Nudges against pandemics: Sweden’s COVID-19 containment strategy in perspective

Abstract

Sweden’s strategy to contain the COVID-19 pandemic stands out internationally as more liberal in terms of not ordering a complete lockdown of society. Sweden kept its primary schools, daycare centers and industries largely open. The government financially supported furloughed workers and increased its support to regional and local governments delivering healthcare and elderly care. However, the death toll in Sweden which passed 4000 by late May 2020 stands in stark contrast to those of other, comparable countries, raising questions about the design of the strategy, and its appropriateness. The paper argues that key assumptions sustaining the strategy, for instance that symptom-free people do not carry, and cannot transmit the Coronavirus, or that local and regional government staff had the necessary training and equipment to tackle the pandemic, along with problems associated with coordinating a decentralized healthcare system, may explain the poor performance of the Swedish containment strategy.

A comparison of COVID-19 epidemiological indicators in Sweden, Norway, Denmark, and Finland

“…Sweden experienced disproportionate incidence among the very elderly and nearly half of all COVID-attributed deaths occurred in seniors’ care homes [ 1 , 29 ]. Pierre discusses the institutional arrangements and challenges of the Swedish seniors’ care system that are likely to have contributed towards this failure: decentralized leadership often run at municipal level; privatization; underfunding of public care homes; highly mobile employees who work at multiple facilities; and workers lacking infectious disease training, equipment, and PPE [ 30 , 31 ]. COVID-19 has similarly had an impact on seniors’ care facilities in many other developed countries including Canada, Spain, and France [ 32 ].…”

“…Early public health response decisions were made under tremendous scientific uncertainty around the infectiousness and natural history of COVID-19, while trying to find a balance between protecting the population, avoiding overwhelming the health system, protecting individual freedoms, and maintaining a functioning employment-based and consumer-driven economic system. In retrospect, Sweden’s decisions underestimated the impact of asymptomatic transmission [ 30 ] and lacked foresight about how underlying challenges in the seniors’ care system would affect their support staff and elderly inhabitants. Sweden’s chief epidemiologist admitted that “if we were to encounter the same disease again…we would settle on doing something in between what Sweden did and what the rest of the world has done” [ 34 ] in an interview on June 3.…”

Learning from the COVID-19 crisis: an initial analysis of national responses

“…The Netherlands, for example, assembled a national Outbreak Management Team (Boin, Overdijk, et al 2020). In Sweden, due to its government structure, the response was largely dictated by public health experts (Pierre 2020). In many countries, there was much discussion about the apparent 'rule of scientists'.…”

“…We do not offer these insights in terms of systematic probing into select countries, but draw selectively on wider comparative research (see f.i. Boin, Ekengren, et al 2020;Capano et al 2020;Maor, Sulitzeanu-Kenan, and Chinitz 2020;Pierre 2020). In the next four sections, we discuss potential lessons for the essential crisis management tasks of sensemaking, decision-making, crisis communication and "crisis exiting".…”

COVID-19: Is herd immunity the answer?

“…In absolute contradiction to international convention Sweden's preschools and schools remained operational. 23,24 A comparison between England's lockdown and Sweden's herd immunity using a comparative interrupted time series analysis by Ali and team suggests that lockdowns do reduce new cases more effectively than the herd immunity model as the new case rate in England during the lockdown period was reduced by 19 cases per 10,000,000 people as when compared to Sweden. 25 Although Sweden's stance is liberal and its deaths per capita due to COVID-19 are ranked 9th highest in the world (57.3/100 000 people), The United Kingdom's deaths per capita are ranked as the 5th highest (62.6/100 000 people).…”