What is wrong with Sweden? Measures during the coronavirus pandemic: one right approach for all?

By Ala Sivets

In Sweden, just like in Belarus? An attempt to find out.

As the Covid situation relatively improved in the European Union over the summer, the cases increased in the Americas and Asia and it now seems that Europe is entering the second wave WHO was foreseeing in June. Somewhere in the middle of this ocean of events, Sweden’s soft measures left no one indifferent and created fertile ground for the holy war on approaches to stop the spread of the pandemic and conspiracy theories.

The situation has caused a lot of resonance in the EU and abroad. However, it seems that it especially disturbed the minds of Belarusians, who live in the country where the only football league in Europe kept playing for months after the rest of the continent had been put under lockdown, of the only World War II parade being held and of the general denial of coronavirus containment measures. Being accustomed to the long-lasting contempt of their government, Belarusians are genuinely confused with the measures of the world’s most reputable country – Sweden.

As a Belarusian living in Sweden and observing trends in both countries, I see this comparison as a peculiar case worth deeper discussion. This is not only to distinguish between the approaches of these countries and show the uselessness of such a comparison, but to gain a little more clarity about how, in principle, different countries approached (or could have approached) the choice of measures to contain the pandemic.

On social media, conversations about the measures recommended by the WHO and adopted by many countries, suggest that not everyone understands the logic of quarantine measures. Consequently, the Swedish approach is either severely criticized or dramatically idealized. But, as you know, life is more complex than this dichotomy. Fasten your seat belts and let’s try to figure it out from the very beginning.

The whales, elephants and turtles of coronavirus pandemic: flattening the curve

Since the discovery of the virus in China, its spread and effect has been growing exponentially. The specificity of Covid-19 is that it attacks more harshly the most vulnerable – meaning the elderly and people with an existing medical condition. The rapidly growing number of patients with coronavirus is equal to rapidly filling hospital beds. As no country had enough trained specialists to work with mechanical ventilation and to welcome such a number of people who needed intensive care, nobody was ready for this.

Since the beginning of the summer, WHO announced the likeliness of  a second wave, or even several waves, until 50-60% of people get sick. Under the laws of epidemiology, in order for the mass spread of the infection to decline, resistance to infection must be developed. This phenomenon is called herd immunity[7]  – that is, a large part of the population must get sick and recover. Options not to get sick are possible only with genetic resistance or vaccination, or the aforementioned herd immunity, when a meeting with a virus carrier becomes more of a rare case than common. Of course, this works only if we assume that there is a lack of probability to be infected a few times.

In the end, it is incorrect to compare statistical data for several months on Covid-19 with other diseases, like the flu:
– the growth of the disease is non-linear,
– statistics in some countries are opaque,
– countries mainly do not provide mass testing and statistics show only confirmed cases,
– there are no international standards as to who should be counted as a victim of corona virus,
– no vaccine exists for coronavirus and therefore it is difficult to predict its future development.

Mathematicians from the institute of health metrics and evaluation – and I want to believe that they are the best in predicting probabilities – had estimated in April that within a year, the number of deaths from coronavirus could reach more than one million, a number that was actually reached in September 2020. Quarantine and isolation are not a panacea: Humanity is. Lockdowns are mainly a way to gain time before the development of a vaccine.

Why are there more cases in some countries than in others? Is corona a myth?

The unknown affecting our life so massively provokes a reasonable degree of anxiety. It is in human nature to assign meanings to life events and revise the existing worldview especially at critical moments when the ground under the feet seems to disappear. The process is tied to psychological resilience that ensures our ability to cope with the crisis,  adapt to survive and not to fall into endless despair and rumination.

Our worldview depends largely on the narratives, discourses and practices existing in our histories and cultures. Therefore, some tend to rely on scientific analysis, which is slow because it requires data and proved causality. Others rely on spiritual interpretations, which by their nature are much quicker to give an event meaning. They reproduce familiar relationships and connections, and the understanding gives us some feeling of stability in this enduring chaos.

As a part of this, the belief in supernatural power of a global elite totally taking control over our freedoms has become predominant during the coronavirus crisis. In the plot of these theories, this elite either kills us or uses a pandemic to introduce chips in our bodies – or there is no virus at all and quarantine is used to create a new world order. The different measures and statistics from one country to another can breed such myths. Nevertheless, it is worth attempting to analyze facts first, without any guesswork.

Take, for example, Italy. In terms of demographics, Italy is one of the top three oldest countries in the world and the oldest in the EU. From a cultural point of view, Italian society is more community-based than individualistic: it is essential to meet up with people, live in large families of several generations and have close physical contacts. Italy being the fifth most visited countries in the world, it was particularly exposed to the virus’ exportation.

In addition, the introduction of quarantine measures in a country that was barely pulling itself out of economic stagnation, with a high level of unemployment, looked like economic suicide. This may explain the state’s hesitation when it came to introducing quarantine regimes. At a certain point, it was no longer possible to deny how bad the situation was: lives had to be saved, and the country was locked down.

On the other hand, in countries like Belarus the virus revealed issues that had been brewing for long, such as poor infrastructure, low living standards, a significant cultural and an economic gap between the cities and its periphery, lack of social guarantees, rigidness of the governmental system and the lack of cooperation between the government and the scientific sector as a whole. Recognizing the problem and quarantining means implementing relief measures. However, in authoritarian countries’ sensitivity to people’s comfort and struggles is not common. In such countries, therefore, the virus does not exist, and if it exists, we will not see real statistics.

In most states, facts are followed by responsibility but in authoritarian regimes, they bring about impunity. However, open impunity spoils the international image, so it becomes easier just to deny everything, sit in a tractor and go play with the cute baby goats. As economists point out: the statistics from these countries say more about politics rather than the progression of the virus.

The ex-totalitarianism and current authoritarianism deeply anchored in the consciousness of the people, could explain the popularity of the conspiracy theories in the post-soviet region. As authorities have built authoritarian relations with the people for decades, where trust in everything that the authorities broadcast is the key to basic safety, it is safer not to trust your feelings and thoughts, while sinking deeper into the Stockholm syndrome: there is no virus and no quarantine in the country – because we are protected from psychosis and chipping. Why would the government betray us?

What about Sweden?

Among the various measures taken to curb the coronavirus, Sweden will stand out not only in its specific approach, but also in that it happened in one of the most moderate and not venturous countries in the world. It surprises many and not without a reason. But how does what is happening in Sweden fit into the Swedish cultural context?

Sweden is a large country with a small population compared to its size. Its 10,3 million inhabitants are distributed unevenly, increasing in density in the south. Unlike southern Europe, different generations of the family here do not tend to live together and Swedes are known for their respect for personal space, both metaphorically and physically. As Norwegian epidemiologist John-Arne Røttingen ironically pointed out: “In Nordic countries we sometimes joke that, when they told us that we can stop having to keep two meters between each other, we said ‘Phew, finally, we can go back to our usual five meters.’” Sweden is also a country with mutually shared level of trust between the government and the people. In addition, unlike in other European countries, the Swedish law stipulates that in critical cases as a pandemic, the country’s leaders rely on the expertise of professionals in the field – in this case, scientists and the health department.

The existing economic model and attention to the mental health of citizens at risk of unemployment played a role in the Swedish approach. Sweden has a very strong welfare state, where high taxes allow to balance social inequalities. Thus, it strongly depends on ongoing employment. Given all these aspects, by deciding to maintain a balance between public health and economic support, Sweden took the risk of living just one wave while building herd immunity.

The country’s main epidemiologist, Anders Tegnel, quite in the spirit of the Swedish contextual composition, suggested that people be aware of the threat, and then conscious and responsible of their actions. He said: “[In this model of interaction between the state and the population] you give them the option to do what is best in their lives.” His colleague added: “Therefore, you don’t need to micromanage or control behavior at a detailed level through prohibitions or threat of sanctions or fines or imprisonment.” The way Sweden handled the covid crisis fits the Swedish sociocultural, political, demographic and economic situation, but is unlikely to work in India, Belarus, Brazil, the USA or Italy – and this is important to understand.

In addition, measures recommended by WHO were adopted too: the distance between tables in cafés was increased,public places were cleaned more often and passengers now get on buses through the back door. The biggest restrictions taken in Sweden are the recommendation to people at risk and those over 70 to stay at home, the ban on events of more than 50 people, the transition to online education (and work, if possible) and the ban on visiting hospitals and nursing homes. But there, Sweden blundered.

Flashback

As the situation with the virus was heating up and tourism was not yet banned, COVID19 arrived in Sweden. Suddenly, the virus enters nursing homes in Stockholm. Half of the total number of deaths of the group of 70 years or older are from the nursing homes, plus a quarter of them have been receiving home care.

Among the reasons for getting the virus into homes are the admission of new residents and the return of residents from hospitals. Some say that the precautions were not followed – the staff did not use gloves, masks and an antiseptic – to be fair, this was quickly fixed, but too late. Others complain about the rotation of workers between potentially infected and healthy elderly people; the rotation even between several nursing homes, and the lack of medical education and staff flair. In their defense, however not in favor of the Swedish approach, the testing policy in Sweden could have been more effective.

Testing was only done on patients with serious symptoms like breathing difficulties, while others were advised to just stay at home. This eliminates the detection of an asymptomatic course of the disease in working personnel. Thus, workers followed the prescriptions and at the same time, they treated themselves similarly if they had mild symptoms – without being tested. Most of them simply could not afford not to work as they were employed under a short-term contract and risked losing their jobs without social guarantees.

The death of the elderly does not diminish the significance of these deaths. But maybe this makes the Swedish approach less monstrous: the virus ended up in confined spaces with the most vulnerable group, and this shocking number of deaths is not only the result of Sweden not introducing strict quarantine: the overall age of the population influences the mortality rate of Covid-19. Among other countries where nursing homes are most affected are France, Spain, Belgium and the UK, but not all of these countries include these deaths in their official statistics or have begun to do so relatively recently. This makes the statistics unreliable unfortunately for the worse.

However, along with the dry statistics, there are also ambient factors from the social sciences, for example, structural inequality. Not everyone has the opportunity to practice social distancing, even in Sweden. The most affected areas in Stockholm are those where people with a refugee background live. Even with high qualifications, these people are often forced to engage in low-skilled labor, in environments, where it is easier to catch the virus. As they do not receive a high income, lack a balanced diet, while experiencing post-traumatic disorder for many their health is thus more fragile. They often live in large families with several generations in a small room. In addition, the coronavirus informational agenda was initially held in Swedish, but not all immigrants master the language. As a result, there are three times more cases of coronavirus among people with a refugee background in Stockholm than among native Swedes. And here the narrative begins to converge, doesn’t it?

Conclusion: Between hypes and facts

There were two hype points about Sweden on the Russian-speaking Internet: when the Swedish approach was compared to the Belarusian’s and when all media reported on the speech of the Swedish epidemiologist Anders Tegnel, arguing that “Sweden recognized its total failure”.

Seriously? Firstly, notification of the situation in Sweden occurs regularly and transparently – about the number of cases, security measures, government reaction policies, results, mistakes and changes in work.  The state informs the population, provides all the data and support for civic awareness and responsibility of people. Already at this stage, it makes no sense to compare Sweden with Belarus neither the reasons for the existing measures, nor their results. We have two completely different contexts – political and sociocultural.

In the case of Sweden’s results, it is questionable to blame the government when it relies on your individual conscience and responsibility, out of respect for the uniqueness of your life practices, while providing support for different options, including isolation. There were many risks in this freedom, and they affected the less protected group of the population, but the authorities discovered this mistake without blaming the victims, recognized and corrected it. This cannot be said about the Belarusian government’s handling of the crisis, which ended up relying completely on civil society.

Secondly, Anders Tegnel pointed out, “if we encountered the same disease, knowing what we know today, I think we would end up doing something in the middle between what Sweden did, and what the rest of the world did. There’s potential to improve upon what we have done in Sweden, of course. And it would be good to know exactly what should be closed down to better hinder the spread of the disease. He also added that, as countries begin to weaken quarantine measures, it will be possible to monitor the behavior of the infection and determine which of the measures were the most effective, and then compare them with the Swedish ones. This does not sound like a “recognition of failure”.

Here, as with statistics, it seems like the way the media behave tells more about politics than facts.  Condemning the Swedish approach is understandable – raw data on mortality cause anxiety and bewilderment. By following the collective instinct – which makes it seem like those who are many are right – we tend to forget that each approach right now is an experiment.

Thus, the eagerly desired comparison of the effectiveness of measures, weighed down by the lack of uniform statistics and without considering very different contexts in countries, leads to rushed conclusions. This pandemic is a unique phenomenon for all countries and exposes political maneuvers as well as cultural codes and social and structural problems. Thus, perhaps, it tells us more about each other than we were comfortable knowing… which means there is a chance for a more comprehensive reading of events.

Picture Credits: Karolina Grabowska, Pexels

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