Sweden does not mind standing out from the crowd on coronavirus, and the latest sign is on its refusal to introduce face masks. The Scandinavian country, renowned for its lighter-touch approach to Covid-19 regulations, is one of the few European countries not to recommend using face masks after neighbouring Norway, Denmark and Finland all changed their positions in the past week.
“It is very dangerous to believe face masks would change the game when it comes to Covid-19,” Anders Tegnell, Sweden’s state epidemiologist, told the Financial Times. Mr Tegnell has been branded stubborn by some for again refusing to follow most of the continent.
But infectious disease specialists say there are reasons why Sweden has so far resisted their use for the general population. Jonas Ludvigsson, professor of clinical epidemiology at Karolinska Institute in Stockholm, said one was the way the country was governed. In Sweden, independent bodies such as Mr Tegnell’s public health agency played a “very strong role” and elected officials listened to them, he said. “In Denmark and Norway, politicians have a stronger role.
Politicians in this era of crisis want to look strong and don’t always take decisions that are evidence-based,” he added. Face mask use in other Nordic countries will also be fail limited. In Norway, they are recommended on rush-hour public transport; in Denmark, they will from Saturday be compulsory on public transport but not elsewhere.
Soren Riis Paludan, a viral infections expert from Aarhus University, said research had suggested that at Denmark’s current infection rate 100,000 people would have to wear face masks properly for a week to avoid one infection. “If there’s very little virus in the community, the effect is limited. But if you’re in the middle of a hotspot, then everything says that they can have an effect. In Denmark, we have compromised and said face masks may be another tool in the toolbox,” Prof Paludan said.
Another reason for Swedish reluctance, according to experts, is high trust in the authorities. “When the Swedish health agency says there’s no reason to wear face masks, people don’t wear face masks,” said Prof Ludvigsson. “In other countries, where there’s less trust and they don’t recommend wearing masks, people might do it anyway.”
Prof Paludan agreed but added another element for Denmark: the importance of seeing people’s faces to help establish trust. Parliament two years ago banned the Islamic burka, niqab and other full-face coverings. “It’s tangled into a very complex debate,” he said. Nordic experts also point to a lack of hard evidence over the effectiveness of face masks.
Many countries as well as the World Health Organization have changed their advice on wearing masks as studies have appeared to point to a link between their use and lower infection rates. But some Nordic experts are still sceptical. Mr Ludvigsson noted that in a meta-analysis by the WHO of 29 studies that showed face masks were effective, only three concerned their use outside hospitals and of those that did not none involved Covid-19.
Still, he said his personal position had changed and he now believed they should recommend their use on public transport in Sweden but for a set period. “It would increase compliance if people know it’s only for three months,” he added.
Mr Tegnell himself is keeping an open mind. “Face masks can be a complement to other things when other things are safely in place. But to start with having face masks and then think you can crowd your buses or your shopping malls — that’s definitely a mistake,” he said, adding that countries such as Belgium and Spain with widespread mask use still had rising infection rates.
Sweden’s public health agency said on Tuesday that it was working on proposals for the government in the next few weeks and could open up for face mask use in specific circumstances such as visits to hospitals or dentists. Sweden is not the only European country sceptical about face masks. In The Netherlands, they must be worn on public transport and at airports but are not mandatory elsewhere.
The government’s medical advisers have said there was “insufficient” evidence that face coverings help prevent the spread of coronavirus although a group of 11 behavioural and public health experts this month called that position “stubborn”. The Netherlands registered more than 4,000 new Covid-19 cases in the week to August 18, the highest level since late April, while its infections per capita surpassed Sweden’s last week for the first time in four months.
Ben Coates, author of Why the Dutch are Different, said wearing masks had become a “totemic” issue and was tied up with a wider debate about personal freedom in the Netherlands. “There is a libertarian streak in the Netherlands which values personal freedom — where people are not instructed on how to behave by the government but trusted to act for the public good,” he added.
Prof Paludan said public acceptance was crucial in the Nordic region and that, for instance, forcing people to wear them in the street would probably be resisted. “For Danes and Scandinavians, things have to make sense to impose them,” he added.