Swedish model holds lessons for America

As a partisan debate rages over whether and how to reopen the country, America is drifting, with no coherent strategy from the White House. States are opening up helter-skelter. President Donald Trump contradicts his experts and rages at perceived enemies, leaving ordinary citizens confused and angry.

In a sane world, the Trump team would be assessing models adopted by nations that have handled COVID-19 better than we have. It would be devising an American model to transition to a safe new normal.

South Korea and Germany have rightly reaped praise. But Sweden is now in the spotlight because it never imposed lockdowns, left much of its economy open and made social distancing mostly voluntary. Anti-lockdown activists are touting the “Swedish model” as proof that stay-at-home orders were some kind of power grab.
We should look at the Swedish model but for different reasons: Clues it offers for how we might escape the COVID trap in which we are stuck.

But first, a word about the now-popular conspiracy theory that stay-at-home orders were a plot by blue states. Those orders were needed because the White House failed to mobilize testing and equipment during key weeks in February and March.

The South Korean government, on the other hand, facilitated massive testing for the virus in January and ensured the health system got everything it needed. It contained the virus before it was widespread. In the United States, the virus was spreading widely before the Trump administration began to aid beleaguered states and cities. So lockdowns were necessary to mitigate the spread.

Now, back to the Swedish model — and it is a model, devised by their leading health experts. It’s not just a reckless decision to throw this country of 10 million people open to the virus, until the uncertain day when 60% of the public is infected and herd immunity is achieved, as some epidemiologists charge.

Sweden’s chief epidemiologist, Anders Tegnell, told journalists that his country chose not to go to lockdown because it decided to “put its trust in the public.” Sweden’s government rightly believed its citizens would practice social distancing on a voluntary basis.

Restaurants stayed open, under social distancing guidelines and with light traffic. The Swedes kept schools open for students under 16, because they believed older students were more capable of distance learning.

Factories stayed open, with some halts in production due to difficulties with global supply chains.

The Swedes were willing to gamble that young people were less likely to get or transmit the disease. Tegnell says, “Only 200 cases in Sweden (out of the current 28,000) were under the age of 20, and there is very little evidence that it spreads from children to adults.” He also admits that we have very little solid scientific evidence of anything yet.

The Swedes also gambled that the disease was mainly a risk to older people, especially those with other risk factors, whom they advised to socially isolate. More than 50% of those who have died were “very old and ill,” according to Tegnell. They also gambled that many Swedes under 65 who became mildly infected would gradually develop immunity.

But note that Sweden has had a higher mortality rate from the virus than its Nordic neighbors, of roughly 34 per 100,000 population. This rate is less than Spain, France, or Italy, which all went through lockdowns. Compare this to 25 per 100,000 for the U.S.

However, the Swedes have learned some lessons that are relevant to the U.S. situation. For one thing, the state of their elder-care homes, where many deaths occurred, was subpar and must be remedied. For another, they found that minorities contracted the disease at higher rates, and more attention must be paid to these communities.

So how useful is the Swedish model to the U.S.?

The caveats are huge. In a small country, this experiment was easier. Moreover, Swedes, like South Koreans and Germans, trusted scientists to lead the process. In all three countries, their political leaders refrained from partisan battles.

That said, the Swedish model should make Americans realize that the choice before them is not between a permanent lockdown and a Wild West revival. There is a middle option that involves risk, which could be mitigated if we only had a testing strategy devised at the top.

As many leading epidemiologists have argued, random sample testing at a national level could reveal how many Americans in different age groups, and ethnic groups had the disease and recovered. Once that risk factor was revealed, our country could focus on protecting older people, the ill and other groups at risk.

At a time when America is still badly lagging in testing and tracing, the Swedish model does offer hints of a third way, if the Trump team would grasp it and do the necessary testing. Otherwise, the country is in for a dismal year.

Trudy Rubin is a columnist and editorial-board member for the Philadelphia Inquirer. Readers may email her at trubin@phillynews.com.