Sweden stayed open during the coronavirus pandemic: Is it a model for the future?

LONDON -- Sweden has pursued its own distinct path when it comes to tackling the coronavirus pandemic. By choosing to stay open rather than instituting a policy of lockdown, Sweden's policies have drawn both international praise and criticism.

While Sweden's decision early in the pandemic to allow bars, restaurants, schools and shops to remain open was almost unthinkable for the rest of the world under lockdown, the Scandinavian country is now being looked at by some as a model for the future.

Recently, Republican Sen. Rand Paul said the U.S. must “keep an open mind” when it comes to the Swedish approach, as governments across Europe and the U.S. chart a way out of lockdown.

Epidemiologist Anders Tegnell, the architect behind Sweden’s policy, has repeatedly doubled down on the merits of his country's approach. Sweden, he said, is playing the long game despite the country having a much higher death rate than its neighbors.

“In the autumn, there will be a second wave. Sweden will have a high level of immunity and the number of cases will probably be quite low,” Tegnell told The Financial Times earlier this month. “But [neighboring] Finland will have a very low level of immunity. Will Finland have to go into a complete lockdown again?”

Only time will test Tegnell’s hypothesis, but as countries around the world, and particularly the U.S., ponder what the coming months will look like, the case of Sweden is a fascinating case study. According to one sociologist, the country’s alternative path is a chance to “learn more” where so many others have shut down to stop the spread of COVID-19.

COVID-19 deaths

Tegnell’s approach to the pandemic has proved highly controversial. Social distancing was encouraged by government officials but for the most part Swedes have continued on with their lives. They were still able to send their children to school and visit bars and restaurants, although gatherings of over 50 people remain banned.

Sweden, with a population of 10 million, has so far had 4,029 officially recorded COVID-19 deaths, according to data compiled by Johns Hopkins University. But the country has a far higher rate of infections and deaths than its Scandinavian counterparts.

According to the European Center for Disease Prevention and Control, Sweden has an estimated 328.6 cases and 39.3 deaths per 100,000 of the population. Norway has 156.4 cases and just 4.4 deaths respectively. Denmark and Finland have similarly low figures. Those same statistics still indicate that Sweden has a lower number of deaths per capita than Italy, Spain and the U.K., all countries that have enacted stringent lockdowns.

This is a “stark difference” to the rest of Scandinavia, according to Stefan Hanson, a Swedish infectious disease expert and signatory to a letter from top scientists criticizing the health authorities' response.

"When we compare the other Nordic countries in terms of mortality, it is clear that we are having roughly 500 deaths per week, and in Norway they had seven deaths last week,” Hanson told ABC News. “If we see the mortality per million, we are five times higher than all the other Nordic countries, taken the number of inhabitants into consideration."

“There is no doubt that this strategy is causing a lot of unnecessary deaths,” he added.

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Tegnell and other government officials have repeatedly dismissed the idea of going into lockdown and reversing Sweden’s course.

The government has not said it explicitly, but the strategy of staying open has the de facto goal of “herd immunity” – the view that if enough people have become immune to the virus, the spread will slow, Hanson said. In the U.S., Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, has dismissed the idea, saying the first step is to develop a vaccine.

Herd immunity would require between 60% and 80% of the population becoming immune to the virus. But new data shows that only 7.3% of the inhabitants of Stockholm, Sweden’s capital, has COVID-19 antibodies, meaning the pursuit of immunity, given the likely increase in deaths, is a “dangerous approach,” Hanson said.

"Even those [countries] who have had very severe epidemics, lots of deaths, lockdowns ... they have had very low immunity levels in the population," he said.

Stockholm will not have herd immunity by the end of this month, Tegnell noted.

Yet Sweden, like the U.S. and the rest of Europe under lockdown, has suffered from the virus entering nursing homes, or care home facilities. Residents of these homes account for almost half of coronavirus deaths in Sweden. But in mainland Europe, the percentage of nursing home deaths is remarkably high, according to data compiled by the European Center of Disease Control. That problem is not unique to Sweden’s approach.

With warnings that Europe will experience a second wave of infections this fall, there is arguably a long-term rationale behind the Swedish model: that over time infection and death rates will equalize between comparable countries that locked down and those that did not.

‘Wealth is health’

In the U.S., Fauci has been adamant that the development of a vaccine, rather than "herd immunity," is crucial in defeating the virus. But with a minimum of 12-18 months before a vaccine could be ready, if at all, and a further period allocated for the distribution of the vaccine, it’s clear that the coronavirus is going to be a part of our daily lives for a long time, according to Tegnell.

In the rest of Europe, the economic impact of the lockdown is already being felt, although the true extent is being masked by generous government loan schemes. In the U.K., the government have pledged to pay 80% of furloughed workers' wages until October, but that hasn’t stopped the Bank of England from forecasting the worst recession in three centuries. The European Commission has warned that the continent’s economy will contract by 7.4% this year.

A number of economists have supported the government’s policy. Lotta Stern, a professor of sociology at Stockholm University who recently co-authored an article suggesting that Sweden’s approach would soon be the world’s, told ABC News that the country has taken “the least bad option” and the issue is more complex than a simple trade of health and economics.

“That framing is entirely wrong,” she said. “Wealth is health. Whichever way you count, freedom and flexibility usually perform better than central command.”

Sweden’s economy has too suffered, she said. But by keeping schools, bars and restaurants open, the country has not seen the same rise in unemployment figures elsewhere in the world.

“As surreal as things are here in Sweden, it seems so much more surreal in the U.S. and U.K.,” she said. “Swedes don’t realize how oppressive other countries have become. What is their exit strategy? The more we learn about the disease the more it seems that they have overreacted.”

Ordinary Swedes in general have been very supportive of the government. Fredrick Kahånsson, a risk management consultant at a construction company in Stockholm, told ABC News that despite how the country’s policy is perceived, there is “no right or wrong,” and it must be up for ordinary people to decide how to live their lives.

“I do support Sweden’s general approach because what you see in the other countries when they open up it starts spreading again,” he said. “So if you can’t really terminate it with a complete lockdown this is just going to be a prolonged process.”

A viable model?

Sweden benefits from a number of favorable conditions when it comes to encouraging individuals to take responsibility for how they interpret social distancing. The country has a strong public health and education systems as well as near unparalleled levels of public trust in the government.

Yet for Hanson, the stand-off approach has proved too costly and he argued the country is “definitely not a model” for the international community to emulate in the long run.

"First of all you have to focus on the disease, to get that under control," he said. "The control is in the other Nordic countries. We don't have to have the lockdown, we just have to be a little bit stricter with the rules."

The economic consequences of lockdown will be felt with a greater intensity than the coronavirus pandemic itself, according to Stern.

“Other countries will have to let up on lockdowns, yes,” she said. “They panicked and hoped to buy enough time. But I think they will increasingly see that their medicine was worse than the disease.”

Early indications suggest that Sweden’s GDP fell by just 0.3% in the first quarter of 2020 compared to 3.8% in the rest of the Eurozone, the European economic bloc which holds the Euro as currency, according to The Financial Times. It is still too early to say whether Sweden will reap the economic benefits of "lockdown-lite" in the coming years.

But with a vaccine still at the very least a year away, there may be a matter of inevitability in how countries like the U.S. and U.K., so badly hit by the pandemic, chart their future.

'We are going to have second wave and third wave -- I think the rest of the world is going to have to do more of the Swedish approach because there is not going to be a world to save if we shut everything down again, and again, and again,” Kahånsson said.