Sweden's COVID-19 response is based on trust, rather than lockdown. But it may backfire.

As large swathes of Europe live under lockdown during the COVID-19 pandemic, people in Sweden continue to go about their day with relative normalcy.

Students aged under 16 are still going to school, restaurants and bars are still serving, businesses are trading, and gyms are open. There have been no full border closures or swarms of police enforcing strict social-distancing policies.

Instead, the Nordic nation’s response is built on ‘trust-based’ measures and individual responsibility. It has asked — not ordered — people over 70 to avoid social contact, and recommended that the rest work from home if possible, regularly wash their hands and avoid non-essential travel.

The comparatively hands-off approach has raised eyebrows around the world, as experts continue to debate the best ways of minimising infections until a vaccine is developed.

But why has Sweden chosen such a different path? And is it working?

What’s the current situation in Sweden?

At the time of writing, there are 15,322 confirmed cases of COVID-19 in Sweden. 550 people have recovered and 1,765 have died as a result of the infection. On Tuesday, it recorded its highest daily death toll, with 185 people succumbing to the disease.

Sweden has a population of just under 10.1 million.

‘The citizen has the responsibility not to spread the disease.’

Sweden hasn’t ignored the pandemic.

As well as the measures mentioned above, it has closed down high schools and universities, barred visits to nursing homes and limited public events to a maximum of 50 people. But that applies to things like concerts, shows and lectures; not gatherings at private parties, gyms, libraries and so on.

And that’s about as far as it goes.

“We, who are adults, need to be exactly that: adults. Not spread panic or rumours,” Prime Minister Stefan Lofven said in a statement last month.

“No one is alone in this crisis, but each person has a heavy responsibility. Every one.”

Speaking to Nature, Anders Tegnell, an epidemiologist at Sweden’s Public Health Agency and the architect of the country’s response, noted that a) entire city/region lockdowns aren’t actually legal, and b) Swedish laws on communicable diseases are rooted in individual responsibility.

“It clearly states that the citizen has the responsibility not to spread a disease. This is the core we started from, because there is not much legal possibility to close down cities in Sweden using the present laws. Quarantine can be contemplated for people or small areas, such as a school or a hotel. But [legally] we cannot lock down a geographical area,” she said.

“As a society, we are more into nudging: continuously reminding people to use measures, improving measures where we see day by day the that they need to be adjusted.”

Meanwhile, the Australian Government wants to trace its citizens via an app. The Quicky explains.

Sweden has not formally adopted the goal of ‘herd immunity’. But there are signs that may be the outcome.

(Herd immunity refers to a significant proportion of a population having immunity to a contagious disease. This typically occurs through vaccination, but that’s not yet available for SARS-CoV2, the virus that causes COVID-19. So in this case, herd immunity relies on people becoming infected with the virus and their immune system developing antibodies that may ward it off in the future.)

Modelling released by the Swedish Public Health Agency over the weekend, indicated that 25-40 per cent of residents in the capital, Stockholm, may have actually already had the virus, and that the number could jump to 60 per cent by late May.

Is the Swedish approach working?

It’s very difficult to tell. In truth, no one will know what success looks like until the pandemic is over.

But looking at the current numbers in comparison to Sweden’s Nordic neighbours, its caseload per capital is broadly similar, but its death rate is higher. Significantly so.

At the time of writing, 11.5 per cent of the people who have contracted the disease in Sweden have died. In Norway, it’s just 2.5 per cent. In Finland, 3.5 per cent. And in Denmark, 4.8 per cent.

Critics point to a failure to shield elderly people in aged care homes, who now make up one-third of the country’s fatalities. Swedish Prime Minister Stefan Lofven conceded earlier this month that part of his Government’s response “should have been better”.

Those figures have certainly alarmed some. Just last week, 22 leading Swedish doctors, virologists and researchers penned an opinion piece for a major newspaper in which they slammed the Public Health Agency’s strategy and urged it to intervene with “swift and radical measures”.

Economically, it’s not great news either. Despite not having a lockdown imposed, Sweden is currently not fairing much better than its neighbours. Unemployment is at eight per cent and the economy is predicted to shrink by 4.2 per cent this year. Norway is bracing for 3.3 per cent.

There are some positives, though.

Even without strict physical distancing regulations, life in Sweden caters to isolation better than most: more than half of Swedish households have only one resident, more than two-thirds already work from home at least some of the time, and internet access is fast and reliable across the country.

Also, hospitals have not become overwhelmed, which is a significant risk of more hands-off strategies. And government modelling has predicted far fewer hospitalisations per 100,000 of the population than has been predicted in Norway, Denmark and the UK.

For now, Sweden doesn’t appear to be heading for the scale of disaster seen in countries like Italy, Spain and the United States. But thanks to its strikingly light-touch approach, experts around the world will certainly be watching closely.

Will trusting adults to be adult actually work?

Read more about COVID-19:

• What you need to know about COVID-19 today, Wednesday April 22.
• Singapore looked like it was managing the spread of COVID-19. Then it all fell apart.
• All your questions about Australia’s COVID-19 tracing app, answered.

To protect yourself and the community from COVID-19, remain in your home unless strictly necessary, keep at least 1.5 metres away from other people, regularly wash your hands and avoid touching your face.

If you are sick and believe you have symptoms of COVID-19, call your GP ahead of time to book an appointment. Or call the national Coronavirus Health Information Line for advice on 1800 020 080. If you are experiencing a medical emergency, call 000.

To keep up to date with the latest information, please visit the Department of Health website.

Feature image: Getty.