Notes from the Desk: Sweden tried “herd immunity” with Covid-19. I was one of the herd.

By Porter Bowman

It’s March 10, 2020. At around 1:30 p.m., Middlebury students received word to pack their suitcases in preparation for an early spring break. It was around 7:30 p.m. in Stockholm, Sweden. As texts rolled in from frantic friends back on campus, I stood among a roaring crowd of over 5,000 Swedish hockey fans.

“Are you coming home? We just got the official email,” a friend texted. “Nah I’m still here, we’re still going strong,” I sent back. “The Swedish government is pretty chill right now, luckily.”  Luckily.  I thought I had nothing to worry about. 48 hours later, I was on a plane home.

In the wake of Sweden’s controversial approach to battling Covid-19 through “herd immunity,” I’ve reflected on my Covid-19-shortened semester abroad in Sweden’s capital city of Stockholm. I hope that my perspective of Sweden’s response from right before the pandemic can shed a light on Sweden’s widely covered response over the last seven months.

Especially when — after being completely asymptomatic — I would later test positive for Covid-19 antibodies.

March 10th, 2020

A product of your own environment

When I arrived in Stockholm in January, Covid-19 was making its way through China and beginning its slow but steady global spread. It wasn’t until the Milanese outbreak in Italy in mid-February that most of the West began to wake up to the potential threat of a worldwide pandemic.

Even as President Trump downplayed the threat of the virus in the United States, Americans were nevertheless starting to learn the basics of social distancing and other measures that we’ve grown to know all too well. This was not happening for Swedes; it was from my parents over FaceTime that I first heard about the idea of social distancing. Life in Sweden faced no interruption, and thus neither did my daily routine. Classes, public transit and every business in the city were still running as normal. I was a product of my own environment.

The Italian outbreak was my first wakeup call. In Italy, Middlebury shut down its schools abroad, sending home friends from Middlebury and others in the program in late February. My roommate in Stockholm, Jacob, was traveling in Milan during that outbreak. When he returned, we convinced our program that he should quarantine. “We are not expecting to see new cases of Covid-19,” said Dr. Anders Tegnell, Sweden’s Dr. Fauci, after Sweden’s second confirmed case on Feb. 27. “It is important to remember that there is a difference between individual cases and the spread of infection in society. That is not taking place in Sweden.” That assertion would not hold for long.

 

Testing

Let’s first use testing as an early case study of Sweden’s response. Sweden’s cases per capita has remained on par with much of Europe despite its more open approach. One reason for Sweden’s apparent success at first glance might be a skew in the numbers. Here in the US, testing for Covid-19 is increasingly available, albeit with a significant delay, to those with or without symptoms. In Sweden, it remains difficult today to get a test without either being hospitalized or showing recognizable symptoms.

When Jacob, my roommate who traveled to Milan, returned to Sweden in early March, my other roommate and I vacated the room so he could quarantine for two weeks. Yet, it took a week and a half of constant contact with public health authorities to authorize his test. Swedish climate activist Greta Thunberg, who expressed she likely had contracted the virus during her travels around the continent during the late winter, was unable to get a test herself in the spring due to similar reasons and standards. Even today, the Public Health Agency’s guidance on voluntary quarantine states, “If for some reason you have been tested despite not having symptoms, the seven days start from the day you had the test.” I think we can agree that “if for some reason” countries are not testing asymptomatic people potentially exposed to Covid-19, they’re not doing enough testing.

 

Sweden vs. the United States

To understand Sweden’s lax response to Covid-19, it is also crucial to understand how it is one based on qualities so ingrained Swedish culture.  These qualities make the Swedish model difficult to directly compare with a chaotic “herd immunity” method of the US, but we can still compare their basic differences.

Sweden is built on an intense trust in their welfare state, as is crucial in any social democracy, which is palpable in Swedish society. Swedes entrust the state to provide them with free healthcare, education, generous unemployment and many other benefits in exchange for high rates of taxes.

This trust has defined Sweden’s response to Covid-19. With its lack of any sort of national lockdown, Sweden stands almost alone with its approach to confronting the Covid-19 pandemic.

So how has Sweden attempted to confront the virus? The short answer: lagom. A term in Swedish meaning “not too much, not too little,” lagom is a balancing concept found in nearly every part of Swedish daily norms from work hours to alcohol consumption. In response to the Covid-19 pandemic, Sweden has tried, and failed to find a point of lagom.

In the spring, they closed universities, banned social gatherings larger than 50 people and encouraged the elderly and the at-risk to isolate themselves. However, restaurants and other shops remained open and few steps were taken to discourage people from public interaction.  Swedish primary and secondary schools remained open and compulsory to attend — it is still illegal to homeschool your children or keep them home from school for family or personal reasons. Social distancing is encouraged, but few masks are worn.

Many conservatives in the United States, including the President, have pointed to Sweden as an effective example of Covid-19 mitigation largely free of state-wide lockdowns and masks.  Here in the United States, lockdowns, masks and many public health guidelines have been unnecessarily and dangerously politicized. We’ve learned all too well that one’s feelings about each of these safety measures are the product of one’s environment, culture and political leanings.

In the U.S., small government libertarians pointed to Sweden as a reason to lift these lockdowns and the far right spent months protesting social distancing guidelines and stay-at-home orders.  This is an errant comparison for two reasons. First, they fail to recognize that the very example they reference relies instead on more government trust and influence, and, second, occurs in a far smaller country with a population largely centered in only three major cities.

The depoliticized Public Health Agency in Sweden trusts the population to adhere to basic guidelines and have Swedes trust one another to do the right thing. The approach of “herd immunity,” which has not been specifically endorsed by name by the agency, hopes the virus spreads at lagom: slow enough to not overwhelm the healthcare system.

However, Swedish deaths per capita nearly match the tragic levels seen in the United States.  Sweden’s nursing homes were decimated in the early stages of the virus, the main source of its nearly 6.000 deaths, a substantial number in a country of only 10 million. In Sweden, around 90% of its deaths are from those 70 or older; 95% are of those 60 or older. In the US, on the other hand, around 57% of deaths are 75 or older and 79% are 65 or older. Sweden’s overall health has spared more younger people from death than in the US, but the results are nevertheless tragic for its elderly population.

Additionally, despite keeping much of the economy open, Sweden’s economy was hit even harder than its Nordic neighbors that locked down. Sweden’s GDP fell 8.3% in the second quarter, compared with 6.8% in Denmark and 5.1% in Norway. Even if a restaurant or store is open, people’s behavior still changes in a pandemic.

 

Where do we go from here?

In June, my dad and I both tested positive for Covid-19 antibodies. After seeing how remarkably similar Sweden’s approach looked to my experience in March, I decided to get tested along with my father, who was still commuting through the middle of Times Square only weeks before the New York outbreak began to emerge. Even after my antibody test, I continued (and still continue) to follow precautions amidst the risk of a false positive test or even of reinfection. My father and I also can’t account for the unknown long term health effects that two healthy men may suffer going forward.

Sweden has sacrificed several thousand lives in exchange for a more open approach to tackling the disease. Swedish Prime Minister Stefan Löfven admitted in April that “[Sweden] will count the dead in thousands.” To their credit, Swedes are largely following health guidelines and keeping politics out of it. Cultural differences matter — this is a very Swedish strategy and is not something even remotely possible in the United States. The buy-in from Swedes is there, but the results are not. Sweden is far away from being anywhere close to “herd immunity,” and with no end in sight, the tradeoff is simply not worth the extra loss of life.

I did not expect to be part of the herd. When and if this pandemic reaches an end after months if not years of interruption, death and economic collapse, Sweden will not be standing above the fray. It will be right there in the middle of it.

 

Porter Bowman ’21.5 is an Opinion Editor for The Middlebury Campus.