Sweden’s business-as-usual approach in the war against COVID-19 pandemic has been held up by many conservatives such as Senator Rand Paul as a less costly alternative to national lockdowns adopted by most countries around the world.  We have always maintained that Sweden’s laissez-faire or lazy approach (also tried for a short time by the UK and Netherlands, and still followed by devastated Brazil) is inhumane and does not save lives or even economic fortunes.  Moreover relying on “herd immunity” may be wishing thinking — scientific studies show that coronavirus immunity could disappear after 6 months.

While Sweden has always insisted that theirs is not a herd immunity approach they have always hoped that they could achieve herd immunity quickly to end the pandemic in Sweden.  Their latest antibody study showed that just 7.3% of Stockholmers developed COVID-19 antibodies by late April.  Sweden is losing the war on COVID-19 not just because they failed to impose a national lockdown – they failed in basic epidemiology.  They failed in every aspect of the 4T’s required to successfully manage a Pandemic: test, track, treat, and restrict travel.

  1. Testing has been poor – testing 2.1% of their population but only down to 16% positive results while Denmark’s testing returned only 2% positive results (see table below).  Sweden is the worst of all major European countries in testing.  They try to make up for this deficiency with some random serological antibody testing, but the latter is far less reliable than the viral testing they should be doing.  D
  2. Tracking down all potentially infected is tough if their testing is so spotty but they really make little effort at contact tracing.  D.
  3. Treatment yields them their best grade of B.  They have a good medical system that is well prepared to handle the pandemic, but because their testing is so lackadaisical, they often fail to catch the patients in their early stages of infection.  By the time they are hospitalized and tested they are sometimes left with few good treatment options.  Sweden has attributed their poor case fatality rate (CFR) of 12% to outbreaks in senior facilities with many sick, old people.  Poor testing also causes them to miss the asymptomatic and mildly symptomatic cases and artificially lower the denominator and increase the measured CFR.  The figure below plots CFR against patient age and shows that Swedish (purple line) people fared worse than those in Spain, South Korea, and every major country except Italy.  We don’t know how much of this tragic result is due to poor testing and how much is due to delayed treatment.
  4. Travel restrictions get a C grade.  While their voluntary social distancing and travel avoidance, plus some congregation limits (<50) has worked to flatten the curve, the lack of a national lockdown combined with a lack of thorough testing and tracking is causing them to experience thousands of more deaths than their Nordic neighbors: Denmark, Norway, and Finland (see table below).  Sweden has flattened the curve but there is no sign that their pandemic is easing or under control.  Sweden has the highest coronavirus death rate per capita in the world, with an average of 6.1 deaths per million inhabitants a day over the last 7 days. 

Our criticism of Sweden is not that they did not impose a national lockdown — there are countries that have managed their COVID-19 crisis without draconian lockdowns.  But if they chose to leave their country open domestically, they had to implement the other 3Ts: test, track, and treat thoroughly.  Iceland, Norway, and Denmark did not impose stay-at-home orders and left most businesses open.  They all controlled their infection with thorough testing, contact tracing, and early treatment.  Sweden should have done the same and now many top officials in the country are reconsidering their strategy.    

Fatality (CFR)Tests
 Testing PositiveMedian Age
Sweden        3,291     33,188    3,992        39612.0%  20,79816%41.1
Denmark        1,951     11,289       561          975.0%  90,8952%42.3
Norway        1,541        8,340       235          432.8%  42,4194%39.2
Finland        1,186        6,568       306          554.7%  29,8934%43.1
Iceland        5,290        1,804         10          290.6%170,7453%37.5