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No obligation to wear masks in public places, open restaurants, stationary education in schools, open borders, recommendations instead of orders and no lockdown. Sweden went against the tide in its strategy to combat the COVID-19 pandemic. Closed at home and full of fear of contracting the coronavirus, the world wondered for months whether there was a method in this madness. Today, when the Swedes – in reaction to the growing covid statistics – slowly withdraw from their plan, no one remembers this question anymore. Perhaps wrongly.
Pictured: Anders Tegnell, Sweden’s chief epidemiologist
- The liberal strategy of fighting the pandemic made Sweden on the lips of the whole world in 2020. Experts wondered if this approach made sense
- When the second wave of the epidemic began in the country, the authorities decided to introduce stricter restrictions
- Epidemiologist prof. Jarosław Drobnik in Medonet assessed the Swedish tactics for the fight against COVID-19
- You can find more such stories on the TvoiLokony home page
January 2020. The media is devoting more and more space to the strange disease that has taken over Chinese Wuhan. It is still unknown whether there is anything to be afraid of, but the authorities of many countries are increasing vigilance just in case. Sweden is no exception. Inhabitants travel in large numbers to the Middle Kingdom, there is a high risk that a mysterious virus will come home with one of them. The government has already prepared the appropriate procedures. They are based on a special plan that was developed after the bird flu outbreak in 2005 in the event of another outbreak. Since then, the regulations have been changed several times, but there has been no opportunity to apply them on a larger scale. The Swedish Public Health Agency – an expert unit responsible for monitoring diseases with epidemic potential in the Scandinavian country – stands on guard just in case.
You don’t have to wait long for the first case. Patient zero is a woman from the city of Jönköping on Lake Wetter, who has just returned from Wuhan. The Swedes do not know yet that the coronavirus appeared in the country probably as early as December 2019. As it was established, patients complained about breathing problems and malaise came to the clinic at that time. Common denominator? Everyone contacted the person who traveled to China.
At this stage, the government’s strategy is to isolate confirmed cases and closely track their contacts. In the case of a woman from Jönköping, this is one hundred percent successful, but the next patient does not have to wait long. The man returning from northern Italy is one of over two hundred people diagnosed with COVID-19 in the following weeks and who traveled to high-risk countries – China, Iran, South Korea, Italy and Austria. However, there is still no evidence of internal transmission – all cases are imported from abroad.
On March 11, the World Health Organization announces that we are dealing with a pandemic. The first patient infected with the SARS-CoV-2 virus dies in Sweden.
The Public Health Agency makes an official recommendation that anyone experiencing any respiratory symptoms should refrain from social contact. Six days later, she asks seniors to avoid crowded places and limit close contacts with other people. This is only a recommendation again, but as much as 93 percent. people over 70 years of age declare at the end of March that they comply with the recommendations. The same is happening in other social and professional groups. More than half of the Swedish workforce is moving their jobs home, and secondary and higher education are switching to distance learning. The scale of voluntary quarantine is visible in the empty streets. Urban transport in most districts accounts for 50 percent. decrease in the number of passengers.
There is only one specific prohibition – gatherings. The limit was set at 500 people, arguing that big events usually attract the most people, but it was quickly lowered to 50 people. The restriction does not apply to meetings at schools, workplaces, shopping malls, shops, fitness clubs and private events.
Sweden’s COVID-19 Strategy: ‘Recommend and Trust’
Most countries in the world followed the strategy of dealing with the coronavirus in Sweden with astonishment and growing anxiety. The Swedes were also surprised – with the scale of restrictions introduced by their neighbors (and not only). According to Anders Tegnell, an infectious disease physician and architect of the local covid strategy, such radical steps had no justification. The main Swedish epidemiologist assumed that the SARS-CoV-2 virus was not a temporary threat, but would stay with us for a long time. He saw no point in closing borders or limiting the activities of individual sectors of the economy, because in the long run such actions could do more harm to Sweden than the pandemic itself.
It was not only about economic effects, with impaired functioning, and in extreme cases with bankruptcy of enterprises and an increase in unemployment, but also about the impact of possible restrictions on the everyday life of Swedes. Example? Closing schools would entail the necessity of providing care to the youngest by parents who would not be able to perform their professional duties, and this would affect employers and ultimately the economy. This scenario has been confirmed by numerous examples of countries around the world where lockdown has been introduced.
Another, equally intensively analyzed problem was a high risk that in such a situation parents would ask for help in caring for their grandparents’ children, i.e. people at risk. In addition, concerns were also raised about children from poor families who could not provide their members with conditions for study or remote work and would condemn them to exclusion, as well as those with high sensitivity who would have the greatest problem coping with the new situation of disconnection from their peers and teachers.
Tegnell’s opposition to the international coronavirus strategy was at its peak when he said it was unnecessary to wear masks. In his opinion, there is no evidence that this method of protection against SARS-CoV-2 is effective, and perhaps covering the mouth and nose is even harmful. The Swedes persevered in this conviction for a long time, until December last year, when the increase in cases and deaths due to COVID-19 increased significantly. The obligation to wear masks was, however, such a complicated “legend” (public transport users were supposed to wear them, but only during rush hours and only if they do not occupy a seat in the vehicle) that most Swedes did not even reach for the cover. No wonder – not wearing them has not been associated with any consequences.
- See also: Who doesn’t have to wear a mask in Poland?
Despite criticism from Tegnell’s strategy abroad and in some Swedish political and scientific circles, the Swedes themselves trusted the epidemiologist with great confidence. At the beginning of March 2020, they were declared by 65 percent. residents of the country, two weeks later – already 74 percent. In April it turned out that more than half of Swedes trust an epidemiologist more than any leader of a political party.
For so much support, Tegnell worked diligently, outlining the philosophy of his plan to the people in detail. It was based on respect for the individual and his free will, as well as the constitutional right to free movement. The Swedish government decided to simply trust its citizens. As commentators on the anti-COVID-19 strategy in Sweden ironically say, hopes have found fertile ground. Swedes are not a nation as outspoken in social contacts as Italians or French. They did not have to be persuaded to keep their social distance, and working or studying at home – although only recommended – became the choice of the majority of citizens. The pandemic appeared to be under control by Sweden.
- Read: Swedish cities forbid the wearing of face masks. Why?
COVID-19 in Sweden. The virus knows better
The problem is that the implementation of this plan did not significantly affect the statistics. So far, over 700 jobs have been recorded in Sweden. cases of COVID-19 and over 13 deaths due to this (as of March 14, 2021). Although Sweden managed to prevent the situation known from Italy for a long time, and the health service survived the first wave, no one thought about success.
It turned out that over 1/3 of those who died from COVID-19 in Sweden were residents of nursing homes or used professional care for the elderly at home. The rise in the number of cases and deaths and the overall course of the pandemic – with its two waves, a flattening of the summer disease curve and a drastic spike at the end of the year – also did not differ much from other countries. However, the strategy of recommendations and confidence has still not been backtracked.
The breakthrough in thinking about the next steps in the fight against the pandemic came only in autumn, when Sweden – as in many European countries – saw the second wave of cases. Hospitals were running out of beds and staff had to be recruited from the private sector.
This time, the actions were also more decisive. Meetings were limited to a maximum of eight people (funerals are an exception – here the limit is 20 people), schools (except for the youngest students) switched to remote learning, the sale of alcohol was forbidden after 22 p.m. and the restaurant’s working hours were shortened, the limit of people per service room was set, and finally the wearing of masks began to be recommended.
Sweden’s borders have not been closed, but you need a good reason to enter the country. It was absolutely forbidden to come to Sweden from Great Britain, Denmark and Norway. People who want to cross the Swedish border and stay in the country must submit a negative COVID-19 test result (interestingly, this order does not apply to nationals of the country). The authorities allow a lockdown.
We will probably find out in a few years whether the Swedish government’s strategy to fight the coronavirus was right. Only then will we fully feel the effects of the COVID-19 pandemic and assess how much the accompanying restrictions and fear have left a mark on our lives and the place where we live. Experts have no doubts that this cost will be high.
As noted by prof. Dr. Jarosław Drobnik, MD, chief epidemiologist at the University Teaching Hospital in Wrocław, will mainly consist of a health debt, which we have been incurring constantly since March last year.
– We have conscious health needs that are postponed. We are talking about planned procedures, which patients did not undergo at the optimal time for them and in many cases they are still waiting for them. But we also have what we call an unconscious health need. We still have health prophylaxis, but we must remember that throughout the pandemic period we have limited the performance of check-ups to a minimum, often for reasons beyond our control, e.g. difficult access to primary health care. There is also an indirect cost related to chronic diseases. The majority of such patients is not well monitored on an ongoing basis. On top of all this, there is a huge social cost associated with the experience of lockdown, closure, restrictions, bans and the specter of penalties for non-compliance. And a number of threats facing the most vulnerable group – children and adolescents: the issue of socialization, loneliness, the risk of being addicted to social media and many others. These are things that are badly cracked and it will be very difficult to stick them together. The Swedes will not pay this price, at least in such a drastic way – explains.
According to the epidemiologist, any strategy, no matter which path we take, must be based on acceptance, understanding, and not fear. If we build a strategy based on fear, it will eventually fall over. That is why social trust and proper communication between government and society are so important. What the authorities say must be understandable and acceptable to citizens so that they have a sense of participation and responsibility.
– The Swedes have it. Of course, they will also get their bill to pay. We should remember that the inhabitants of Sweden are also aware that they can become infected, they also live under stress, they do not live in the land of milk and honey – says prof. Draft and adds: – But thanks to the fact that they are able to maintain even a bit of normality, these costs will probably be lower for them and for balance Sweden, however, is still in the black.
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