Many countries considering easing lockdowns are wondering whether the effectiveness of quarantine in limiting coronavirus spread will outweigh economic costs. Sweden’s strategy has been highlighted as an alternative to the rest of the world – but how effective has their approach really been?
What is Sweden’s Policy?
In contrast to other countries like the UK or Germany, Swedish guidelines have been fairly vague. Visits to nursing homes and public gatherings of over 50 people were banned in late March – which has limited the number of people allowed into restaurants, stores, etc. – but apart from these, no other social distancing measures have been introduced.
Primary schools have remained open and enforced attendance for healthy children, travel has not been restricted, and although encouraged to stay an arm’s length apart, restaurants, gyms, and even some cinemas have all remained open. The core message of Sweden’s policy has been that acts of social distancing are self-regulated and voluntary, placing the responsibility on the individual and hoping for a more sustainable approach than the more draconian measures other countries have chosen to adopt. Sweden has emphasised that it is not taking this approach in order to create herd immunity. Rather, the country hopes that asymptomatics are only responsible for a small percentage of transmissions and that it is possible to flatten the curve without widespread testing or stay-at-home measures.
Has their approach been effective?
We have all heard that we need to ‘flatten the curve’ over the last few months, but what does that actually mean and why is it so important? An effective reproduction rate (R0) of 2 means that on average each person infected passes the Coronavirus on to 2 new people, who also infect 2 new people each, and so on. This exponential growth means that in a very short period of time, so many people will have gotten sick that hospitals will no longer be able to cope with the demand for care. Anything above an effective reproduction rate of 1 is going to overwhelm the healthcare system eventually because it means that the number of cases is no longer growing linearly (meaning in a straight line where one person infects only one other) but exponentially (meaning each ‘extra’ person that is infected will, on average, also infect more than one person). Since hospitals are not expanding at the same rate as infections, we need to assure that the growth remains linear – with a rate of, or preferably under, 1.
The information around how well Sweden is doing has been conflicting – some saying the results have been better than expected while others have been deeply concerned with this approach. One such warning came from a letter written by 22 Swedish researchers urging elected officials to intervene and take more serious lockdown steps.
The effective reproduction rate has fallen from 2.3 since Sweden’s first case in early February to 1.1 (as of May 1st), which by all measures is a good sign that limiting public gatherings over 50 people has been helpful. However, the rate remains above 1 which will cause considerable issues for managing treatment if R0 does not fall further to 1 or below it. A large part of the reduction Sweden have made can be attributed to voluntary social distancing. As a country, Sweden is already somewhat socially-distanced by nature. The population density is only 25 people per square kilometre in comparison to 259 in the UK and 205 in Italy, working from home is already fairly common, and over half of the country lives in single-person households.
For these reasons, Sweden has had a considerably easier time keeping its coronavirus numbers down without formal distancing measures. According to the mobile network operator Telia Company, trips from Stockholm to Gotland were down 96% over the Easter weekend and Citymapper has reported an almost 75% reduction in mobility in Stockholm. With voluntary social distancing being such a large part of Sweden’s partial success in reducing its infection rates, the worry has emerged as to whether this really is a sustainable long term solution. The self-imposed restrictions are beginning to falter as some have suggested that “Swedes are becoming increasingly unconcerned about keeping their distance as time goes on.”
All of this is also assuming that the numbers reported are accurate, which is not a given due to Sweden’s low testing rates. Especially when comparing Sweden to other European countries that have chosen to implement lockdowns, the Swedish approach appears much less successful.
Even Italy, one of the worst-hit countries, was able to lower its rate to 0.6 following its lockdown order. The BBC has reported that worryingly, despite only having 10 million inhabitants and almost only testing those with severe symptoms, Sweden’s total case numbers still puts them in the top 20 worldwide. All of this evidence suggests that Sweden’s approach has been much less successful in limiting the spread of the virus than measures taken by most other European countries thus far.
Moving on to limiting fatality rates, Sweden’s approach has been even more worrying. Death rates have been 3 times greater per capita than in Germany and hover around 131 per million people, in comparison to its Scandinavian neighbours with averages of only 55 per million in Denmark and 14 per million in Finland.
The Swedish government has attributed this particularly high death rate to the spread of the virus through care homes, especially in Stockholm where the virus has spread to 75% of the city’s 101 homes. This, rather than justifying the deaths, highlights that the strategy of merely encouraging over-70-year olds to stay home has not been enough to protect this vulnerable group. In the open letter from the 22 researchers, Lena Einhorn wrote “it’s not like it goes from one old age home to another. It comes in separately to all of these old age homes, so there’s no way it can be all be attributed to the personnel going in and working when they are sick. There’s a basic system fault in their [the government’s] recommendations. There’s no other explanation for it.”
The New York Times has also led an investigation to dispel the idea that vulnerable groups ‘would have died anyway’. Between March 16th and April 19th, the Swedish Mortality rate was 24% above its usual numbers, while Germany’s was only up by 3%.
All of this leads back to the question of whether these risks are justified in order to save the economy. Unfortunately, the Swedish economy has been doing just as poorly as its quarantined nordic counterparts. The country’s Central Bank has predicted a best-case fall of 6.9% and a worst-case 9.7% contraction, while the IMF has projected the Finish and Danish economies to contract by 6% and 6.5% by the end of this year. Part of this can be attributed to the country’s export-dependent economy as trade makes up 89% of Sweden’s GDP but equally important to keep in mind, especially as other countries begin to ease their restrictions, is the lessened desire to go out and shop amidst a pandemic. As Eric Levitz puts it in his article for New York Magazine, “…legally forbidding consumers from frequenting nonessential businesses — or merely allowing consumers to make informed choices about what businesses are worth frequenting when a potentially deadly, emergent virus is on the loose — just doesn’t make that big of a difference in economic terms.”
Of course, it is impossible for us to predict the long term impacts of any of these decisions and we will only know what the ‘right’ decision was when the crisis is over. As we continue to dream about life going back to normal, it is critical that we do not romanticise the normality and freedom of life in countries like Sweden without being aware of the full ramifications of its policies.