There is no doubt that the coronavirus already has and will continue to put the whole world in a very challenging position. No one knows how to battle the virus nor its implications on the world’s health systems and economies. What is clear, however, is that Sweden is relatively alone in its approach to manage this ongoing crisis, at least in terms of control over the spread of the virus in the population.
On Sunday March 22, Swedish Prime Minister Stefan Löfven spoke to the nation in a pre-recorded clip for a total of five minutes. For some – the economic sector – those five minutes created a sense of trust in the government, that it is strong and will not let the economy in free fall, that citizens can believe in the expertise of the Swedish public health agency (Folkhälsomyndigheten) follow its’ recommendations, and go on with their lives. For others, those five minutes only brought questions and concerns to the fore.
Individual or collective responsibility?
In Sweden, the public health authority – free from ministerial rule – recommends life to go on basically as usual; stay home if you are ill; wash your hands; cover your mouth with your elbow when you cough or sneeze; keep a safe distance from others; if you can, work from home, and if you do go to the mountains, no after ski partying. These recommendations are at the moment the most liberal among countries who are affected by the virus, and as such they also place heavy emphasis on individuals to act responsibly and follow the recommendations. On Thursday March 26, the Public Health authority commented that they were ‘receiving signals’ that people over 70, one of the risk groups, were not following the recommendations. In consequence, information campaigns towards the risk groups have increased. In order to be able to follow given recommendations, however, individuals must understand what their responsibilities are and why they are responsible for following the recommendations. So far, individuals are trusted, but at the same they are packed in commuter buses in order to get to work because they are asked to do so. That sends mixed signals.
In Norway, on the other hand, comprehensive measures, such as the “Corona law”, were undertaken in order to limit transmission of the virus and not overburden health and care services. Among these measures are closing schools, universities and day cares, a ban on cultural events, closed swimming pools, gyms, and all service provisions that involve physical contact with persons less than two meters away – with an exception for critical health care services, and finally no cabin trip to the mountains, which is a huge deal and has spurred a debate whether it is a human right for Norwegians to go to their cabins. Responsibility to not overburden hospitals and risk putting healthcare workers in difficult ethical dilemmas is placed on the collective, a national dugnad.
In Sweden on the other hand, the public health authority encourages the public to keep gyms and other training venues, youth and children activities and sport events open. A Scandinavian gym chain recently re-opened its centers there, while at the same time keeping the other centers in the Nordic region closed, as instructed by the countries’ respective Public Health agencies and governments. The same approach was adopted by a company that owns and runs winter sports facilities in Norway and Sweden. It closed its facilities in Norway but kept them open in Sweden, and alas will continue to do so, despite the hazard of overburdening hospitals in the regions with less resources to handle the influx of broken legs and COVID-19 at the same time.
The logic behind these companies’ decisions is that they are simply following public health agencies’ and governments’ recommendations or rules – blindly.
Inevitably, witnessing the diametrically different approaches to battle the spread of COVID-19 leave the observer with doubt about what the right approach is. And it begs the question: do Swedish authorities have too much trust in the public? Can people really be trusted to act responsibly without the more extreme measures seen in Norway? On the other hand, one can ask if the Norwegian government doesn’t trust its population to follow recommendations and therefore sees the need to implement stricter rules?
Trust in common sense and responsibility
As a Swedish citizen living in Norway, I find this development rather perplexing. The differences in each government’s approach to combat COVID-19 is above all seen in the posts of acquaintances, friends and family on social media in Sweden. I’ve seen social gatherings, parties, game nights and trips to Stockholm, Gothenburg, cabins in the mountains and archipelago – to get some much-needed break from the ‘corona hysteria in the cities’ – girl’s night out, to name a few of the examples. It makes me wonder if Swedes are immune. More critically it makes me question whether the measures millions of people are affected by in other countries are legit. Clearly, Swedes are not immune. In fact, the death rate per million people in Sweden is nearly double that of Norway.
Most people in both countries, however, want to and do trust their governments, above all their respective public health agencies. Support for the governments have increased – as they tend to do in times of crisis. In a recent interview with Dagens Nyheter, foreign minister Ann Linde commented that the level of trust the Swedish public have in its government and public agencies is very high. And, according to the latest government at a glance report from OECD, ‘there is consensus in the academic literature that trust influences the relationship between citizens and the government and has an impact on public policy’.
Thus, the keywords to understand these diametrically different approaches are trust and the Swedish governments belief the common sense – folkvett – of its citizens. Yet, while many people do understand the consequences of their decision to not stay at home and go to the family gathering at grandma’s house with symptoms, alas there are too many who don’t understand that in the end their actions may inflict on doctors and nurses the difficult decision of choosing what life to save – which is a reality in Italy, Spain and now even the U.S.
“It’s a huge experiment. […] We have no idea – it could work out. But it could also go crazily in the wrong direction”.
Starting in mid-March, the Public Health Authority in Sweden and Norway have both commented on the situation almost every day. Journalists in both countries cover their comments meticulously and the Swedish press conferences are screened on Norwegian TV as well. Former Swedish state epidemiologist, Johan Giesecke calls the Norwegian measures draconian and unnecessary; ‘We are right while Europe are wrong’ is his message to anyone who want to understand what they are doing, and acting state epidemiologist Anders Tegnell agrees. The public health authority expects people to get seriously ill, and that people will die. But ‘500-2000 people die from the seasonal flu every year’, Johan Giesecke says. The head of analysis at the Swedish public health institute recently commented on international criticism from media and other experts: ‘We do not believe it is possible to keep society closed until a vaccine is developed […] the economy will collapse long before that […] and people will not follow the recommendations.’
Unwilling to risk the economy
The Swedish strategy is based on volunteering, information campaigns and a high level of public trust in the public health agency, and keeping the economy alive. The Norwegian approach on the other hand is based on collective suppression of the virus, but Norway also has the world’s largest financial security – the pension fund. Nevertheless, both the Swedish and Norwegian governments do adhere to advice from various authorities with various expertise and capacities to handle this crisis. Based on the similarities Sweden do share with its Nordic neighbors in terms of levels of education and other and socio-economic factors developed simultaneously during the last century, it is plausible to claim that the countries are not that different, except in crises.
Time will tell. The Swedish approach might be right. Joacim Rocklöv, Professor of epidemiology and Public Health at Umeå Univeristy, emphasizes that we don’t know and that he does “not see why Sweden would be so different from other countries. It’s a huge experiment. […] We have no idea – it could work out. But it could also go crazily in the wrong direction”.