The Swedish Model Trades More Disease for Less Economic Damage

The next few weeks or months will tell whether Tegnell’s strategy is brilliant or—as many experts outside of Sweden believe—benighted. The Swedish government has deferred to him and his fellow scientists to set the rules for a relaxed semi-shutdown of Swedish society in response to the Covid-19 pandemic. Gatherings of more than 50 people are banned, but Swedes have continued eating in restaurants, shopping, going to work, getting haircuts, and sending children under 16 to school. Few Swedes wear masks. Bloomberg Economics expects the economy to shrink 5.6% in 2020, vs. 8.1% for the nations of the euro zone.

The downside to the strategy is that the virus has claimed a far higher percentage of lives in Sweden than in its neighbors that locked down. As of May 10, Sweden had about 31 deaths per 100,000, vs. Denmark with 9 and Norway with 4. (The U.S. had 24 per 100,000.) Many of Sweden’s deaths were in nursing homes, which the government admits were poorly looked after. Prime Minister Stefan Lofven now says his government plans to spend about $220 million to protect senior citizens.

Tegnell argues that the scales will tip: the better the job countries did suppressing the first wave of infection, the greater their risk of a second wave. He estimates that roughly 25% of Swedes have been exposed. The more people who are immune, the harder it is for the virus to spread; full herd immunity in a homogeneous population comes at 60% or so.

It’s a very risky bet. The standard strategy, pioneered by China and replicated by the likes of South Korea and New Zealand, is to subject the population to extreme but temporary social distancing measures to drive down the number of active infections to the point where they can be kept to a minimum through testing, tracing, and quarantine. It’s a costly strategy: The suppression phase devastates the economy, and the subsequent stamping-out-brush-fires phase requires ceaseless effort. In Seoul one 29-year-old man inadvertently infected dozens of people in a single evening when he visited a number of recently reopened bars and nightclubs.

The siren song of Sweden is that none of that is necessary. Trust your citizens to be prudent about social distancing and stay home if they’re sick. Keep the number of cases low enough so hospitals aren’t overwhelmed. Isolate the most vulnerable while allowing the disease to spread gradually through the rest of the population, most of whom will get only mildly ill. That will increase resilience. Such a strategy can be tolerated for years, in case that’s how long it takes for a vaccine and antiviral drugs to be developed. “The Swedish strategy is sustainable for a long, long time,” Tegnell said in the interview.

Polls of Swedes show strong support for Tegnell’s approach. One man got a tattoo of the epidemiologist on his arm. “Sweden does not seem to be much worse off in terms of the spread of the virus than countries with stricter measures,” says Victoria Denie, owner of a clothing boutique outside Stockholm. “This has been a tough spring for us Swedes, but it is acceptable.” Michael Ryan, who runs the World Health Organization’s health emergencies program, said on April 29 that “if we are to reach a new normal, in many ways Sweden represents a future model.”

Perhaps. But it’s too soon to declare the strategy a success, as even Tegnell concedes. Accepting more deaths in exchange for long-run sustainability won’t look so smart if a vaccine or effective treatment arrives soon. Conversely, there’s no certainty that Sweden’s neighbors will have serious secondary flare-ups of infection—not if they master testing, tracing, and quarantine. “If you want to put out a forest fire, it’s a lot better to start doing it when only a few square meters are burning than when thousands of hectares are in flames,” says Anders Vahlne, a professor of clinical virology at the Karolinska Institute in Stockholm.

The high death toll in nursing homes also sullies Sweden’s record. The government was slow to restrict visits to them. Authorities in Stockholm emailed one on March 11 saying it had no legal right to bar visitors. Despite the new spending for senior citizens, the fact remains that nursing home workers live in the community and are liable to bring infections into their workplaces if the virus is on the loose.

Even if the relaxed attitude is right for Sweden, it might not be right for others. The country has a generally disease-resistant population and the world’s lowest rate of obesity, a condition that makes Covid-19 more deadly. Close to half of households in Stockholm are single-person, allowing for easier social distancing.

Tegnell isn’t budging. “If you look at the curve over time, it is quite clear now that it is slowly but surely decreasing,” he told the Swedish newspaper Dagens Nyheter. “As it get warmer, it means that you are more out in the environment where the virus can’t thrive and spread as quickly.” As the white nights of summer come to Sweden, the white-hot spotlight of international attention isn’t going away. —With Niclas Rolander and Love Liman
 
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