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14 December 2020

How Sweden is being forced to abandon its failing Covid-19 strategy

The country hailed by lockdown sceptics has suffered one of the worst second waves in Europe.  

By James Savage

The tone was solemn, the message stark: “Don’t go to the gym. Don’t go to the library. Don’t have dinners. Don’t have parties. Cancel.” 

The grim words came from Swedish prime minister Stefan Löfven in a televised address on 16 November, in which he announced a ban on public events of more than eight people. At first glance, it appeared that Sweden, which had eschewed strict lockdowns since the start of the pandemic, had reversed its stance after spiralling Covid-19 infection rates. Was this an admission that the Swedish strategy had failed?

During the first wave of coronavirus, Sweden left most decisions on social distancing in the hands of individuals. People were asked to work from home if possible and avoid public transport, and many complied, but in legal terms the only major restriction on people’s freedoms was a ban on events of more than 500 people, a number that was later reduced to 50. A temporary law that allowed the government to close transport hubs, restaurants or shopping centres expired in July without being used. 

Anti-lockdown activists around the world looked to Sweden for inspiration, and Swedish flags were waved at protests in London, Berlin and the US. Sweden’s strategy was fronted not by politicians, but by the country’s Public Health Agency and its chief epidemiologist Anders Tegnell. His stated aim was to impose measures that would be sustainable over time and would prevent hospitals from becoming overwhelmed, rather than completely suppressing the disease. He also thought natural herd immunity would play a role in slowing the virus’s spread

[See also: Sweden’s Anders Tegnell: We did not pursue “herd immunity” against Covid-19​]​ 

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The first wave in Sweden was brutal: by June over 5,000 people had died after being infected with Covid-19. A study by Imperial College showed that while overall excess deaths in Sweden, at 58 per 100,000 for men and 49 per 100,000 for women, were lower than in countries including the UK, Spain and Belgium, neighbouring Norway, Denmark and Finland had no detectable excess deaths in the first wave.

By the autumn, however, the picture appeared more positive. As the second wave gathered pace in the UK and other parts of Europe, infections in Sweden remained low. As recently as the first week of October, Tegnell said he thought Sweden’s approach, with voluntary measures designed to gain public acceptance, might help it avoid a full-blown second wave.

That hope would soon be dispelled. By the end of November infections were rapidly accelerating, with a 14-day rate of 698 cases per 100,000, compared to 316 in the UK or 346 in Denmark. On 9 December Stockholm’s health authority declared that 99 per cent of its intensive care beds were occupied and asked national authorities to help them find extra staff.

The capital has since requested assistance from the country’s military, while Finland and Norway have offered outside support. Sweden’s cumulative death rate per million people (744) is around seven times higher than those of its Nordic neighbours and its caseload is rising at the fastest rate of almost any European country

Amid increasing government alarm, and with the first part of a report on the handling of the pandemic due this month, the Public Health Agency has been sidelined. Recent decisions have seemingly been taken in the face of opposition from Tegnell. When public gatherings of more than eight were banned, Tegnell immediately took to the airwaves to distance himself from the decision: “We have absolutely not put our foot down [to insist on the restrictions],” he said.

But what has changed beyond the rhetoric? Reports that Sweden has now entered lockdown are incorrect: the rule of eight applies only to public gatherings such as plays, operas, film showings, lectures, religious services and markets. Löfven said he wanted people to treat eight as the maximum in all circumstances, but private gatherings of more than that are not banned. Restaurants remain open, though last orders of alcohol have been set for 10pm and tables, which can’t be set for more than eight diners each, must be spaced one metre apart.

Other rules technically have the force of law, but are in practice unenforceable. From 14 December a string of guidelines will take the form of “regulations”, which are legally binding, rather than “general guidance”, which is not. However, the regulations are mostly vague, encouraging people in general terms to limit their contacts with others, and there are no sanctions for breaking them.

In the case of protective masks, there are neither rules nor recommendations: the government is so far upholding the Public Health Agency’s insistence that masks’ effectiveness is unproven, despite the Royal Swedish Academy of Sciences, which awards the Nobel Medicine Prize, last month endorsing them. 

[See also: Masks are rare in Sweden as residents debate the pros and cons of its non-lockdown]

But even without strict regulations, there is evidence that many Swedes are socially distancing. Google mobility data shows that the number of people using public transport has fallen by 43 per cent since the pandemic began, a similar decline to the UK. While reports of people with desk jobs being forced to go into the office abound, home-working has become the norm for many. In a poll for the Swedish Civil Contingencies Agency during the second half of November, a quarter of Swedes said they were following official guidance more closely than before.

Yet the government appears to believe that more is needed: on 9 December it published draft legislation that would allow it to close shops, gyms and public transport. The law, if passed, won’t take effect until 15 March.

Could the government have done more, sooner? Health minister Lena Hallengren claims opposition amendments made the pandemic law passed this spring unusable. Many legal experts disagree and say that a broader shutdown of society would have been possible.

So where does this leave Sweden’s famed strategy? The country’s death toll and significant second wave certainly give little succour to lockdown sceptics, even if the hit to economic growth (a fall in GDP of 3.4 per cent is projected for 2020 by the European Commission) has been lower than in most other EU countries (the average is 7.4 per cent). And with the Swedish government gradually moving in favour of more restrictions, the Swedish flag might flutter less often at anti-lockdown protests around the world.