What's the worst about Sweden

Sweden: role model or deterrent example?

The coronavirus has paralyzed all of Europe. Only one country is less strict - Sweden. Many restaurants and shops are open, as are kindergartens and schools for under 16s. Sweden has waived bans and strict restrictions. The strategy is: If you feel sick, stay at home, if you are over 70 years old or have a previous illness, you should avoid social contacts. The authorities in Sweden also advise you to keep your distance, if possible, to work from home, and to wash your hands frequently. Like Austria since May 1st, Sweden has lived since the beginning of this pandemic.

Despite everything, social life has also declined significantly in Sweden. According to data from Google for stops and train stations, these were 35 percent less busy in Sweden at the end of April, while the decline in Austria was 45 percent. In Sweden, the time spent at home increased by nine percent, in Austria by 14 percent.

Deaths postponed

Anders Tegnell is an epidemiologist at the Swedish Health Authority, whose recommendations are followed by the policy in Sweden. He often speaks of herd immunity and believes parts of his country could reach them as early as May. At the same time, he keeps emphasizing that this is not the strategy that Sweden has chosen. You just try - as elsewhere - to keep the number of infections low. Sweden has so far 2,854 deaths in a population of 10.2 million. In Austria there are 608 out of 8.9 million.

The comparatively high number of deaths in recent weeks is also what the critics of the Swedish strategy use as evidence of failure. Epidemiologist Johan Giesecke, who advises the Swedish government and WHO, has an answer. Many countries have only postponed their deaths into the future, after the lockdown, he believes. In a year's time, one should compare the death rates of the countries, then they will be about the same, he suspects - with the difference that the Swedish economy is doing better and there are fewer follow-up costs of a strict lockdown, such as suicides, mental illness or other, while Illnesses inadequately treated during the pandemic. And: the citizens were not locked up, given them freedom and they were not patronized.

No more dead

The Graz public health expert Martin Sprenger, who was part of the advisory team for the management of the corona pandemic at the Ministry of Social Affairs until the beginning of April, is of a similar opinion. He believes there will be no more deaths in both Austria and Sweden at the end of the year than in 2019 or 2021. His reasoning for this: "A virus like this hits those who are closest to death. They are, at least in these two countries, now died of Corona instead of a natural death a few months later. " After excess mortality in March and April, Sprenger expects immortality in the months thereafter. In Sweden, too, the average age of those who died of Covid 19 was 81 years.

The epidemiologist Eva Schernhammer from Med-Uni Vienna sees it differently. You can already see that the total mortality from Corona has increased in many countries: "I can't get much out of it that it will even out at the end of the year," she says. And further: "Sweden took a big risk with it. And for how relaxed the measures are there, the country got away with it lightly."

When it comes to human life, "it is better not to risk anything and act more strictly than to regret something afterwards," says Schernhammer. And Sprenger also confirms that he would not have chosen the Swedish route: "With as much uncertainty as we had in mid-March, the principle of caution is important," he says. But when it became clear at the end of March that the hospitals in Austria would not reach their limits, "one would have had to concentrate on other types of damage, such as standard care or economic effects," Sprenger continued.

Criticism in the country

The Swedes' course, which is primarily dictated by experts and not by politicians, has been criticized again and again in the country. In mid-April, 22 high-ranking scientists criticized the health authorities and called on politicians to intervene with stricter measures. They cited the overall mortality rate as a reference, which is also significantly higher in comparison with neighboring countries Denmark and Finland.

But those responsible have a different view of comparisons with other countries. Johan Carlson, Director General of the Public Health Agency, announced on Swedish television: It is not Sweden that dares to experiment with its population, but all other countries that want to lock people up for several months.

And again and again in Sweden people rely on evidence, more precisely on the fact that it does not exist. For example when it comes to school closings. There is simply no evidence that they have an epidemiological benefit, Tegnell emphasizes again and again. In addition, it is of crucial importance for mental and physical health that the younger generation remains active, said Tegnell in an interview with the journal "Nature". There are also voices in Austria who praise Swedes for this attitude. For example, health expert Claudia Wild from the Austrian Institute for Health Technology Assessment: "In my opinion, political decisions like this require that so many people, yes, that the whole world has to stay at home, scientific evidence," she says.

No country match

Another problem with the assessment of right and wrong is that both the number of infections and deaths are difficult to compare because they are often collected differently in different countries. "It is almost unbearable how people manipulate numbers in order to get their own view of things through," says Sprenger, using Sweden as an example. "Everyone is basing on the country, but this is not a country match," he says and criticizes everyone who sees the situation as a competition instead of an opportunity to learn from each other. And Schernhammer adds: "Every country is trying in its own way to cope with the uncertain situation."

Regardless of this, numerous factors influence the development of a pandemic in different countries. Country comparisons are therefore difficult from the outset. "We don't understand a lot at the moment. For example, why some countries suffer so badly and others hardly," says Schernhammer. She cites Haiti and the Dominican Republic as examples. The two adjoining countries are affected in extremely different ways. In the former there are 100 confirmed cases and twelve deaths, in the latter 8,480 cases and 350 deaths.

Many single households

In the case of Sweden, there are several factors that could be decisive: The country is much less populated than Austria. However, Stockholm, where the majority of infections and 60 percent of Swedish deaths have occurred, is more densely populated than Vienna. In addition, Sweden is the country with the most single households in Europe, traditionally relies more on the voluntary nature of its citizens, and shaking hands is less common in everyday life than in Austria. What could have increased the infections: When the virus spread in northern Italy, Sweden was on spring break and many were on skiing holidays in the Alps. The supply situation could also play a role: Sweden has 5.8 intensive care beds per 100,000 inhabitants, in Austria it is 21.8.

There is also a different mentality: press conferences in Sweden are sober and factual. And if something has gone wrong, those responsible admit it, says Sprenger, who sees essential differences to Austria here: "The Swedes do not just allow something to be prescribed, they would feel incapacitated. They want to understand why something has to happen, and then they stick to it. "

One factor has probably had the greatest influence on the number of deaths: In Sweden, a particularly large number of people have died in old people's and nursing homes; it is estimated that it is almost a third of the cases, in Stockholm it affects every second death. The government has admitted omissions here. A visit to these facilities was only prohibited from April 3.

No second wave

And what are the scenarios for the future? Has Sweden possibly survived the worst and Austria has a second wave yet to come? All of this will only become apparent afterwards. From previous pandemics, according to Schernhammer, we know that some regions are relatively spared from a first wave, but can be hit harder by a second.

For Sprenger it is at least one possibility that the virus will not come back as a wave at all: "Maybe instead there will only be individual local infections, which has now also become a real option for me," he says and is certain: "The Austrian health care will no longer have any problems with this pandemic. " Accordingly, it might even be possible to find a more objective, less emotional and knowledge-based way of dealing with viruses in the future - just a bit like in Sweden. (Bernadette Redl, 7.5.2020)