A scathing review has been released evaluating the "failures" of the policies that guided Sweden's response to the COVID-19 pandemic.
The review, published in the journal Humanities & Social Sciences Communications Tuesday, discusses how, throughout the pandemic, Sweden attempted to avoid lockdowns and stay-at-home orders implemented by many of its neighboring countries.
The authors -- from Sweden, Belgium, Norway and the U.S. -- said Sweden was able to achieve this by portraying advice from independent scientists as "extreme," keeping the public in the dark regarding facts about how COVID-19 spreads and not issuing any mandates.
This is despite the country's history of collaboration between authorities and the scientific community and the general public's high level of trust of those in power.
As a result, Sweden had a higher COVID death rate than the surrounding Nordic nations.
"The Swedish response to this pandemic was unique and characterised by a morally, ethically, and scientifically questionable laissez-faire approach, a consequence of structural problems in the society," the team wrote. "There was more emphasis on the protection of the 'Swedish image' than on saving and protecting lives or on an evidence-based approach."
Prior to the COVID-19 pandemic, Sweden's Public Health Agency had published two pandemic planning documents in the last decade to prepare for such an event, according to the review.
Although both focused on the value of antiviral drugs and vaccines to treat and prevent cases, they also emphasized the importance of "limiting the consequences for individuals and society" and how "the negative effects on society must be as small as possible."
So, when COVID-19 was declared a global pandemic by the World Health Organization in March 2020, Sweden was determined to keep its economy up and running and emphasized individual responsibility rather than collective responsibility.
According to the review, the Prime Minister and Minister of Health and Social Affairs "mainly referred to the authority of the Public Health Agency," a stark contrast from past collaboration between the government and scientists.
Unlike the strict lockdowns implemented by most of Europe, the PHA merely recommended staying at home if feeling ill, washing hands regularly, social distancing and avoiding unnecessary travel.
Meanwhile, restaurants, bars and shops remained open; children under 16 were required to attend school in person with no exceptions for those with at-risk family members; and no mask mandates were ever implemented.
The review noted that the PHA did eventually recommend face masks in hospitals and care homes in June 2020, but only when treating confirmed or suspected COVID patients.
The authors said the PHA discouraging the use of masks and claiming they were ineffective helped spread fear in the population and misinformed the public about how COVID spreads, that asymptomatic people can be infectious and that masks protect the wearer and those around them.
According to the review, there was also a lack of transparency from public health authorities. The number of ICU beds per region was not publicly available and schools often did not inform parents or teachers when students tested positive for the virus.
Then there were efforts to actively squash medical researchers who criticized Sweden's strategy and accused authorities of not being properly prepared.
When researchers voiced their criticisms on social media, in interviews or in scientific papers, they were often reprimanded by their superiors for reasons such as not being allowed to use their university affiliation, even though this is against Sweden's right of Academic Freedom of Speech, according to the review.
Additionally, the PHA also "discredited any critique and national/international scientific evidence" and the authors say the agency "cherry picked" scientific papers that agreed with its viewpoint.
Ultimately, this led to Sweden having worse COVID-19 outcomes than its neighboring Nordic countries.
In late December 2020, Sweden was recording an average of 44 COVID-19 deaths per 1 million people, according to Our World in Data.
By comparison, Denmark was recording 5 deaths per 1 million, Norway was recording 0.5 deaths per 1 million and Finland was recording 0.3 deaths per 1 million, the data shows.
One month earlier, a report from the Swedish Inspectorate of Health and Social Services found half the country's deaths at the time were among nursing home residents.
About one year later in January 2022 -- during the omicron wave -- Sweden was faring better and recording 5 deaths per 1 million.
However, the other three countries were recording half as many deaths with Denmark recording the highest at 2.4 per 1 million, Our World in Data shows.
"The cost in terms of infections and deaths of this pandemic in Sweden has been larger in some other more densely populated and more centrally located countries, yet is still markedly higher than in the other Nordic countries," the authors wrote. "This Swedish laissez-faire strategy has had a large human cost for the Swedish society."