Explained: Sweden’s approach to fighting coronavirus

Explained: Sweden’s approach to fighting coronavirus

People walk along the main pedestrian shopping street in Stockholm, Wednesday, March 25, 2020. (AP Photo: David Keyton)

As countries across the globe witness a rise in coronavirus cases, lockdowns seemed to be the go-to approach to contain the outbreak. The curfew-like method seems to have worked in China, where the outbreak first emerged in December last year. The country put millions of its citizens under lockdown and is only now starting to lift it after it was able to 'flatten the curve'.

Earlier this week, India too adopted a similar measure and imposed a 21-day nationwide lockdown. However, one country whose methods seem to have stood out is the Scandinavian nation of Sweden. With a population of over a crore and with over 2000 COVID-19 cases, few things have changed in the daily lives of its residents.

How bad is the coronavirus outbreak in Sweden?

According to Sweden's Public Health Authority (PHA), over 2,800 have been infected with COVID-19 in the country as of now, which amounts to about 28 cases per 100,000 inhabitants. Fifty three percent of all cases are among men and 66 COVID-19 patients have died in the country. As per PHA’s five-degree scale of risk assessment, the current risk of import cases and the risk of infection spreading in Sweden to people other than those around individual import cases are both classified as “very high”.

What are the restrictions and guidelines in Sweden?

Dining habits have changed. According to new rules, imposed on March 25, restaurant-goers have been asked to dine while at their tables and not standing at bar counters as a precautionary step.

In fact, there's a partial restriction on schools and some children can still attend. This, in contrast to the rest of the world where more than 800 million youth and children have been impacted due to the closure of educational institutions.

Gatherings in Sweden have also been given more generous limits - of up to 500 people - compared to that in other countries like India where nobody is allowed on the streets, and in Germany, where public gatherings have been limited to up to two people. The idea behind restricting the number to 500 people is based on measures beyond that being considered to be intervening for people and a restriction of their fundamental rights.

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Moreover, while coronavirus has led to cancellations of most sporting events in the world, including the postponement of the Tokyo Olympics 2020, the PHA maintains that sports and exercise are good for public health and has also allowed gyms to remain open while advising precaution.

Sweden's PHA has urged those who feel ill with symptoms such as sniffing, coughing or fever to stay at home. It says that they should “try not to meet other people”. “This is true even if you just feel a little sick. You should not go to work or school. It is important not to risk infecting others,” the guidelines read.

Explained: Sweden’s approach to fighting coronavirus

Director General of the Public Health Agency of Sweden Johan Carlson (L) and Minister for Health and Social Affairs Lena Hallengren during the daily press briefing on the coronavirus Covi-19 situation. (Photo: Anders Wiklund)

Further, people have been advised to work from home to the extent possible. PHA states its purpose is to try and slow down the spread of infection, in a bid to not overwhelm the healthcare system. “By a slower increase in the number of infected people, the healthcare system has a greater opportunity to maintain their operations,” the PHA website says.

There are also no travel restrictions in place at the moment and PHA advises people to think if a trip is “really necessary” before embarking on it. Buses, trains and taxis are still operational in Sweden and citizens are urged to cough or sneeze in their sleeves while using public transport, to not travel if one is feeling sick and keeping a distance from other travellers. As per PHA, “It is not yet entirely clear whether so-called indirect contact contamination, that is, spreading via droplets that land on surfaces or objects, has any significance for the spread of covid-19”.

Why has Sweden not shut pre and primary schools yet?

PHA maintains that it is not yet a “significant measure” to close schools in the country since there are no scientific studies that show that such a measure would have a significant impact. “Also, there are no data pointing to any major spread of covid-19 in schools anywhere in the world,” they say. PHA has also taken into account the “negative consequences” of shutting schools down for the rest of the society considering that many parents working in healthcare and other socially significant functions would need to cater to childcare if schools were shut, even prompting them to stay at home or lead vulnerable groups such as their grandparents to take care of the children.

Further, PHA has emphasised on there being a need for a plan catering to where the children should go if schools were to shut. Even so, it advises staff and children to stay at home if they feel ill.

What about the elderly?

People over 70 years of age have been told to limit their close contacts and have been urged to stop using public transport and to stop going to crowded places. “Ask your family or neighbours to help with your food shopping and other errands,” the advisory says.

Explained: Sweden’s approach to fighting coronavirus

Military personnel prepare a field hospital at the Ostra Sjukhuset hospital area, part of Shalgrenska Unversity hospital, in Gothenburg, Sweden, on Tuesday March 24, 2020. (Adam Ihse / TT via AP)

So, is Sweden not serious about the spread of Covid-19?

A look at the PHA’s website indicates that the health agency does not yet agree with the WHO that COVID-19 can spread through droplets. It appears to casts doubts on “so-called indirect contact contamination” through droplets landing on surfaces or objects. In its advisories, it has asked people to wash their hands and avoid touching the face as well as to avoid contact with sick people to reduce the spread of infection.

The WHO has said that the virus mainly spreads through droplets of saliva or discharge from the nose when an infected person coughs or sneezes, “so it’s important that you also practice respiratory etiquette (for example, by coughing into a flexed elbow),” it says.

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Further, as scientists from across the world are learning more about the coronavirus, new information is emerging. For instance, a paper published in the New England Journal of Medicine recently has said that the virus survives on surfaces such as plastic and steel for up to three days and on cardboards for up to 24 hours. Another study published in The Journal of Hospital Infection said that coronaviruses had the ability to survive on dry surfaces for between two and nine days.

In an interview, Sweden’s current state epidemiologist, Anders Tegnell told the Swedish newspaper Svenska Dagbladet that the strategy is not to build herd immunity, a tactic which was initially being followed by the UK (and questions arose that Sweden was following something similar), before it changed its approach after a grim projection from the Imperial College London predicted over 5 lakh deaths in Great Britain if the situation was left unmitigated.

In the interview Tegnells told the newspaper that while as a concept herd immunity was great, “The main tactic is not about that, but that "we have a slow spread of infection and that the healthcare system gets a reasonable amount of work”.

What have critics said about Sweden's approach?

There are a number of health experts who disagree with Sweden’s measures. A report in the Financial Times referred to the opinion of an epidemiologist at Umea University, Joacim Rocklov who said that the Swedish authorities were taking “huge risks” with public health “when so much remained unknown about coronavirus,” the report said.

“I do not see why Sweden would be so different from other countries. It is a huge experiment,” the FT report quoted him as saying. “We have no idea — it could work out. But it could also go crazily in the wrong direction,” Rocklov told FT.

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