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Christina Anderson and Henrik Pryser Libell: Will Sweden’s Outlier Strategy for Fighting the Coronavirus Work?

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STOCKHOLM — When the coronavirus swept into the Scandinavian countries, Norway and Denmark scrambled to place extensive restrictions on their borders to stem the outbreak. Sweden, their neighbor, took a decidedly different path.

While Denmark and Norway closed their borders, restaurants and ski slopes and told all students to stay home this month, Sweden shut only its high schools and colleges, kept its preschools, grade schools, pubs, restaurants and borders open — and put no limits on the slopes.

In fact, Sweden has stayed open for business while other nations beyond Scandinavia have attacked the outbreak with various measures ambitious in their scope and reach. Sweden’s approach has raised questions about whether it’s gambling with a disease, Covid-19, that has no cure or vaccine, or if its tactic will be seen as a savvy strategy to fight a scourge that has laid waste to millions of jobs and prompted global lockdowns unprecedented in peacetime.

By Saturday, Norway, population 5.3 million, had more than 3,770 coronavirus cases and 19 deaths; Denmark, population 5.6 million, reported 2,200 cases and 52 deaths; Sweden, with 10.12 million people, recorded more than 3,060 cases and 105 deaths.

A recent headline in the Danish newspaper Politiken, encapsulates the question ricocheting around Europe, “Doesn’t Sweden take the corona crisis seriously?”

There is no evidence that Swedes are underplaying the enormity of the disease rampaging across the globe. The country’s leader and health officials have stressed hand washing, social distancing and protecting people over the age of 70 by limiting contact with them.

But peer into any cafe in the capital, Stockholm, and groups of two or more people can be seen casually dining and enjoying cappuccinos. Playgrounds are full of running, screaming children. Restaurants, gyms, malls and ski slopes have thinned out but are still in use.

The state epidemiologist, Anders Tegnell, said in an interview that Sweden’s strategy is based on science and boiled down to this: “We are trying to slow the spread enough so that we can deal with the patients coming in.”

Sweden’s approach appeals to the public’s self-restraint and sense of responsibility, Mr. Tegnell said. “That’s the way we work in Sweden. Our whole system for communicable disease control is based on voluntary action. The immunization system is completely voluntary and there is 98 percent coverage,” he explained.

“You give them the option to do what is best in their lives,” he added. “That works very well, according to our experience.”

Sweden’s method flies in the face of most other nations’ stricter strategies. India is attempting a lockdown that affects 1.3 billion people. Germany has banned crowds of two or more people, except for families. In France, residents are asked to fill in a form stating the purpose of each errand when they leave their homes; each trip requires a new form. Britain has deployed police officers to remind residents to stay home.

Still, while Sweden may appear to be an outlier in Scandinavia and in much of the wider world, it is too soon to say whether its approach will yield the same results as other countries’. And the Swedish authorities could still take stronger action as coronavirus hospitalizations rise.

In explaining Sweden’s current strategy, experts point to other underlying factors: The country has high levels of trust, according to the historian Lars Tragardh, and a strict law in the Constitution prohibits the government from meddling in the affairs of the administrative authorities, such as the public health agency.

“Therefore, you don’t need to micromanage or control behavior at a detailed level through prohibitions or threat of sanctions or fines or imprisonment,” Mr. Tragardh said in a phone interview. “That is how Sweden stands apart, even from Denmark and Norway.”

The government has deferred to the agency’s recommendations to fight the virus, which has infected more than 600,000 people and killed more than 27,000 worldwide by Saturday. If the health agency were to say that closing borders and shutting down all of society was the best way to go, the government would most likely listen.

Mr. Tragardh said Swedes’ level of trust was manifested in other ways: Not only do citizens have confidence in public institutions and governmental agencies and vice versa, but high social trust exists among citizens, as well.

That is evident in the country’s approach to the virus. Norway did not completely shut its 1,000-mile land border with Sweden, but most people returning from abroad must enter a two-week quarantine (Reindeer herders and daily commuters are exempt.) Finland closed the borders of its most populous region — which has 1.7 million people and includes the capital, Helsinki — for three weeks to fight the outbreak there.

Norway limited groups outdoors to no more than five people, and those indoors must keep a distance of more than six feet (except relatives). Denmark closed its borders, sent public workers home with pay and encouraged all other employees to work from home. It shut nightclubs, bars, restaurants, cafes and shopping centers, and banned gatherings of more than 10 people outdoors.

Sweden initially banned gatherings of 500.

Early in the outbreak, some event organizers suggested they would try to get around the crowd limit by allowing precisely 499 ticket holders into their venues. (That stopped when cases of Covid-19 were confirmed among staff members.)

Mr. Tegnell, the state epidemiologist, said that is why bans don’t work: “People find ways around the rules.”

He also said he did not believe Sweden was a maverick and did not understand its neighbors’ strategy. “Closing borders at this stage of the pandemic, when almost all countries have cases, to me does not really make sense,” he said. “This is not a disease that is going to go away in the short term or long term. We are not in the containment phase. We are in the mitigation phase.”

He also said that closing schools had not been ruled out.

The Netherlands, which reported more than 9,700 cases of the virus and 639 deaths by Saturday, is taking a similar approach to Sweden’s. On March 16, Prime Minister Mark Rutte said his country of 17.1 million was opting for a “controlled spread” among groups at the least risk of getting seriously ill. He argued that it was too late to shut down the country “completely.”

A majority of Swedes, 52 percent, support the measures to contain the virus, according to a survey conducted by the newspaper Svenska Dagbladet and published on Tuesday. But 14 percent said that too little consideration was being given to public health in order to benefit the economy.

There is growing concern as Swedes prepare to travel to their country houses and to the ski slopes for Easter, even though the public health agency has asked citizens to reconsider such trips. (Norway announced a “cabin ban” to prevent residents from going to their country homes.)

Even Prime Minister Mette Fredriksen of Denmark issued a warning about its neighbor on Monday: “Don’t go on a ski vacation in Sweden!”

Last week, a cluster of Covid-19 cases was traced to an après-ski party at a Swedish alpine center, Are, prompting officials to close an aerial tram and gondola and shut bars and nightclubs. Hundreds of Covid-19 cases in Scandinavia have stemmed from vacationers returning from ski trips in Italy — which has the most cases in Europe — and in Austria.

Now, there is a petition on social media to close the ski slopes.

Some Swedes have suggested that their country is deviating from most other nations’ response to hasten herd immunity, risking lives unnecessarily.

The public health agency denies this.

In the meantime, the infection curve in Sweden has started to rise sharply, and on Friday the government tightened the limit on crowds to no more than 50 people.

Some residents like Elisabeth Hatlem, a hotelier, are of two minds about the Swedish approach. She is grateful that she can keep her business open. But she and her partner do not like sending their six children to school amid the pandemic.

“For us, a total lockdown is a disaster,” she said. “But I am worried Sweden will explode at some point. I feel like I’m living in a huge experiment, and I was never asked if I wanted to sign up.”

Christina Anderson reported from Stockholm, and Henrik Pryser Libell from Oslo. Follow Ms. Anderson on Twitter @candersonSTO and Mr. Libell @hlibell.

  • Answers to Your Frequently Asked Questions

    Updated April 3, 2020

    • How does coronavirus spread?

      It seems to spread very easily from person to person, especially in homes, hospitals and other confined spaces. The pathogen can be carried on tiny respiratory droplets that fall as they are coughed or sneezed out. It may also be transmitted when we touch a contaminated surface and then touch our face.

    • What makes this outbreak so different?

      Unlike the flu, there is no known treatment or vaccine, and little is known about this particular virus so far. It seems to be more lethal than the flu, but the numbers are still uncertain. And it hits the elderly and those with underlying conditions — not just those with respiratory diseases — particularly hard.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

    • What if somebody in my family gets sick?

      If the family member doesn’t need hospitalization and can be cared for at home, you should help him or her with basic needs and monitor the symptoms, while also keeping as much distance as possible, according to guidelines issued by the C.D.C. If there’s space, the sick family member should stay in a separate room and use a separate bathroom. If masks are available, both the sick person and the caregiver should wear them when the caregiver enters the room. Make sure not to share any dishes or other household items and to regularly clean surfaces like counters, doorknobs, toilets and tables. Don’t forget to wash your hands frequently.

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • Should I stock up on groceries?

      Plan two weeks of meals if possible. But people should not hoard food or supplies. Despite the empty shelves, the supply chain remains strong. And remember to wipe the handle of the grocery cart with a disinfecting wipe and wash your hands as soon as you get home.

    • Should I pull my money from the markets?

      That’s not a good idea. Even if you’re retired, having a balanced portfolio of stocks and bonds so that your money keeps up with inflation, or even grows, makes sense. But retirees may want to think about having enough cash set aside for a year’s worth of living expenses and big payments needed over the next five years.

Miles Kimball
Miles Kimball is Professor of Economics and Survey Research at the University of Michigan. Politically, Miles is an independent who grew up in an apolitical family. He holds many strong opinions—open to revision in response to cogent arguments—that do not line up neatly with either the Republican or Democratic Party.

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