In the coronavirus fight in Scandinavia, Sweden stands apart

A photo taken on March 13, 2020, shows tourists with protective face masks visit an old town in Stockholm. PHOTO: AFP

STOCKHOLM (NYTIMES) - When the coronavirus swept into Scandinavian countries, Norway and Denmark scrambled to place extensive restrictions on their borders to stem the outbreak. Sweden, their neighbour, 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 pre-schools, 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 scope and reach. Sweden's approach has raised questions about whether it's gambling with a pandemic, 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 older than 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, Dr 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, he said.

"That's the way we work in Sweden. Our whole system for communicable disease control is based on voluntary action. The immunisation system is completely voluntary, and there is 98 per cent 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 Swedish authorities could still take stronger action as coronavirus hospitalisations rise.

In explaining Sweden's current strategy, experts point to other underlying factors: The country has high levels of trust, according to 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 behaviour 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 had 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.

Sweden initially banned gatherings of 500. Early in the outbreak, some event organisers 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.)

Dr 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 neighbours' 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.

People walk at Strandvagen in Stockholm on March 28, 2020, during the the coronavirus pandemic. PHOTO: AFP

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

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 Ms 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."

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