Story at a glance
- In early 2020, Sweden did not enter lockdown in response to the COVID-19 pandemic, unlike many surrounding countries.
- A new paper investigates the Swedish response and strategy during the pandemic.
- “The lack of accountability reveals a structural political pathology where no one really can be held accountable for the failures and the loss of all too many lives,” write the authors.
Early in the pandemic, many people were watching Sweden as they took a different approach to responding to the threat of COVID-19 compared to other countries in Europe, with no lockdown and few restrictions. Overall, Sweden has experienced a death rate from the coronavirus ten times greater than neighboring Norway with more than 18,000 deaths. In a new paper, a group of experts investigates what happened, especially in the first six months to a year of the pandemic, and evaluates the Swedish strategy. The authors of the paper focus on pandemic preparedness in Sweden prior to the coronavirus pandemic and how science was used or misused during the COVID-19 pandemic.
They took a “wait and see” approach instead of the precautionary principle
While many governments in March and April 2020 were practicing caution by shutting down businesses and issuing guidance, Swedish officials kept mostly everything open while refraining from making public what was the national strategy. The Swedish strategy was focused on individual responsibility and not overwhelming health care systems. While officials publicly said they were not following a “herd immunity” strategy, they said it would be a welcome side effect. Private communications, cited in the paper, showed attaining natural herd immunity was a significant consideration, including speculations on using children to get there.
The precautionary principle is a concept in public health in which governments and organizations proceed to act with care when there are risks involved and not enough scientific evidence yet. The term first came into use when considering toxic substances in the environment. The precautionary principle provides a “a legal justification for acting, even though scientific causation is either incomplete or perhaps unavailable,” according to a book chapter on environmental health. In the context of the coronavirus, acting in line with the precautionary principle would have meant treating the COVID-19 pandemic as an emergency and a threat to public health when it emerged on the world stage in January 2020 to March 2020.
‘International scientific advice was ignored and discredited on almost all levels‘
In Sweden, the Public Health Agency was the main organization responsible for the coronavirus response. However, they were “systematically incorrect in their risk assessments, and ignored scientific evidence on suppression strategies, airborne transmission, pre- symptomatic and asymptomatic spread, face masks, children and COVID-19, ‘long-COVID,’” write the authors.
There was very little information made publicly available. For example, the number of available ICU beds per region was not public information and regions were “unwilling to share information,” according to the paper. In addition, the authors had to specifically request the only official crisis management plan using Freedom of Information laws. They write, “The key points included: not to spread fear and panic, to prevent social unrest, and to limit the impact on the industry/economy/hospitality sector. This plan does not include anything about healthcare, healthcare capacity or infection control measures.”
What resulted was a “one-way trust in ‘the authorities’” that was expected from the entire population, write the researchers. They continue, “Yet, the authorities did not trust the people enough to be transparent in their communication, strategy, and outcomes.” In the media, officials labelled advice that did not align with their own from national scientists and international authorities as extreme positions.
Social and racial injustices weren’t considered
One area that Sweden has come under criticism for has been the treatment of elderly people and people at care homes. Medical care was withheld from elderly people and many were not medically examined. The authors cite an investigation by the Swedish Health and Social Care Inspectorate that found “one-fifth of the people in nursing homes were denied their right to receive an individual medical assessment” and less than a tenth of COVID-19 patients had been examined by a physician.
Immigrants and people who are socioeconomically disadvantaged experienced greater excess deaths, according to research cited in the paper. In their investigation, the authors found that racist ideas were expressed by the Public Health Agency: “The corona infection in the nursing homes may have been spread by staff with poor command of the Swedish language”, “we have larger spread because of the larger immigrant population”, “only the foreigners get ill”, “only people looking like tourists wear face masks in public.” This type of content promotes a dangerous narrative that is not supported by data or science from pre-pandemic or during the pandemic, the authors noted.
Policy and preparation are not enough
By comparing planning documents prior to 2020 to the evidence of how the coronavirus pandemic was handled, the authors make the argument that the Swedish government’s actions were not in line with the policy and reports for pandemic preparedness that existed. One of the reports they cited was mainly focused on influenza, but much of the thinking expressed in them is applicable more broadly. They quote a 2019 report’s overarching aim as:
“to minimise mortality and morbidity in the population;
to minimise other negative consequences for individuals and Society;
Public health must be affected as little as possible;
The negative effects on society must be as small as possible;
Confidence in the authorities, healthcare and care must be maintained.”
A reason why there is such a discrepancy between this report and what transpired in 2020 may be because of choices made by those in control. The study authors discovered the Swedish response to the pandemic was mainly controlled by a handful of individuals. The group seldom sought advice from people outside of their group and did not seem to want to hear from those who were opposed to their approach. The officials backtracked on their official opinions, such as whether masking was recommended, and deleted emails requested by journalists.
The Public Health Agency of Sweden did responded by email to a request for comment: “Several experts at the Public Health Agency have read the article. The material that is referenced is mostly subjective articles of debate and unsubstantiated quotes from individuals. We can conclude that the article contains factual errors, that the references does not refer to scientific articles that underpin claims in the text and that the scientific method of choice not have been applied.”
“The lack of accountability reveals a structural political pathology where no one really can be held accountable for the failures and the loss of all too many lives,” write the authors. “There were even attempts to revise history by changing, or deleting official documents, communication, and websites, and gaslighting the public.”
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