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‘Life Has to Go On’: How Sweden Has Faced the Virus Without a Lockdown ‘Life Has to Go On’: How Sweden Has Faced the Virus Without a Lockdown
(7 days later)
STOCKHOLM — She stood leaning on her cane, briefly resting among dozens of bubbly young Swedes out enjoying one of the first sunny spring days of the year.STOCKHOLM — She stood leaning on her cane, briefly resting among dozens of bubbly young Swedes out enjoying one of the first sunny spring days of the year.
“I’m trying not to get too close to people,” said Birgit Lilja, 82, explaining that she had left her house to pick up a new identity card in person. “But I trust them to be careful with me.”“I’m trying not to get too close to people,” said Birgit Lilja, 82, explaining that she had left her house to pick up a new identity card in person. “But I trust them to be careful with me.”
Trust is high in Sweden — in government, institutions and fellow Swedes. When the government defied conventional wisdom and refused to order a wholesale lockdown to “flatten the curve” of the coronavirus epidemic, public health officials pointed to trust as a central justification.Trust is high in Sweden — in government, institutions and fellow Swedes. When the government defied conventional wisdom and refused to order a wholesale lockdown to “flatten the curve” of the coronavirus epidemic, public health officials pointed to trust as a central justification.
Swedes, they said, could be trusted to stay home, follow social distancing protocols and wash their hands to slow the spread of the virus — without any mandatory orders. And, to a large extent, Sweden does seem to have been as successful in controlling the virus as most other nations.Swedes, they said, could be trusted to stay home, follow social distancing protocols and wash their hands to slow the spread of the virus — without any mandatory orders. And, to a large extent, Sweden does seem to have been as successful in controlling the virus as most other nations.
Sweden’s death rate of 22 per 100,000 people is the same as that of Ireland, which has earned accolades for its handling of the pandemic, and far better than in Britain or France.Sweden’s death rate of 22 per 100,000 people is the same as that of Ireland, which has earned accolades for its handling of the pandemic, and far better than in Britain or France.
Yet, on this warm spring day, at least, there was little evidence that people were observing the protocols — adding further mystery to Sweden’s apparent success in handling the scourge without an economically devastating lockdown.Yet, on this warm spring day, at least, there was little evidence that people were observing the protocols — adding further mystery to Sweden’s apparent success in handling the scourge without an economically devastating lockdown.
All around Ms. Lilja along Skanegatan Street in the Sodermalm neighborhood of Stockholm, younger Swedes thronged bars, restaurants and a crowded park last week, drinking in the sun.All around Ms. Lilja along Skanegatan Street in the Sodermalm neighborhood of Stockholm, younger Swedes thronged bars, restaurants and a crowded park last week, drinking in the sun.
They laughed and basked in freedoms considered normal in most parts of the world not long ago, before coronavirus lockdowns, quarantines and mass restrictions upended social norms. As other nations in Europe begin to consider reopening their economies, Sweden’s experience would seem to argue for less caution, not more.They laughed and basked in freedoms considered normal in most parts of the world not long ago, before coronavirus lockdowns, quarantines and mass restrictions upended social norms. As other nations in Europe begin to consider reopening their economies, Sweden’s experience would seem to argue for less caution, not more.
“My respect for those who died, but we are doing something right here in Sweden,” said Johan Mattsson, 44, as he was having a drink at a cafe on Skanegatan Street.“My respect for those who died, but we are doing something right here in Sweden,” said Johan Mattsson, 44, as he was having a drink at a cafe on Skanegatan Street.
The restaurant consultant praised the freedoms he had in Sweden compared to other countries. “I’m not seeing very different statistics in many other countries,” he said. “I’m happy we didn’t go into lockdown. Life has to go on.”The restaurant consultant praised the freedoms he had in Sweden compared to other countries. “I’m not seeing very different statistics in many other countries,” he said. “I’m happy we didn’t go into lockdown. Life has to go on.”
While other countries were slamming on the brakes, Sweden kept its borders open, allowed restaurants and bars to keep serving, left preschools and grade schools in session and placed no limits on public transport or outings in local parks. Hairdressers, yoga studios, gyms and even some cinemas have remained open.While other countries were slamming on the brakes, Sweden kept its borders open, allowed restaurants and bars to keep serving, left preschools and grade schools in session and placed no limits on public transport or outings in local parks. Hairdressers, yoga studios, gyms and even some cinemas have remained open.
Gatherings of more than 50 people are banned. Museums have closed and sporting events have been canceled. At the end of March, the authorities banned visits to nursing homes.Gatherings of more than 50 people are banned. Museums have closed and sporting events have been canceled. At the end of March, the authorities banned visits to nursing homes.
That’s roughly it. There are almost no fines, and police officers can only ask people to oblige. Pedestrians wearing masks are generally stared at as if they have just landed from Mars.That’s roughly it. There are almost no fines, and police officers can only ask people to oblige. Pedestrians wearing masks are generally stared at as if they have just landed from Mars.
On Sunday, five restaurants were closed down for failing to observe social distancing requirements. They were not fined, however, and will be permitted to reopen after passing an inspection, Per Follin, the regional medical officer with the Department of Communicable Disease Control and Prevention, said.On Sunday, five restaurants were closed down for failing to observe social distancing requirements. They were not fined, however, and will be permitted to reopen after passing an inspection, Per Follin, the regional medical officer with the Department of Communicable Disease Control and Prevention, said.
Throughout the crisis Sweden has had enough intensive care units to deal with Covid-19 patients, the minister of health and social affairs, Lena Hallengren, said in an interview, referring to the disease caused by the virus. “We have 250 empty beds right now.”Throughout the crisis Sweden has had enough intensive care units to deal with Covid-19 patients, the minister of health and social affairs, Lena Hallengren, said in an interview, referring to the disease caused by the virus. “We have 250 empty beds right now.”
A compilation of mortality figures by The New York Times found that many countries were undercounting Covid-19 deaths by the thousands, while Sweden reported just 400 more deaths than expected between March 9 and April 19.A compilation of mortality figures by The New York Times found that many countries were undercounting Covid-19 deaths by the thousands, while Sweden reported just 400 more deaths than expected between March 9 and April 19.
This is not to say that Sweden has escaped Covid-19’s deadly consequences entirely.This is not to say that Sweden has escaped Covid-19’s deadly consequences entirely.
The Swedish Public Health Authority has admitted that the country’s seniors have been hit hard, with the virus spreading through 75 percent of the 101 care homes in Stockholm. Employees of the homes complain of shortages of personal protective equipment.The Swedish Public Health Authority has admitted that the country’s seniors have been hit hard, with the virus spreading through 75 percent of the 101 care homes in Stockholm. Employees of the homes complain of shortages of personal protective equipment.
The authority announced last week that more than 26 percent of the 2 million inhabitants of Stockholm will have been infected by May 1. But even that figure was presented as something of a win: a number of infections that might limit future outbreaks, reached without suffering an inordinate number of deaths.The authority announced last week that more than 26 percent of the 2 million inhabitants of Stockholm will have been infected by May 1. But even that figure was presented as something of a win: a number of infections that might limit future outbreaks, reached without suffering an inordinate number of deaths.
The freer approach has not fully insulated Sweden’s economy, mainly because the country is dependent on exports, the minister of finance, Magdalena Andersson, said. She said the economy was likely to shrink by 7 percent this year, “but of course hairdressers, restaurants and hotels are less affected compared to other countries.”The freer approach has not fully insulated Sweden’s economy, mainly because the country is dependent on exports, the minister of finance, Magdalena Andersson, said. She said the economy was likely to shrink by 7 percent this year, “but of course hairdressers, restaurants and hotels are less affected compared to other countries.”
From the first signs of the pandemic, the Swedish Public Health Authority decided that a lockdown would be pointless. “Once you get into a lockdown, it’s difficult to get out of it,” the country’s state epidemiologist, Anders Tegnell, said. “How do you reopen? When?”From the first signs of the pandemic, the Swedish Public Health Authority decided that a lockdown would be pointless. “Once you get into a lockdown, it’s difficult to get out of it,” the country’s state epidemiologist, Anders Tegnell, said. “How do you reopen? When?”
Scientists like Mr. Tegnell, who has become something of a celebrity in Sweden, and not politicians have driven the debate over the coronavirus response.Scientists like Mr. Tegnell, who has become something of a celebrity in Sweden, and not politicians have driven the debate over the coronavirus response.
Political leaders rarely attend news conferences about the virus, and the Swedish Constitution prevents the government from meddling in the affairs of independent administrative authorities, such as the Public Health Authority.Political leaders rarely attend news conferences about the virus, and the Swedish Constitution prevents the government from meddling in the affairs of independent administrative authorities, such as the Public Health Authority.
While there was some early talk in Sweden of achieving “herd immunity,” which would mean infecting at least 60 percent of the population, Mr. Tegnell denies that was ever the government’s policy. Updated June 22, 2020
“Basically we are trying to do the same thing that most countries are doing — slow down the spread as much as possible,” he said. “It’s just that we use slightly different tools than many other countries.” A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
When responses are assessed after the crisis, Mr. Tegnell acknowledges, Sweden will have to face its broad failing with people over the age of 70, who have accounted for a staggering 86 percent of the country’s 2,194 fatalities to date.
Updated June 16, 2020
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
While there was some early talk in Sweden of achieving “herd immunity,” which would mean infecting at least 60 percent of the population, Mr. Tegnell denies that was ever the government’s policy.
“Basically we are trying to do the same thing that most countries are doing — slow down the spread as much as possible,” he said. “It’s just that we use slightly different tools than many other countries.”
When responses are assessed after the crisis, Mr. Tegnell acknowledges, Sweden will have to face its broad failing with people over the age of 70, who have accounted for a staggering 86 percent of the country’s 2,194 fatalities to date.
That percentage is roughly on par with most other countries, but some critics here say the mortality rate among seniors could have been far lower with adequate preparation. In a letter to one of Sweden’s most prominent newspapers, Dagens Nyheter, 22 scientists accused the Public Health Authority of negligence.That percentage is roughly on par with most other countries, but some critics here say the mortality rate among seniors could have been far lower with adequate preparation. In a letter to one of Sweden’s most prominent newspapers, Dagens Nyheter, 22 scientists accused the Public Health Authority of negligence.
“They tell people, stay home, but they also keep the restaurants open,” said Lena Einhorn, a virologist and one of the signatories of the letter. “They are advising people working in elderly homes only to wear masks when a patient is sick. Their policies are both ambiguous and rigid.”“They tell people, stay home, but they also keep the restaurants open,” said Lena Einhorn, a virologist and one of the signatories of the letter. “They are advising people working in elderly homes only to wear masks when a patient is sick. Their policies are both ambiguous and rigid.”
In the absence of recommendations from the Public Health Authority, a Jewish care home near Stockholm unilaterally decided to ban visitors, said Aviva Kraitsik, the head of operations, who asked that the facility’s name be withheld because of previous threats it has received.In the absence of recommendations from the Public Health Authority, a Jewish care home near Stockholm unilaterally decided to ban visitors, said Aviva Kraitsik, the head of operations, who asked that the facility’s name be withheld because of previous threats it has received.
The health authority even went so far as to order the “no visitors” signs removed. Ms. Kraitsik refused. “I said they could put me behind bars,” she said. “I was prepared to take my punishment to protect our residents.”The health authority even went so far as to order the “no visitors” signs removed. Ms. Kraitsik refused. “I said they could put me behind bars,” she said. “I was prepared to take my punishment to protect our residents.”
But it was too late. The virus had already crept inside, and eventually killed 11 of the 76 inhabitants.But it was too late. The virus had already crept inside, and eventually killed 11 of the 76 inhabitants.
It was only after the home required employees to wear face shields and masks when working with all the residents, even those displaying no symptoms, that it managed to halt the spread of the infection, Ms. Kraitsik said.It was only after the home required employees to wear face shields and masks when working with all the residents, even those displaying no symptoms, that it managed to halt the spread of the infection, Ms. Kraitsik said.
The minister of health and social affairs, Ms. Hallengren, acknowledged that there had been a shortage of protective gear, though she also noted that “many people in the health care sector for the elderly aren’t used to working with P.P.E.”The minister of health and social affairs, Ms. Hallengren, acknowledged that there had been a shortage of protective gear, though she also noted that “many people in the health care sector for the elderly aren’t used to working with P.P.E.”
“They should have been able to prevent this,” said Elisabeth Asbrink, a writer and publicist who has been critical of the government’s approach. In recent years Sweden, like many other countries, has transferred such homes from state to private control, she said, and the level of care had suffered. “This has not been good for the weak and the elderly, especially now.”“They should have been able to prevent this,” said Elisabeth Asbrink, a writer and publicist who has been critical of the government’s approach. In recent years Sweden, like many other countries, has transferred such homes from state to private control, she said, and the level of care had suffered. “This has not been good for the weak and the elderly, especially now.”
Such thoughts were far from the minds of the dozens of graduating students who gathered to celebrate Friday night in several bars on Medborgarplatsen Square in Stockholm. They crowded around the bar, hugging and kissing, and generally flouting the rules. The police made no move to stop them.Such thoughts were far from the minds of the dozens of graduating students who gathered to celebrate Friday night in several bars on Medborgarplatsen Square in Stockholm. They crowded around the bar, hugging and kissing, and generally flouting the rules. The police made no move to stop them.