Do not judge Sweden until the autumn. That was the message from its state epidemiologist Anders Tegnell in May and through the summer as he argued that Sweden’s initial high death toll from Covid-19 would be followed in the second wave by “a high level of immunity and the number of cases will probably be quite low”.
Now the autumn is here, and hospitalisations from Covid-19 are currently rising faster in Sweden than in any other country in Europe, while in Stockholm — the centre for both the first and second waves in the country — one in every five tests is positive, suggesting the virus is even more widespread than official figures suggest. “So far Sweden’s strategy has proven to be a dramatic failure,” said Lena Einhorn, a Swedish virologist and prominent critic of its strategy. “Four days ago, we had eight times higher cases per capita than Finland and three and a half times more than Norway. They were supposed to have it worse off than us in the autumn because we were going to have immunity.”
Even Sweden’s public health agency admits its earlier prediction that the country’s Nordic neighbours such as Finland and Norway would suffer more in the autumn appears wrong. Sweden is currently faring worse than Denmark, Finland and Norway on cases, hospitalisations and deaths relative to the size of their population.
“We also see that many other countries in Europe that had a big effect during the spring that had lockdowns and now again have lockdowns also see a big increase now. So it seems to follow this pattern that if you had a lot of cases during the spring you also see a lot of cases now,” Sara Byfors, a specialist at the health agency, said in response to a question from the Financial Times. She added: “We don’t know why this is.”
Mr Tegnell himself told the FT’s Global Boardroom event on Wednesday that it was “a big mystery” who had immunity and who did not. But he insisted Covid-19 was a “long-term haul” and that having a sustainable strategy that could work for many months or even years was the most important thing. Sweden is persisting with its strategy of standing out from other European countries by not ordering a formal lockdown. Instead, the public health agency issues recommendations on social distancing, hand hygiene, and working from home. It is the only European country not to compel people to wear face masks outside hospitals.
One difference with the second wave is that Sweden is also issuing local recommendations for regions with particularly high infections. It has issued such recommendations — such as to avoid shops or public transport — to more than two-thirds of the population. But Ms Byfors said it had yet to measure the effectiveness of the local recommendations, although she added that national advice such as on masks or travel could be implemented if needed. “By tradition, our law is based on voluntary measures . . . We will continue on this path and then expect all the people in Sweden will follow those recommendations and that will have the effect we aim for: to lower the spread of the disease,” she added.
Sweden’s strategy and the public health agency still enjoy strong public support, but there are some signs of dissent. Fredrik Sund, head of the infectious disease clinic at the university hospital in Uppsala, the first Swedish region to get local recommendations three weeks ago, told state broadcaster SVT on Friday that Sweden should consider a lockdown and quickly in order to handle the second wave. “We have seen in the past few weeks that the restrictions are not complied with. With such a rise in infections as is now happening, it is as if we in Sweden are in free fall,” he added.
The number of patients hospitalised with Covid-19 is doubling in Sweden every eight days currently, the fastest rate for any European country for which data is available. Its cases per capita have sextupled in the past month to more than 300 new daily infections per million people, close to the UK and way ahead of its Nordic neighbours. Mr Tegnell said that the numbers were “concerning” but added that Sweden still had 75-80 per cent capacity left in its intensive care and that the numbers were increasing in part because the country was hit later than others in Europe by the second wave.
More than one in 10 Covid-19 tests in Sweden are positive and one in five are in the capital, suggesting that its cases would be higher if it did more testing. This week, care homes in the capital said the virus was spreading rapidly again among residents, a worrying sign given that was where most of Sweden’s deaths in April, May and June occurred. Both Stockholm and Gothenburg, Sweden’s second-largest city, said on Wednesday they would ban visitors from care homes.
Critics are not expecting a reversal of Sweden’s position any time soon, arguing that the more the strategy is questioned, the more the public health agency digs in. “They are just being stubborn. They are unable to admit mistakes. The mistakes are costly,” said Dr Einhorn. More than 6,000 Swedes have died with coronavirus, putting its death rate on a per capita basis behind only Belgium, Spain, the UK, Italy and France in Europe.
Stefan Lofven, Sweden’s prime minister who has been widely criticised for inaction over coronavirus, said on Wednesday that bars and restaurants would be banned from selling alcohol after 10pm from Friday next week. Mr Tegnell said Sweden was stepping up its communication in areas where it saw problems, such as private parties. He added: “It’s going to be a long fight for all of us but we’re all going to have to adapt as we go along because there a lot of things we don’t know yet.”