Sweden’s top epidemiologist, Anders Tegnell, has acquired the kind of devil-may-care reputation that doesn’t often attach to a public health official. His refusal to issue the mandatory lockdown orders that proliferated around the world in response to the coronavirus pandemic has drawn international suspicion. It has also won him admiration from some Americans, particularly those who chafe at the strict orders issued by various state governors and fear the calamitous economic consequences of widespread social distancing.
According to some officials, Sweden hasn’t issued a raft of new rules to restrict movement, backed by threat of punishment, because if the government gives advice, the citizenry tends to accept it. “We recommend social distancing,” Ambassador Karin Olofsdotter, the Swedish envoy to the United States, told the Washington Examiner. “It is a recommendation, but most people follow these recommendations. So that’s why it has been decided that we don’t need to go into a formal lockdown.”
Tegnell, in international interviews, has pointed to traffic data that suggests that roughly 90% of the expected holiday travel did not take place over Easter as one sign of voluntary compliance. The restaurant and bar scene looks “just like it was here a couple of weeks ago — they took away every other table” to create distance between patrons, Olofsdotter added. High schools and colleges have been closed, though lower grades remain open, in part because closing school for younger children would force nurses and doctors to return home with them.
“Twenty percent of the healthcare workers wouldn’t come to work,” the ambassador said. “It’s a public health recommendation that the schools should be open for the little kids, because for them, it’s much tougher to stay home.”
Still, the prudence of such decisions can be debated. Sweden had suffered more than 1,500 confirmed COVID-19 deaths as of April 20, out of more than 14,000 confirmed cases, compared to just 154 fatalities from 7,000 cases in neighboring Norway. In any case, Swedes are at pains to make clear that they have the same basic theory of the case that everyone else does.
“I think it has been overstated how unique the approach is,” Tegnell said in a recent Nature interview. “As in many other countries, we aim to flatten the curve, slowing down the spread as much as possible — otherwise the healthcare system and society are at risk of collapse … What every country is trying to do is to keep people apart, using the measures we have and the traditions we have to implement those measures.”
Failure to do so can have staggering consequences, as evidenced by the number of fatalities in New York. The number of deaths in the state in a given month is a fairly predictable figure, usually, but the emergence of the novel coronavirus has coincided with a historic spike in deaths over the last several weeks. “COVID is genuinely a once-in-a-century kind of mortality event,” as Demographics Intelligence Chief Information Officer Lyman Stone put it recently.
In any case, Tegnell’s statement challenges conventional wisdom. It suggests that critics and admirers of the so-called Swedish model are learning the wrong lessons from Sweden’s experience. A worsening of the outbreak might seem to reinforce the case for mandatory lockdowns — if you believe that Sweden is a rollicking bacchanal compared to the rest of the world. Inversely, Swedish success might strike frustrated Americans as proof that both public health and economic prosperity can be preserved through one comfortable policy of benign neglect.
In fact, “our economy has been hurt very badly,” Olofsdotter said. “We are as eager as anyone else that we should all get back to where we were.”
Still, lockdown opponents may find some justified inspiration in Sweden’s approach, rightly understood. Tegnell believes they have flattened that famous curve. “We’re on a sort of plateau,” he said on April 19.
That outcome, if it holds, would place the small Scandinavian state on a short list of governments that weathered the pandemic without imposing the kinds of intensified restrictions that provoked protests around the U.S. Such voluntary alternatives might prove more sustainable and less harmful to the economy, according to some analysts, though their success depends on citizens taking the preventative measures seriously.
“Broadly speaking, the evidence suggests that lockdowns don’t really do anything,” Stone, also an adjunct fellow at the American Enterprise Institute, told the Washington Examiner. “That is, they don’t do anything for public health, and they also don’t do anything to the economy.”
Stone offered that provocative idea from his home in Hong Kong, a semi-autonomous region of China that braced for the novel coronavirus to arrive from the mainland nearly two months before the contagion paralyzed the U.S. He is not arguing that social distancing accomplishes nothing or that people should feel free to go back to normal. Instead, he notes that widespread social distancing usually begins before a government mandates a lockdown — which he defines as a blanket shelter-in-place order, a ban on gatherings that involve more than a very small number of people, and “forced closure of wide sections of businesses.” It is the earlier voluntary behavior that saves lives and, simultaneously, does most of the economic damage.
“In almost every case, the social response has predated the governmental response,” Stone said, citing his own research into coronavirus deaths in countries that have lockdown policies. “The daily deaths began to decline too early for lockdowns to be able to explain it.”
Hong Kong provides one of the clearest examples of the efficacy of voluntary behavior, as opposed to government mandates. Unlike in Sweden, where the government and the population enjoy a very trusting relationship, the coronavirus outbreak reached the de facto city-state after months of protests by Hong Kongers who believe that their local authorities are dominated by the mainland Chinese communist regime. That suspicion was apparent in the earliest days of the outbreak, when Hong Kong medical workers went on strike over their belief that Chief Executive Carrie Lam was slow to close border crossings from mainland China due to political pressure from Beijing.
Roughly 1,000 Hong Kong residents have fallen ill from the new coronavirus, with just a handful of deaths, despite their proximity to mainland China. That record makes Hong Kong “the gold standard” for this pandemic, according to local medical officials, who attribute this success to a variety of countermeasures that fall well short of the mandatory lockdowns seen in parts of Europe and the U.S.
Those policies include border closures with China, aggressive attempts to test for coronavirus infections, and the quarantining of infected patients — and anyone who came into contact with those infected — in dedicated centers or hotels. Most restaurants have remained open, but Hong Kongers have adopted disciplined social distancing measures. And the Hong Kong population raced to put on face masks in the earliest days of the outbreak.
“Our findings strongly suggest that social distancing and population behavioral changes — that have a social and economic impact that is less disruptive than total lockdown — can meaningfully control COVID-19,” University of Hong Kong researchers concluded in a study published in the Lancet on April 17.
That finding was offered as a roadmap for managing the coronavirus crisis over the long term. “Hong Kong has demonstrated that Covid-19 transmission can be effectively contained without resorting to the highly disruptive complete lockdown adopted by mainland China, the United States, and Western European countries,” one of the experts who conducted the study emphasized.
When the coronavirus first emerged in Europe and the U.S., health officials and leaders had a limited, ominous set of information: They lacked the ability to conduct enough coronavirus tests to track down the majority of cases quickly, hospital systems lacked the bed space to care for a sudden influx of patients, and the new coronavirus spreads quickly enough to cause that kind of influx and a substantial increase in fatalities. To make matters worse, the U.S. and other Western countries suffered from a woeful lack of medical gear, including hospital masks.
If the Hong Kong experience is any guide, the combination of ubiquitous mask-wearing and quarantine measures could provide a low-tech solution. Such tactics are more common in Asian societies than in the West, but they have found some support in Europe as well. It’s difficult to disentangle the effects of mask-wearing from other mandatory policies in these countries, but Czech Republic officials believe that mask-wearing “decreases the spread of the virus by 80 percent,” as Czech Prime Minister Andrej Babis wrote last month in a tweet directed at President Trump.
Of course, the face mask shortage that afflicted the U.S. and other Western countries was also felt in the Czech Republic in mid-March, when the government ordered the wearing of masks in most public situations. Yet the Czech people addressed that problem with the kind of self-reliant attitude familiar to Americans: They made the masks themselves.
“We had to go through this period of communism, and part of the survival strategy was to be creative, to be innovative, and to rely on yourself,” former European Union diplomat David Stulik, a Czech national at the European Values Center for Security Policy in Prague, told the Washington Examiner. “We were not expecting the state to take care of our problems.” They did rely on the government for clear information about the need for the masks and other measures. The prime minister and other senior government officials wear masks in their public television interviews, as a retired State Department official in Prague emphasized.
“They’re setting an example themselves that this is something that we all need to do,” Steve Kashkett, a former U.S. diplomat who teaches at the Anglo-American University in Prague, told the Washington Examiner. “And when they look at the United States, they see very clearly that the opposite is happening.”
The idea of placing coronavirus patients and their contacts in a centralized quarantine center has found little support in Western countries, but Stone thinks that’s a mistake. For one thing, the use of quarantine centers allowed Hong Kong residents who hadn’t come into contact with infected patients to live “basically normal lives,” he noted.
“It also means if symptoms begin to develop among ‘suspected infectious’ people, we can get them medical care ASAP, reducing death rates,” Stone said. “Thus, centralized quarantine is by far the most effective, and also by far the least invasive, strategy for achieving isolation of infected people.”
Czech officials have begun to ease some of the restrictions imposed at the beginning of the outbreak, as are other European countries where officials believe they have flattened the curve. In Germany, a bright spot in the pandemic due to the preparation that made it possible to administer coronavirus tests far more quickly than in the U.S., some sub-national governments have begun to require mask-wearing while they prepare to ease other lockdown measures.
“So, what we need to have is information that communicates to people sustainable practices to reduce the frequency of re-outbreak; the most important policy in that regard is mask-wearing,” Stone said. “In the long run, mask-wearing and social distancing measures should enable more and more normalcy as the baseline number of infectious people falls. But there’s ultimately no substitute for centralized quarantine. Without centralized quarantine, normalcy will remain a long way off.”
In this regard, Swedish officials give more restrictive guidance. Tegnell, who is skeptical of the utility of masks, would prefer to have anyone who displays symptoms of any cold or similar ailment remain at home. For now, at least, Tegnell doesn’t have to confront the question of how to emerge from a lockdown that confronts his European colleagues and American officials troubled by the economic crisis that has followed the pandemic.
“The main difference between our policies and many other countries’ policies is that we could easily keep on having these kinds of policies in place for months or maybe even years,” Tegnell said during a recent event with the German Marshall Fund.
“I have a hard time seeing that this disease goes away the way that SARS went away,” he added. “This seems to be a much more sustainable virus in our environment and most likely something we’re going to have to live with in one way or the other.”
Joel Gehrke is a foreign affairs reporter for the Washington Examiner.
