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Feature Coronavirus

Has Sweden’s controversial covid-19 strategy been successful?

BMJ 2020; 369 doi: (Published 12 June 2020) Cite this as: BMJ 2020;369:m2376

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An inconvenient reality: Swedish solution is for the Swedish

Dear Editors

I have previously commented on the content of this article, with potential misrepresentation of information (Ref 1)

It has been almost 8 weeks since this article was published and what difference that time had made!

Remarkably many exemplar nations demonstrating the effectiveness of public health measures of COVID-19 by containment and community lockdown, are now facing another wave of community transmission as they attempted to open their economies, requiring a reintroduction of movement restrictions and perhaps strict lockdown again.

In the meantime, Sweden’s strategy dealing with the COVID-19 pandemic, remains essentially the same, other than trying to improve testing accessibility and monitoring. For staying on course to their declared measures, Sweden’s daily newly identified cases and COVID-19 related deaths has plummeted, without overwhelming their ICU capacity. Throughout the last 5 months, her case fatality rate (CFR) is always significantly less than that of UK, despite the latter’s strict lockdown measures; both have CFR plateau for the last 2 months, but UK’s CFR remains double that of Sweden’s (Ref 2). This is despite many government including the UK, using Sweden’s allegedly high death rate, as justification for a strict lockdown to flatten the curve; the fact is Sweden’s deaths per capita is no worse than Italy, and definitely better than UK by a country mile.

Many commentators had previously tried to enhance the difference in death rate by comparing Sweden with other Scandinavian countries citing similar demographics (Ref 3). Despite this, some of them have started to wane in their stance against the Swedish solution, softening their criticism of the voluntary self-administered movement restrictions.

At the same time, there are increasing evidence of COVID-19 immunity in Swedish population beyond the previously reported low antibodies levels (Ref 4). More coherent commentaries on the misinformation put out by media and other outlets (Ref 5), linking potential political gains and convenient narratives to improve compliance by open victimisation and segregation of Sweden for not following the collective herd of conventional wisdom.

Personally I do think Sweden’s model will work for Sweden, mainly due to its unique demographic and social structure, healthcare infrastructure, relatively low population density and distribution over large areas, as well as Swedish outlook in personal responsibility and trust in majority of its resident. Try doing this in UK, the USA and it will be a recipe for disaster. It just takes a small number of irresponsible people to create a situation out of control, as the recent experience in the Australian state of Victoria has shown, having previously enjoyed a very mild first wave of the pandemic which probably embolden much complacency.

I have no doubt that motherland England will see more examples of Leicester city’s COVID-19 spike (and subsequent total lockdown), unless people start thinking and acting for the greater good reminiscent of the British spirit during the Blitz exactly 80 years ago.

In the meantime, we should stop picking on Sweden for choosing a different path; it’s a matter of “knowing me, knowing you” and creating a national solution to suit the behaviour, outlook and expectations of her own people.

That’s, after all, The Name of the Game.


Competing interests: No competing interests

04 August 2020
Shyan Goh
Orthopaedic Surgeon
Sydney, Australia