The Washington PostDemocracy Dies in Darkness

Scientist behind Sweden’s covid-19 strategy suggests it allowed too many deaths

Students celebrate their high school graduation from Nacka Gymnasium in Stockholm on Wednesday. (Jessica Gow/Tt/EPA-EFE/Shutterstock)
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BRUSSELS — For months, the world has watched Sweden's light-touch approach to fighting the coronavirus pandemic, wondering whether it was genius or misguided. This week, the architect of the strategy acknowledged that too many people have died and said that, in retrospect, he might have pushed something closer to other countries' restrictions.

“Should we encounter the same disease, with exactly what we know about it today, I think we would land midway between what Sweden did and what the rest of the world did,” Swedish state epidemiologist Anders Tegnell told Swedish Radio on Wednesday.

Swedish authorities have consistently denied that they were aiming to achieve full-population immunity by keeping much of their public life humming as usual. They said that if they protected the elderly and other vulnerable groups while allowing others to carry on, the country might be more resilient in the face of a second wave of infections and avoid the economic chaos of a total shutdown.

Deaths in Sweden, though, have been eight times higher than in Denmark and 19 times higher than in Norway, even though Sweden is only double each neighbors’ size. The outbreak appears to be continuing to course through Swedish society, even while most other European countries seem to have gotten things under control, at least for now. And because Sweden’s economy is tightly bound to the rest of Europe’s, it also has suffered, although not as badly as others.

Facing heat from voters, Sweden’s center-left government said this week that it would appoint a commission to investigate the country’s handling of the pandemic. Confidence in the public health response is dropping, according to several polls released Thursday. A Novus survey for public television found 45 percent of people now trust the government’s response, down from 63 percent in April.

When other countries shutdown businesses to prevent the spread of covid-19, Sweden stayed open. Now it has one of the highest per capita covid-19 death rates. (Video: ASSOCIATED PRESS)

Trust has been key to Sweden’s strategy from the start. Public health officials expressed confidence that their citizens would wash their hands and stay apart from each other — and said there was no need to impose tougher requirements.

Most restaurants and cafes have remained open, albeit with social distancing rules. Salons, shops and schools for students under 16 never closed, though upper grades and universities did. The biggest change was a ban on gatherings of more than 50 people and an end to big sports events, but most other guidelines have been voluntary and only gently enforced.

Swedish leaders also have gone against the tide by eschewing face masks, saying they could make things worse, even as other previously skeptical governments have mandated their use. “There is a risk of a false sense of security, that you believe that you can’t be infected if you wear a face mask,” Prime Minister Stefan Lofven told reporters last month.

But it is Tegnell who has been the fiercest defender of Sweden’s strategy.

A gruff, self-confident scientist with a mop of graying hair and an ever-present paper coffee cup in his hand, Tegnell has become an object of fascination both inside Sweden and abroad with his iconoclastic approach to the crisis. He shot down other countries’ attempts to close down their societies as a needless overreaction. He was so dismissive of Italy’s approach that he twice drew a reprimand from the Italian ambassador in Stockholm. He reported to police that he and his family have received death threats by phone, email and on social media.

Scientists in Sweden and Britain fight over who took the right public health path

His change of tone this week was notable.

Tegnell appeared rattled by Sweden’s rising death toll. Asked whether too many people in Sweden had died, he replied: “Yes, absolutely.”

“There is potential for improvement in what we have done in Sweden, quite clearly,” he said in the radio interview. “And it would be good to know more exactly what to shut down to prevent the spread of infection better.”

He added that it had been hard to learn what helped and what didn’t, because most countries shut down everything all at once. Public health officials in Norway and Denmark have come to agree with Sweden’s open-door approach to schools, saying it may not have been necessary to close them for children under age 14 because of limited evidence that they contribute to the spread of the coronavirus.

Sweden’s coronavirus strategy is not what it seems

Tegnell later elaborated that, despite his second thoughts, he believes the country’s basic approach remains sound.

“We basically still think that this is the right strategy for Sweden that we are doing,” Tegnell told reporters at a Stockholm news conference, where he was dressed in an olive-green sweater and plain brown pants, as though he had just come in from a long hike. “This is a bit like having an ocean liner and trying to steer it, but with a lag of about three or four weeks.”

The official Swedish death toll rose to 4,562 on Thursday, a toll of 45 per 100,000 residents, according to data from Johns Hopkins University. The United States has seen roughly 33 deaths per 100,000 residents. Britain, Italy, Spain and Belgium are worse off than Sweden, according to the data. But many Swedes say the best comparison is with their immediate neighbors in Scandinavia, which have been relatively spared, even though they have similar population density, political systems and cultures.

At certain points in May, Sweden had the highest death rate in Europe relative to population. Sweden’s testing capacity also has lagged far behind that of some other European countries, limiting Sweden’s ability to quarantine infected people, conduct contact tracing and fight off a possible second wave of the virus in the fall.

Sweden’s go-it-alone approach seemed to deliver a particular sting last week, when Denmark and Norway eased travel restrictions with other countries but not with Sweden, which under ordinary circumstances is tightly bound to both. Policymakers in Finland also have expressed skepticism about allowing travel to and from Sweden.

In the meantime, Sweden’s economy is set to shrink 7 percent this year, its worst contraction since World War II.

Tegnell has said that because the Swedish strategy aims to avoid having to shut down a second time — or to face a significant second wave at all — the most meaningful comparisons can only be made later in the progress of the pandemic.

But studies of coronavirus antibodies among the Swedish population have so far proved disappointing. An analysis of 1,104 blood samples taken in late April and early May found that 7.3 percent of residents tested in the Stockholm region had antibodies, a rather limited number given the death toll, scientists said.

Tegnell has said that weeks-old samples would not give an up-to-date picture of antibody levels and that “20 percent plus” have probably been exposed in the Stockholm region by now.

Still, as even the hardest-hit countries in Europe reduce their infection numbers and step blinking back into the sun, Sweden appears to remain on a different trajectory.

“You look at everyone else’s curve, it is typical. You go up, you peak, then you go down on the other side. But in Sweden you have a plateau at a pretty high level,” said Bjorn Olsen, a professor of infectious medicine at Uppsala University and one of Sweden’s leading researchers of pandemics, who has been sharply critical of the government’s response.

“I know that many countries looked at Sweden as a good example of an open society. We had a relatively low number of cases. And then it started to skyrocket. We understood absolutely nothing,” he said.

Olsen said the Swedish approach had been spurred by a mistaken belief that the virus that causes covid-19 behaves like the seasonal flu, which is extremely fast-spreading and contagious. Instead, he said, it appears to concentrate in certain spots and wreak deep devastation.

About half of Sweden’s deaths have occurred in homes for the elderly, which is similar to some other European countries but has fueled criticism in Sweden that policymakers abandoned the elderly to the virus. After cases in nursing homes began spiking, the government banned visitors.

“We must admit that the part that deals with elderly care, in terms of the spread of infection, has not worked. It is obvious. We have too many elderly people who have passed away,” Lofven, the prime minister, told the Aftonbladet newspaper Wednesday.

In neighboring countries, public health officials say Sweden’s situation does indeed look difficult — although they also say that so little is understood about how to fight the virus that it may still be too early to tell who has taken the best approach.

“It’s a very sad situation with the high number of deaths in Sweden,” said Camilla Stoltenberg, the director general of the Norwegian Institute of Public Health, who has advocated a more conventional lockdown approach. “That does make a strong impression. I am grateful that we are not in the same situation. However, we may regard both the Swedish and the Norwegian approaches as experiments, and we will know only in a couple of years which strategy worked best.”

Antonia Farzan in Washington contributed to this report.