Norway closed all schools and restaurants in mid-March, but Sweden’s are still open, down to its pubs. When Denmark restricted gatherings to 10 people or fewer, Sweden stuck to 500.

Now, Sweden has nearly double the number of COVID-19 cases as its Nordic neighbors, according to Johns Hopkins University. More people are dying, with 10.14 deaths per 100,000 people in Sweden versus 5.16 and 2.62 in Denmark and Norway, as of Feb. 15.

The Swedish government’s hands-off approach could be at fault. Politicians and health leaders say that full lockdowns, like in France and Spain, aren’t sustainable, but their hesitance to impose stricter regulations might be driving COVID-19’s expansion in Sweden.

The Swedish government isn’t calling the shots.

Sweden’s Public Health Agency, a relatively independent government department under the wider Ministry of Health and Social Affairs, is at the center of the country’s coronavirus policy. It’s not overseen by any government minister, but its recommendations have become the basis of government policy.

In an April 9 press release, the agency gave some suggestions to stay safe, but shied away from imposing real restrictions.

What has the Public Health Agency recommended?

People can hold events with fewer than 50 people, but they should run risk assessments, according to an answer on one list of frequently asked questions on the agency’s website. Sweden passed legislation designed to avoid “crowding” in bars and restaurants, but in another FAQ, the agency gives explicit permission for Swedes to “go out and eat in a restaurant with my friends” and for buffets and nightclubs to operate — as long as “guests can keep at an arm’s length distance from each other.”

While the agency has recommended universities move classes online, schools and preschools remain open. Although nearly a quarter of Sweden’s households are single-person, Swedish scientists have said that children may be particularly effective carriers of the virus. Rules for nursing homes are stricter, as cases have been reported in facilities in all but one of the country’s 21 counties.

A “high-trust” society?

The country’s reluctance to go on lockdown might stem from its culture of trust and reliance on voluntary action. Nearly 40% of Swedes reported “very” or “rather” large trust in their government in 2018, while in the U.S. last year, just 17% of people trusted the government always or most of the time.

Politicians appear to trust the population right back. Deputy chief epidemiologist Anders Wallensten told CBC News, "We also consider that most people in Sweden are very good at heeding advice from the authorities, and therefore, maybe there's a difference in the need for having laws about certain things.”

That approach is reflected in the Public Health Agency’s reliance on recommendations over strictly-enforced restrictions. On quarantine policy, the agency’s website says, “If a less intrusive intervention, for example restrictions regarding behaviour and social contacts, can achieve the same effect it should be used instead.” Cell phone data shows that this might be working, with travel across the country dropping sharply in March.

But some argue that this trust in culture ignores Sweden’s sizable migrant and minority populations, which may have different values. As case numbers shoot up, voluntary action might not be enough (the number of new, unique Swedish COVID-19 cases broken down by city can be seen on this public broadcaster’s site).

What do scientists say?

In an April 14 Dagens Nyheter op-ed, 22 medical professionals and researchers criticized the Public Health Agency for not doing enough. Over 2,000 academics in Sweden signed a petition in late March asking the government to pursue a more aggressive strategy.

For his part, chief epidemiologist Anders Tegnell said that the government’s soft approach prioritizes long term-viability. “Locking people up at home won’t work in the longer term. Sooner or later people are going to go out anyway,” he said, according to The Guardian.

But now, the government may be shifting strategies. In early April, the leading coalition asked the parliament to grant it a three-month expansion of executive power, which would allow the government to close airports and public transit without parliament’s approval.

Until then, Sweden remains an outlier in a locked-down Europe.

Article Thumbnail: Jon Harald Søby and others. / Public domain