Sweden took a softer COVID-19 approach. Has it been effective?

Since the beginning of the coronavirus pandemic, Sweden has taken its own approach, choosing to implement less stringent measures to stem the spread of COVID-19 than most other countries.

Prime Minister Stefan Lofven previously said Sweden is pursuing a “common sense” approach that will keep the country operating, while also protecting its most vulnerable.

“I feel confident in the overall strategy,” Lofven said last week. “One reason that we have chosen this strategy, and where we have supported the agencies, is that all measures have to be sustainable over time.”

The country has banned gatherings of more than 50 people, closed high schools, colleges and universities, and has urged isolation for citizens over the age of 70 or for those with underlying medical conditions who may be vulnerable to COVID-19.

That means elementary schools, most restaurants and most businesses have remained open. The decision to do so has drawn criticism.

Why has Sweden been criticized and has the country’s approach been effective? Here’s a look at what’s going on.

Herd immunity

For weeks, members of the international community, including U.S. President Donald Trump as well as scientists, have been critical of Sweden’s approach, saying the country is putting its citizens at risk by trying to develop herd immunity.

In a previous interview with Global News, Dr. Jeff Kwong, an infectious disease specialist and associate professor in the department of family and community medicine at the University of Toronto, explained the idea of herd immunity, saying if enough of the population is immune to a virus, the infection won’t spread as easily.

“Or ideally, it won’t spread at all,” he said.

He said people become immune either through vaccination or by developing natural immunity by becoming infected with the virus.

But Kwong said willingly attempting to develop herd immunity to this novel coronavirus is “dangerous.”

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He said it is unclear at this time if those who have been infected with the virus would be immune from a second infection, or how strong the immunity would be.

Sweden, though, has rebuffed claims it is trying to develop herd immunity.

The country’s minister of health and social affairs, Lena Hallengren, told CNN last week there is “no strategy to create herd immunity in response to COVID-19 in Sweden.”

While that is far more relative to the size of the population than in Denmark, Norway and Finland, where authorities have taken a stricter approach, it is lower than in Britain, France and Spain, where there have also been lockdowns.

Andrew Ammon, director of the European Centre for Disease Prevention and Control, told European Union lawmakers that the country was not seeing a decline and that it had seen “no substantial changes in the last 14 days.”

But, recent modelling from Sweden’s health agency suggests about 25 per cent of people in the Stockholm region have had or will contract the disease, levels at which it has said partial herd immunity could help slow the outbreak.

A “future model?”

Last week, the World Health Organization issued some cautious backing for Sweden’s less stringent approach.

“If we are to reach a ‘new normal,’ in many ways Sweden represents a future model,” said Mike Ryan, the WHO’s top emergencies expert.

“What it has done differently is that it really, really has trusted its own communities to implement that physical distancing,” he said.

But, Steven Hoffman, a York University professor and the scientific director of the Canadian Institutes of Health Research’s Institute of Population and Public Health, told Global News there are a couple factors that allowed Sweden to implement less stringent measures.

The first, Hoffman said, is that Sweden has “invested enormously” in public health infrastructure.

“Moreso than many countries,” he said. “So it has a deeper infrastructure to rely upon in times of a pandemic.”

Hoffman said the other is that there is “social cohesion” in Sweden. He said citizens trust that their government is “mindful of the public good.”

He said there are “very strong social norms” about not putting others at risk, and of everyone “doing their part” to help.

“So I think the Swedish government, in a sense, has been able to draw on that civic-mindedness as a collective resource in its response to the pandemic … in ways that the United States, for example, probably could not,” Hoffman said.

Asked if Canada could have followed Sweden’s lead, Hoffman said: “We definitely could have.”

“And indeed, in post mortem, we might conclude that the Swedish model was the right model,” he said. “I don’t know.”

But, Craig Janes, director of the School of Public Health and Health Systems at the University of Waterloo, said once the pandemic ends, he’s not sure Sweden’s approach will be viewed as successful.

“They do have a lot of cases and they are seeing a fairly significant amount of mortality, particularly, as we do here, in long-term care facilities, retirement homes,” he told Global News. “So I’m not sure that, when it’s the end of the day, it will be highlighted as a successful approach.”

Overall, Janes said Sweden has chosen to take a “very dangerous path,” by not implementing more stringent measures.

“Just the precautionary principle of public health would suggest that Canada probably did pick a better path,” he said.

Ultimately, Janes said Sweden will make for a “good case study,” and will be an “important test to see whether we got things right or not.”

— With files from The Associated Press and Reuters

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