Sweden has become something of a cautionary tale for what happens when you attempt to tackle coronavirus without lockdowns.
In The Conversation last week The Grattan Institute’s Stephen Duckett and Will Mackey said its freer approach caused almost as much economic damage as a lockdown would have, and many more deaths.
Sweden’s death rate is indeed high compared to others at this stage.
At the time of writing worldometer suggests Sweden is one of the worst nations in the world in terms of deaths per million population, being beaten among the populous nations only by Belgium, Britain, Spain, Italy, and Peru.
At 568 deaths per million it has done worse than the United States (480) and much worse than nations such as Denmark (106), Australia (9) South Korea (6) and New Zealand (4).
And on one reading its economic performance doesn’t seem much better than Denmark’s.
Denmark imposed strict restrictions from early March, closing the border to all foreign nationals, limiting social gatherings to ten, shutting schools, universities and non-essential work, and encouraging the entire population to stay home and minimise social contact.
Neighbouring Sweden allowed bars and restaurants to remain open with capacity constraints and table service. Preschools and primary schools were kept open but senior schools closed, and its borders remained open to people from Europe. At the same time it banned visitors from aged care facilities and encouraged old people and those with pre-existing health conditions to avoid social contact.
The University of Copenhagen study cited by those who argue Sweden got it wrong finds that in Sweden aggregate spending dropped 25% whereas in neighbouring Denmark it dropped 29%.
The authors conclude
even when there are no major restrictions on economic activity, as in Sweden, a pandemic induces a sizeable contraction of spending; the additional drop in spending caused by a shutdown, as in Denmark, is relatively small
The University of Copenhagen study was close to a snapshot, presenting data for the four weeks between March 11 to April 5.
Denmark’s death count has also declined, but less smoothly.
Death counts in Australia and many other countries that imposed hard lockdowns are turning up as they get hit with second waves and second lockdowns.
Anders Tegnell, Sweden’s chief epidemiologist, says in many ways the voluntary measures put in place in Sweden were just as effective as the complete lockdowns in other countries, and might be more sustainable.
On its performance to date, Sweden has the world’s eighth highest death rate.
But if present trends continue, the ranking will fall. It is possible that by the time a proper accounting is done it won’t even make the top 20.
We will know soon how Sweden did economically in the second quarter of the year. Bank forecasts have its economy down only 7% to 8% in that quarter compared to 12% for the European Union as a whole.
A full accounting of how Sweden’s approach has fared compared to other country’s will take time, and will involve trading off health, economic, educational and other outcomes.
Confidence in its Public Health Agency remains high at 65%, suggesting Swedes are not unhappy with the tradeoffs made. And they are prepared to follow directions, perhaps more than Australians and residents of the United States and the much-touted Germany.
Sweden’s Civil Contingencies Agency says 87% of the population is complying with the social distancing restrictions that are in place, up from 82% a month ago.
The COVID-19 pandemic has brought once-in-a-generation destruction to the lives and livelihoods of people around the world.
The costs of preventing the spread of COVID-19 must always be compared to the health, social and economic costs of viable alternatives. Countries across the globe have dealt with this balancing act differently.
One country in particular that has attracted attention for its lighter approach to lockdown is Sweden. Some people have regarded Sweden as an example for Australia to follow.
But Sweden shouldn’t be seen as a model for Australia when it comes to COVID-19. The virus has spread rapidly, they’ve had more deaths, and the economy is suffering just as badly as their neighbours with heavier lockdowns.
While some people called Sweden’s approach a “let it rip” policy, this was never the case. Swedes were not free to go about their lives as normal.
Sweden’s policymakers did introduce restrictions to limit the spread of COVID-19 infection, but they tried to do so in a way that minimised the effects on people and companies.
Bars and restaurants could remain open, but with capacity constraints and a requirement of table service. Schools were kept open to preschool and primary students, but were closed to senior students. Non-essential international arrivals were banned, but only from countries outside Europe.
There were social distancing requirements and protections for vulnerable populations. Visits to aged care facilities were prohibited. People over the age of 70, pregnant women, and those with pre-existing health conditions were encouraged to “avoid social contacts” and to ask others to do shopping and errands for them.
These restrictions and recommendations remain in place.
As in Denmark and Norway, the number of new COVID-19 cases rose rapidly in Sweden from the start of March. But Denmark and Norway both implemented tighter restrictions, and their case numbers fell away from April.
Sweden maintained its rate of roughly 600 new cases per day throughout April and May, and then the numbers started to rise again, reaching 1,300 per day at the start of July.
Sweden has to date had about 80,000 confirmed cases of COVID-19 — though this is likely to be an underestimate — and about 5,700 people have died. This would equate to about 15,000 lives lost in Australia.
Even with its lighter lockdowns, Sweden has suffered economic losses almost as severe as its Nordic counterparts.
The Swedish labour market has been hit hard. Unemployment is expected to peak at between 9-11%, cushioned by a fall in labour-force participation as Swedes leave the labour market entirely.
The country’s central bank estimates GDP will fall by 4-6%, depending on a second wave of infections.
In comparison, Australia’s treasury expects the unemployment rate here to peak at 9.25%, and for GDP to fall by 2.5%.
Like in Australia, the Swedish government has provided financial support to businesses to reduce the number of job losses, and given additional support to the “many people” who will lose their jobs.
Economists from the University of Copenhagen have compared Sweden and Denmark. Both countries had similar exposure to COVID-19 at the beginning of the pandemic, and similar economic conditions before the crisis.
Denmark imposed stricter restrictions from early March, closing the border to all foreign nationals, limiting social gatherings to ten, shutting schools, universities, and non-essential work, and encouraging the entire population to stay home and minimise social contact.
The economists examined the spending of 860,000 people in the two countries. They found consumer spending dropped by 29% in Denmark, but it also fell by 25% in Sweden. People in both countries had changed their behaviour to reduce their risk of infection, regardless of government-mandated restrictions.
Swedes’ confidence in the ability of their government and health authority to handle the crisis decreased between April and June.
Their neighbours seem to have limited confidence too. Norway, Denmark and Finland have created a “travel bubble”, but Sweden is excluded from it.
While new COVID-19 cases in Sweden have been decreasing from the peak at the beginning of July, they still sit at about 250 per day. Denmark and Norway have been below that level since mid-April.
Swedes have paid a heavy price to get to where they are — and they’re still quite some way from controlling the spread of COVID-19, as their neighbours have done.
We don’t have to lose the lives that Sweden has to learn from its experience. Loose restrictions make COVID-19 harder to control. When the virus is out of control it spreads rapidly, putting millions of vulnerable people at greater risk and reducing the economic activity of the population.
To understand the spread of COVID-19, the pandemic is more usefully viewed as a series of distinct local epidemics. The way the virus has spread in different countries, and even in particular states or regions within them, has been quite varied.
A New Zealand study has mapped the coronavirus epidemic curve for 25 countries and modelled how the spread of the virus has changed in response to the various lockdown measures.
The research, which is yet to be peer-reviewed, classifies each country’s public health response using New Zealand’s four-level alert system. Levels 1 and 2 represent relatively relaxed controls, whereas levels 3 and 4 are stricter.
By mapping the change in the effective reproduction number (Reff, an indicator of the actual spread of the virus in the community) against response measures, the research shows countries that implemented level 3 and 4 restrictions sooner had greater success in pushing Reff to below 1.
An Reff of less than 1 means each infected person spreads the virus to less than one other person, on average. By keeping Reff below 1, the number of new infections will fall and the virus will ultimately disappear from the community.
Conversely, the larger the Reff value, the more freely the virus is spreading in the community and thus the faster the number of new cases will rise. This means a higher number of cases at the peak of the epidemic, a greater risk of the health system becoming overwhelmed, and ultimately more deaths.
Here are some of study’s findings from states and nations around the world:
The effect of Australia’s strict border control measures, implemented relatively early in the pandemic, can clearly be seen in the graph below. Federal and state governments introduced strict social distancing rules; schools, pubs, churches, community centres, entertainment venues and even some beaches were closed.
This prompted the Reff value to drop below 1, where it has stayed for some time. Australia is rightly regarded as a success story in controlling the spread of COVID-19, and all states and territories are now mapping their paths towards relaxing restrictions in the coming weeks.
Italy was relatively slow to respond to the epidemic, and experienced a high Reff for many weeks. This led to an explosion of cases which overwhelmed the health system, particularly in the country’s north. This was followed by some of the strictest public health control measures in Europe, which has finally seen the Reff fall to below 1.
Unfortunately, the time lag has cost many lives. Italy’s death toll of over 27,000 serves as a warning of what can happen if the virus is allowed to spread unchecked, even if strict measures are brought in later.
The UK’s initial response to COVID-19 was characterised by a series of missteps. The government prevaricated while it considered pursuing a controversial “herd immunity” strategy, before finally ordering an Italy-style lockdown to regain control over the virus’s transmission.
As in Italy, the result was an initial surge in case numbers, a belatedly successful effort to bring Reff below 1, and a huge death toll of over 20,000 to date.
New York City, with its field hospital in Central Park resembling a scene from a disaster movie, is another testament to the power of uncontrolled virus spread to overwhelm the health system.
Its Reff peaked at a staggeringly high value of 8, before the city slammed on the brakes and went into complete lockdown. It took a protracted battle to finally bring the Reff below 1. Perhaps more than any other city, New York will feel the economic shock of this epidemic for many years to come.
Sweden has taken a markedly relaxed approach to its public health response. Barring a few minor restrictions, the country remains more or less open as usual, and the focus has been on individuals to take personal responsibility for controlling the virus through social distancing.
This is understandably contentious, and the number of cases and deaths in Sweden are far higher than its neighbouring countries. But Reff indicates that the curve is flattening.
Singapore is a lesson on why you can’t ever relax when it comes to coronavirus. It was hailed as an early success story in bringing the virus to heel, through extensive testing, effective contact tracing and strict quarantining, with no need for a full lockdown.
But the virus has bounced back. Infection clusters originating among migrant workers has prompted tighter restrictions. The Reff currently sits at around 2, and Singapore still has a lot of work to do to bring it down.
Individually, these graphs each tell their own story. Together, they have one clear message: places that moved quickly to implement strict interventions brought the coronavirus under control much more effectively, with less death and disease.
And our final example, Singapore, adds an important coda: the situation can change rapidly, and there is no room for complacency.