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‘Life has to go on’: How Sweden has faced the virus without a lockdown

A gathering on Sickla Beach in the Nacka district of Stockholm, Sweden, on April 23. Sweden declined to order a wholesale lockdown during the coronavirus pandemic, instead trusting its citizens to follow social distancing protocols. Many did not, but the country has fared about the same as other European nations.
A gathering on Sickla Beach in the Nacka district of Stockholm, Sweden, on April 23. Sweden declined to order a wholesale lockdown during the coronavirus pandemic, instead trusting its citizens to follow social distancing protocols. Many did not, but the country has fared about the same as other European nations.NYT

STOCKHOLM — She stood leaning on her cane, briefly resting among dozens of bubbly young Swedes out enjoying one of the first sunny spring days of the year.

“I’m trying not to get too close to people,” said Birgit Lilja, 82, explaining that she had left her house to pick up a new identity card in person. “But I trust them to be careful with me.”

Trust is high in Sweden — in government, institutions, and fellow Swedes. When the government defied conventional wisdom and refused to order a wholesale lockdown to “flatten the curve” of the coronavirus epidemic, public health officials pointed to trust as a central justification.

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Swedes, they said, could be trusted to stay home, follow social distancing protocols, and wash their hands to slow the spread of the virus — without any mandatory orders. And, to a large extent, Sweden does seem to have been as successful in controlling the virus as most other nations.

Sweden’s death rate of 22 per 100,000 people is the same as that of Ireland, which has earned accolades for its handling of the pandemic, and far better than in Britain or France.

Yet, on this warm spring day, at least, there was little evidence that people were observing the protocols — adding further mystery to Sweden’s apparent success in handling the scourge without an economically devastating lockdown.

All around Lilja along Skanegatan Street in the Sodermalm neighborhood of Stockholm, younger Swedes thronged bars, restaurants, and a crowded park last week, drinking in the sun.

They laughed and basked in freedoms considered normal in most parts of the world not long ago, before coronavirus lockdowns, quarantines, and mass restrictions upended social norms. As other nations in Europe begin to consider reopening their economies, Sweden’s experience would seem to argue for less caution, not more.

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“My respect for those who died, but we are doing something right here in Sweden,” said Johan Mattsson, 44, as he was having a drink at a cafe on Skanegatan Street.

Students celebrating their graduation drank together in the Soderlmalm district of Stockholm, Sweden, on April 24.
Students celebrating their graduation drank together in the Soderlmalm district of Stockholm, Sweden, on April 24.Andres Kudacki/NYT

The restaurant consultant praised the freedoms he had in Sweden compared with other countries. “I’m not seeing very different statistics in many other countries,” he said. “I’m happy we didn’t go into lockdown. Life has to go on.”

While other countries were slamming on the brakes, Sweden kept its borders open, allowed restaurants and bars to keep serving, left preschools and grade schools in session, and placed no limits on public transport or outings in local parks. Hairdressers, yoga studios, gyms, and even some cinemas have remained open.

Gatherings of more than 50 people are banned. Museums have closed, and sporting events have been canceled. At the end of March, authorities banned visits to nursing homes.

That’s roughly it. There are almost no fines, and police can only ask people to oblige. Pedestrians wearing masks are generally stared at as if they have just landed from Mars.

Cyclists on Götgatan Street in the Sodermalm district of Stockholm, Sweden, on April 23.
Cyclists on Götgatan Street in the Sodermalm district of Stockholm, Sweden, on April 23.Andres Kudacki/NYT

On Sunday, five restaurants were closed for failing to observe social distancing requirements. They were not fined, however, and will be permitted to reopen after an inspection, said Per Follin, regional medical officer with the Department of Communicable Disease Control and Prevention.

Throughout the crisis Sweden has had enough intensive care units to deal with COVID-19 patients, the minister of health and social affairs, Lena Hallengren, said. “We have 250 empty beds right now.”

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A compilation of mortality figures by The New York Times found that many countries were undercounting COVID-19 deaths by the thousands, while Sweden reported just 400 more deaths than expected between March 9 and April 19.

This is not to say that Sweden has escaped COVID-19’s deadly consequences entirely.

The Swedish Public Health Authority has admitted that the country’s seniors have been hit hard, with the virus spreading through 75 percent of the 101 care homes in Stockholm. Employees of the homes complain of shortages of personal protective equipment.

A medical staff member in protective gear took a swab for a COVID-19 test at a test facility in a tent outside Skane University Hospital in Lund, Sweden, on April 29.
A medical staff member in protective gear took a swab for a COVID-19 test at a test facility in a tent outside Skane University Hospital in Lund, Sweden, on April 29.Johan Nilsson/TT/Associated Press

The authority announced last week that more than 26 percent of the 2 million inhabitants of Stockholm will have been infected by May 1. But even that figure was presented as something of a win: a number of infections that might limit future outbreaks, reached without suffering an inordinate number of deaths.

The freer approach has not fully insulated Sweden’s economy, mainly because the country is dependent on exports, the minister of finance, Magdalena Andersson, said. She said the economy was likely to shrink by 7 percent this year, “but of course hairdressers, restaurants, and hotels are less affected compared to other countries.”

From the first signs of the pandemic, the Swedish Public Health Authority decided that a lockdown would be pointless. “Once you get into a lockdown, it’s difficult to get out of it,” the country’s state epidemiologist, Anders Tegnell, said. “How do you reopen? When?”

Picnickers in the Soderlmalm district of Stockholm, Sweden, on April 23.
Picnickers in the Soderlmalm district of Stockholm, Sweden, on April 23.Andres Kudacki/NYT

Scientists like Tegnell, who has become something of a celebrity in Sweden, and not politicians have driven the debate over the coronavirus response.

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“Basically we are trying to do the same thing that most countries are doing — slow down the spread as much as possible,” he said. “It’s just that we use slightly different tools than many other countries.”

When responses are assessed after the crisis, Tegnell acknowledges, Sweden will have to face its broad failing with people over the age of 70, who have accounted for a staggering 86 percent of the country’s 2,194 fatalities to date.

In the absence of recommendations from the Public Health Authority, a Jewish care home near Stockholm unilaterally decided to ban visitors, said Aviva Kraitsik, the head of operations, who asked that the facility’s name be withheld because of threats it has received.

The authority even went so far as to order the “no visitors” signs removed. Kraitsik refused. “I said they could put me behind bars,” she said. “I was prepared to take my punishment to protect our residents.”

But it was too late. The virus had crept inside and eventually killed 11 of the 76 inhabitants.

It was only after the home required employees to wear face shields and masks when working with all the residents, even those displaying no symptoms, that it managed to halt the spread of the infection, Kraitsik said.