

Dr. Anders Vahine, one of the experts, a virology professor at the prestigious Karolinska institute, told the Monitor that their biggest concern is the cost in human lives and health of the Swedish strategy. “If you just accept people dying, then it’s a ‘que sera sera’ situation, it’s a very fatalistic view that you cannot interfere.”

But after ferocious public backlash, several of the experts have decided to step out of the debate despite their ongoing concern.

“In Sweden, there is this idea of ‘Jante Law’: If you go outside a social norm or criticize it, you will be castigated and frozen out,” explains Umut Özkırımlı, a political scientist who studies nationalism and is based in Spain and Sweden. “Sweden is about conformity and moderation.”

Goran Rosenberg, a journalist and historian, is alarmed at the waning national cohesion in the country. “I think historically in Sweden we have been a success story. And that has turned into a sort of nationalism – not like traditional nationalism, but a belief that since we have been good at welfare and so on, we must be right. And this nationalism has manifested into an uncritical trust in the authorities and a shaming of critics, calling them traitors.”

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Mr. Rosenberg believes that if possible failures of the Swedish system are being exposed by the pandemic, that could result in questions being raised. “If the Swedish way of doing things is disproven and … seen as broken in a way, it might result in a radical change in society.”

Editor’s note: As a public service, all our coronavirus coverage is free. No paywall.

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