As Sweden's death rate rises, the country defends its refusal to lock down

'I don't think their policies are the right ones,' Bill Gates said of Sweden. But Swedes aren't listening. Analysis.

Y. Rabinovitz ,

Norrkoping, Sweden
Norrkoping, Sweden

You don’t have to be Bill Gates to express an opinion on coronavirus, but when someone of his prominence expresses dissatisfaction with a certain country’s policy, people take notice.

And so, when, in an interview with MSNBC, Gates criticized Sweden and said, “I don’t think their policies are the right ones,” Swedish health officials were quick to respond.

Sweden’s former state epidemiologist (and now an adviser to the World Health Organization), Johan Giesecke, told Swedish newspaper Expressen, “I think we are doing the right thing,” while admitting that “up to two weeks ago, people laughed and said, ‘Those stupid Swedes; they’re not doing anything.’” But he claimed that the tide of international opinion was turning, and named a list of countries whose officials had supposedly been in contact with him asking for advice.

Well, should we want Sweden’s advice? Let’s look at the numbers to see.

As of today, 2,355 people have died in Sweden in deaths attributed to Covid-19. This translates to approximately 225 deaths per million people. The corresponding numbers for hard-hit Spain and Italy are 503 deaths per million and 446 in Italy. That sounds impressive for a moment, until you reckon with another factor that isn’t often mentioned in media reports – and that factor is population density.

Sweden is a very sparsely populated country; just 20 people per square kilometer. In Spain, that number rises to 92; in Italy, it’s almost 200. Spain and Italy also have a relatively high incidence of multi-generational households as well as an aging population, both factors known to inflate the death rate.

Densely-populated cities are already showing much higher death rates; forty percent of US deaths have occurred in New York City alone, where the population density is 10,194 people per square kilometer. (In Bnei Brak, population density is 27,338 people per square km, the 10th most densely-packed city in the world. In Israel in general, the number is just 400.)

So, has something gone wrong in Sweden? If you ask their top health officials, the answer is “no,” and “we are acting correctly.” Articles published in Swedish media in recent days still maintain a self-congratulatory note, commenting that “unemployment has almost tripled in Norway … from 3.6 % to 10%. In Sweden, the corresponding figures are 6.8 % to about 8” (Expressen).

At the same time, the country tightened its restrictions on movement and congregation after it saw the largest rise in deaths in a single day so far – 185 people – on a day when the combined death tally of its Scandinavian neighbors (Finland, Denmark, and Norway) was just 50.

But Sweden is not in a state of emergency, and its laws do not currently allow for the possibility of lockdown. Instead, the government merely recommends that people observe a measure of social distancing and wash their hands regularly, and that the elderly avoid contact with others. Schools have remained open throughout up to the age of 16, and many restaurants and bars never shut down, although fewer people frequent them.

According to a major survey by polling firm Novus, quoted by the BBC, around 9 in 10 Swedes say they keep at least a meter away from others at least some of the time, up from seven in 10 a month ago. The health system is not collapsing; there are still ICU beds available. But as the number of fatalities shows, comparatively, it’s not good enough.

In that case, why is Sweden sticking to its course? Despite official protestations that the country is not aiming for herd immunity, key figures are still bandying about the term. Anders Tegnell is Sweden’s chief epidemiologist and the person running the country’s policy on coronavirus. In an interview last week with Swedish media, he claimed that Sweden might reach the stage of herd immunity by May, although subsequent reports from Swedish health authorities revised the number down substantially.

In another interview with Nature, he changed his tone, stating that Sweden, like other countries, was “aim[ing] to flatten the curve … otherwise the health-care system and society are at risk of collapse.”

He added that, “This is not a disease that can be stopped or eradicated, at least until a working vaccine is produced. We have to find long-term solutions that keep the distribution of infections at a decent level.”

Tegnell claimed that, “lockdown … [does not] have a historical scientific basis … we looked at a number of European Union countries to see whether they have published any analysis of the effects of these measures before they were started and we saw almost none … Closing borders, in my opinion, is ridiculous, because COVID-19 is in every European country now.”

Nature’s reporter then asked him bluntly: “Are you satisfied with [your] strategy?” and Tegnell replied, “Yes! … There has been an increase, but it is not traumatic so far … we will see a lot more cases in the next few weeks … but that is just like any other country.” Then, notably, he added that, “There are enough signals to show that we can think about herd immunity … Each country has to reach ‘herd immunity.’”

There are a number of problems with the “herd immunity” theory, not least of which is that if the virus mutates, any immunity gained will be useless. After all, we all get colds on a regular basis, and many colds are actually variants of coronavirus. In addition, tacitly acknowledged when talking of herd immunity is the fact that in most cases, a large number of people have to die to reach that stage.

Not all Swedes think that’s a price worth paying; last week, 22 high-profile scientists and epidemiologists wrote a letter to Swedish newspaper Dagens Nyheter saying that “public health authorities have failed; now politicians must intervene,” with one signatory saying bluntly, “too many people are dying.”

But the Swedish Public Health Agency has maintained high approval ratings throughout the pandemic, and some Swedes have responded with an “outburst of nationalism” and a “sense of pride, for Sweden deviating from the … norm,” Professor Nicolas Aylott, political scientist at Stockholm's Södertorn University, told the BBC.

“It sort of chimes with a rather deep-seated sense of Sweden's specialness.”