Sweden’s coronavirus gamble

SWEDISH CULTURE AND the country’s national psyche are often described using the word lagom, which defies simple translation, but is defined variously as “just the right amount,” “in balance,” or “moderation.” It describes generally the even-keeled ways of Scandinavia’s most populous country, but it now also extends to Sweden’s controversial approach to the coronavirus pandemic.

While virtually every country being hit by the virus has raced to institute near lockdowns of society, with the enormous disruption and economic convulsions that come with it, Sweden has followed a much more measured path.

Government authorities strongly urge social distancing, visitors to nursing homes — which have been hit hard by the virus  — are banned, and high schools and universities have closed and moved to remote learning. But younger grade schools are still in session, stores, bars and restaurants are open, and virtually no one is wearing a mask. People are encouraged to work from home if they can, but there has been no blanket shutdown of businesses.

The approach has drawn sharp criticism from some public health experts who say the country is recklessly endangering lives. But we may not be able to offer a full appraisal of Sweden’s approach for a couple of years. The broad truth offered by Soren Kierkegaard, the philosopher from neighboring Denmark, captures well the particular challenge of decision-making in the middle of a pandemic with a previously unknown virus: “Life can only be understood backwards; but it must be lived forwards.”

For now, it seems most in Sweden are comfortable living forward under the more modulated approach devised by public health authorities there.

“I would say that we try to do it safe — but still continue living,” said Hanna Radomski, a 40-year-old psychotherapist in the southern Swedish city of Malmö, on this week’s Codcast. “People are making changes,” she said. “The Swedish way is that if we get people to do this, like you say, lagom — do changes, but not too hard changes, then people will keep doing it.”

Radomski — who is a cousin of mine — described well the approach that Sweden’s deputy prime minister said last week involved viewing the pandemic as a marathon, not a sprint. It’s much easier to imagine the measures put in place in Sweden being sustained over the long haul.

Radomski’s 8- and 11-year-old sons are still in school. Her husband, who works in tech, is able to work from home, but she still sees therapy patients at her office. She’s been out to lunch at a restaurant, but says people aren’t doing as much of that. She still goes to her gym, but is opting for outdoor cross-training classes to avoid working up a sweat in close quarters with others.

“It’s certainly different in some ways, but also in a strange way kind of normal,” she said of life in Sweden amidst the pandemic.

But is it the right approach to a highly contagious and potentially lethal virus?

Sweden’s per capita death rate as of late last week was about 26 per 100,000, considerably higher than the rate of its neighbors — in Denmark it was 8, in Norway 4. It was also higher than the US rate of 20 deaths per 100,000, but considerably lower than the rate in the UK, France, and Belgium.

Sweden is taking “a gamble,” said Helen Jenkins, an assistant professor of biostatistics at the Boston University School of Public Health. “You could argue it’s an experiment. I think it’s interesting for the rest of us to look and see what happens.” But Jenkins said she would not be eager to be that guinea pig.

Jenkins thinks more sweeping shutdowns were the way to go in order to do everything possible to stop the virus from taking hold and spreading rapidly, even if it will continue to infect people. “I would say that there’s a lot of value in trying to hold off and slow transmission as much as we can. We’re learning so much more about this virus over time.”

Jenkins pointed to promising results released last week showing some benefit from the experimental antiviral drug remdesivir in treating COVID-19 patients. Even if some large share of the population is likely to eventually become infected with the virus, she said, rapid gains in our ability to treat COVID-19 argue strongly for trying to delay the time of that infection.

“I think it’s a slightly fatalistic attitude,” she said of the Swedish approach. “I think that if we can slow things, we can learn about what treatments might work.”

At the same time, Jenkins said viewing the crisis as a marathon, not a sprint, is on target, and we will have to reckon with what happens as we loosen our lockdown. “This is not sustainable and we are going to have to relax restrictions at some point,” she said. “The main goal was to protect health care systems.”

While Sweden’s per capita coronavirus death rates are much higher than those of its neighbors, it’s not clear what will happen as those countries start to open things up. “We might want to look at those numbers again in six months or a year’s time and see how things have played out over the longer term,” said Jenkins.

The idea that Sweden may achieve sooner than other places some level of “herd immunity,” where enough people have been infected to slow or stop the virus spread, seems to be part of the country’s approach. But that also carries lots of risk, since it’s not clear that prior infection protects against reinfection.

Still, the idea that we will begin slowly opening things up in the US over the coming weeks without slam-dunk treatments or a vaccine yet available underscores the conundrum that the pandemic has presented. “There are only different hellish ways to adapt to a pandemic and save both lives and livelihoods,” New York Times columnist Tom Friedman wrote last week in a piece on the Swedish approach.

“I think almost all of us here think this is the best,” Radomski said of Sweden’s approach, as she pointed to its neighbors now loosening restrictions without certainty of what will follow. “No society can handle this in the long run — that you can’t go outside, everything is closed.”