A letter to my beloved Sweden on the occasion of the pandemic

Sweden coronavirus - Snuggling with the Enemy

Sweden’s behavior during the coronavirus crisis has not only damaged the country’s reputation, it has also been a fully avoidable humanitarian disaster.

SCOTT RITCHER

Since the early days of the global pandemic that began in 2020, I have been fairly obsessed with the data. In a selfish and protective sense, I have wanted to know how close the disease was getting to me and the people I care about. 

Most of the daily numbers that are published about Covid-19 have been in the form of “new confirmed cases” and “new deaths.” Those types of daily tallies don’t make much sense to me. It’s so hard to see both the big picture and the personal story.

So I have made a habit of periodically translating the data – from raw case counts and deaths – into ratios and shares. 

“One in 35” not only makes more sense to me, it also makes it more personal. I can easily name 35 people I know, so if “1 in 35” were the number, I could estimate that the virus has probably gotten to one of us. 

How much worse has Sweden handled it than neighboring countries have? I did the math.

“Thanks for keeping your distance. Take care of each other.” – A public park in Stockholm, November 2020

Although my apartment and most of my belongings are in Stockholm, I spent the first seven months of the outbreak living in my hometown of Louisville, Kentucky. Shortly before the pandemic hit, I had moved back to Kentucky to work on a project there with some friends. The plan was that I would get my own place in Louisville and work there for the rest of the year. If all went well, I would return to Sweden to collect my stuff and move to Louisville more permanently.

But the virus began spreading and locking things down around the world, so I ended up living with my friends for nine months. We made the best of the circumstances and had some fun, but me living in their house for most of the year wasn’t the plan. I suppose I don’t need to tell anyone about how the nature of plans has changed.

In late summer 2020, when it became clear that the pandemic had no predictable end in sight, I began making arrangements to return to Sweden. Believe it or not, a gameshow host named Donald Trump was the president of the United States at the time. The future looked dark and unpredictable from every angle.

I surmised that as long as I was going to be locked indoors for the foreseeable future, I’d rather do it in my own apartment, surrounded by my own things. I had a job in Sweden I could return to, I could work from home and I could sleep in my own bed.

I am a dual citizen of the United States and Sweden, so worst case scenario if I caught the virus and fell ill, I am protected by a universal health care system in Sweden, but I don’t have that safety net when I’m in America. (About 300,000 other people in Kentucky also don’t have health insurance.)

From my vantage point as a citizen of both countries, throughout the pandemic I have been constantly dumbfounded by the realization that the state of Kentucky has done a dramatically better job of handling a widespread health emergency than Sweden has. 

One of the reasons I was so attracted to move to Sweden in the first place, more than a decade ago, was the country’s better grasp on taking care of people. Universal health care is a right in European countries and, although its system isn’t without issues, Sweden has a reputation for maintaining a healthy populace without income-based barriers to care.

Never in my life did I expect that Kentucky or the United States would handle a situation like this virus outbreak better than Sweden (especially surprising during the period with Trump at the helm). I am still surprised by how much wider this gap of management levels grows each day.

Sköndal Sweden Drevviken frozen
The frozen lake Drevviken, south of Stockholm, February 2021

Sweden’s health care and Nordic utopian reputation have taken a serious hit. As has been widely reported, for reasons that are still fairly unclear to me, Sweden “resisted” the lockdowns that became the norm in countries around the world. 

“Hey! I’m going to have a little party today for my 30th birthday.” – Note posted in my apartment building in Stockholm, November 2020

“The Swedish government has left it up to individuals to act responsibly and decide whether to stay home or not,” reported NBC News in April 2020. “Public gatherings of more than 50 people are prohibited, but there are no restrictions on private meetings, meaning parties and corporate events can still go ahead.”

You could say that hindsight is 20/20, but even at the time, foregoing limits on parties and allowing 50 people together in public spaces was seen globally as an irresponsible and foolish dance with the devil.

Sweden never imposed a mask mandate and, in fact, never asked for the widespread wearing of masks at all. Authorities finally recommended that people wear masks when using public transit in December 2020, but even then it was just a guideline, not a requirement, and it was only recommended during rush hours.

It would be 2021 before wearing a mask in Stockholm’s public transit was ultimately required, and even then, not enforced.

“Stay home if you are sick” – A sign posted on the lobby door of a Stockholm apartment building in October 2020.

As of this writing in May 2021, wearing a face covering in public has still never been mandated by the Swedish government.

During a visit last week to my local grocery store in Stockholm’s Skarpnäck neighborhood, I counted a total of 2 people wearing masks out of the 22 people I saw shopping and working in the store. (Make that 3 of 23 if I include myself.)

The sheer audacity of the authorities in Sweden who are still not directing the public to wear masks – more than a year after basic science has proven on a global scale that doing so can prevent the spread of a deadly illness – can only be an issue of pride or stubbornness.

Can they not say it now because they haven’t been saying it for too long? Or is it that they honestly don’t believe the rest of the world’s experience?

Individual choices in uncharted waters

For the most part, people do what they’re told. If you don’t establish visible lines people will not stay within them. You can’t have stores and restaurants open and then expect people to not go to them. (Even the prime minister will go shopping if the mall is open.)

People work with the information and boundaries they have available to them, and they base their decisions on experience and prior knowledge.

You simply can’t leave decisions up to individuals in a situation that nobody has ever experienced before. It’s not any more complicated than that.

The basic idea of freedom in modern society is that you can do whatever you want, within reason, as long as it doesn’t hurt anybody. It’s hard to argue with that concept.

But when you leave a deadly, infectious, airborne disease in the hands of everyone’s personal choices, those individual decisions can have serious, irreversible consequences for society as a whole.

Even as I write this, Sweden ranks number 8 in the world for most new infections in the past 7 days relative to population. What’s embarrassing and disappointing is that Sweden is surrounded on the list by countries that are painfully ill-equipped to deal with the crisis, while Sweden has everything it needs but simply refuses to give a shit.

For the past half year or more we have known how to control this virus. Almost all of Europe got the memo and acted on it. At this point in time there no excuse for the kind of behavior Sweden continues to exhibit.

The New York Times, 18 May 2021

Last month, the minister for health and social affairs, Lena Hallengren, walked unmasked into a public building to get her first vaccination shot. She posted a video of the occasion on social media and wrote in the post that she received early vaccination priority because she is in a high-risk group, undergoing chemotherapy treatment for cancer. I don’t understand how or why 2 and 2 are not being put together.

Of all the places you might want to protect yourself and those around you, how about a place with lots of people where you know everyone in line has not been fully vaccinated? At the very least, if you’re the minister for health, maybe you can set an example and just wear a mask for the cameras.

(Reassuringly, many of the 250+ commenters on the post questioned or criticized her for not wearing a mask – not that I support social media pile-ons.)

There still isn’t a light at the end of this tunnel, but it’s long past time for outrage and blame

When compared with the case counts and death tolls in neighboring countries, the numbers in Sweden are staggering.

Let me rephrase that: the numbers in Sweden are disgusting, embarrassing and amount to a level of carnage that was plainly avoidable.

These numbers are criminal.

Data: Statista, 18 May 2021. Chart: K Composite.

Despite that these are per million figures, some might argue that Sweden has a population double its neighbors and that Stockholm is a more densely populated city than Oslo, Copenhagen or Helsinki. Such arguments are silly, but alright, let’s go down that road.

Even if we were to add Germany into the chart above, with its 83 million residents, Sweden would still tower above the others, topping Germany by an additional 349 deaths per million residents. Proportional to Sweden’s 10.29 million people, this means that 3,582 Swedes would still be alive today had the country taken the preventive measures that Germany did.

Germany aside, let’s look at what might have been if Sweden had taken the same approach to the Covid-19 crisis as its neighbors in Denmark, Norway and Finland. If we take the rate of death from the coronavirus disease in each of those countries and apply it to Sweden’s population, then subtract that result from Sweden’s actual death toll, we can see how many of our fellow Swedes needlessly perished.

Chart: K Composite

To be clear about this chart is showing: This is not what the death toll in Sweden would have been, this is showing how many more people would have survived this ordeal.

Sweden’s Covid-19 death toll today is 14,275. With Denmark’s response, that number would have shrunk to 4,424. An additional 9,851 people would still be here with us today. Is it crazy to suggest that just one of those unnecessary deaths is too many?

The number of Covid-19 deaths that could have been avoided in Sweden is, in fact, the overwhelming majority of them.

Should people maybe have been required to wear masks? Should we maybe close the restaurants and shopping centers for a few weeks? Should we maybe behave in a way that is based on the science of how airborne viruses spread among people? Should we perhaps recognize that almost every other country in the world might be right and we’re not special? What has been the real cost of not shutting down large parts of the economy?

Look at the fucking humanity we have lost. Nearly 10,000 Swedes have died in the past 14 months who simply would not have died had Sweden followed the same common sense guidelines as our neighbors in Denmark. 

It wasn’t so hard to do, really – most of the rest of the planet did it – but Sweden wanted to be special. It certainly is that now. Top 10-level special.

Despite how much of this sounds, Sweden has not been the Wild West during the pandemic. Sweden’s high-speed internet infrastructure and pre-existing work-from-home culture made it fairly well prepared for people in certain types of jobs to avoid offices. Remote work seems to have increased even more as the pandemic has worn on.

And the government eventually passed a temporary “pandemic law” that gave its agencies some of the powers they lacked when the virus began to spread across the globe. Yet the measures that have been put in place since the law took effect have been oddly generous when seen against the scale of illness and death they purport to address.

Restaurants are still open for indoor service with a maximum of 4 people per table, and they must close by 8:30 pm (in Sweden all bars are restaurants; there are no bars that don’t serve meals).

“Shops, gyms, indoor sports facilities, and swimming facilities must calculate the number of visitors so that each person is given ten square meters of space.”

Public gatherings and events have capacity and distancing requirements, though shockingly, there are guidelines for how to hold outdoor events with up to 500 people.

Honestly, why are public gatherings with hundreds of people happening at all? It all seems totally out of touch with the reality of the pandemic and Sweden’s outlier status as a super-spreader society.

It didn’t need to be this way (and it doesn’t need to continue to be this way)

The rate of non-fatal infection and illness from Covid-19 in Sweden has also been shocking. In a country of just 10.29 million people, more than a million Swedes have tested positive for coronavirus – and those are just the people who got tested. How many more have there been in asymptomatic cases, or sick people who simply stayed home but never bothered to get tested? I happen to know a few.

A study released by the Swedish Heath Agency this month showed that 21.9% of non-senior adults who donated blood and were tested had Covid antibodies in their systems, massively more than were previously accounted for.

In confirmed cases, though, 1 in 10 Swedes have borne the pain of this disease. Compare that with 1 in 45 Norwegians, 1 in 61 in Finns, 1 in 23 Germans, and 1 in 22 Danes.

Just as we saw when we looked at deaths, things would have been stunningly different had Sweden followed the same path as one of its neighboring countries. About 84% of the people who tested positive for coronavirus in Sweden would have remained healthy in Finland.

More than half a million additional people tested positive for the virus in Sweden than otherwise would have under different leadership. Let’s just say it: under leadership based on science rather than stubborn pride. 

Chart: K Composite

As I am writing this, SVT is reporting that one of the country’s largest hospitals is searching internationally for health care personnel to help manage intensive care units in the coming summer. The article leads with a quote from the manager of intensive care units, “Please help us.”

I can only imagine what the reaction might be from neighboring countries who sacrificed more and took decisive steps aimed at avoiding the situation Sweden now finds itself in.

“I hope that we can have help from other countries,” he said. “I’m worried about what’s going to happen otherwise.”

Sweden’s state epidemiologist, Anders Tegnell, and the public health agencies in the Swedish government have presided over the unnecessarily early deaths of thousands of people, and the needless suffering and illnesses of more than half a million people.

Yet, bizarrely, Tegnell’s image is sold on t-shirts and he is revered by some as a hero of the Swedish people – a man who saved his country from the inconvenience of lockdowns and masks that the rest of the world endured.

Given the scale of this mismanagement, the embarrassing rates of infection and the heartbreaking loss of life in Sweden – the only explanation for the lack of widespread outrage must be be that people don’t know.

Maybe Swedes don’t know how bad it is in Sweden, or rather, maybe they don’t know how bad it isn’t in other countries. Maybe they don’t know they didn’t have to get sick.

If people haven’t seen these numbers or thought about them in these terms, I should hope that the outrage and accountability is simply being delayed until it can be dealt with. I would hate to think that people are too lazy or callous for so many fully avoidable dead bodies to make a difference.

I wrote this criticism and published these numbers out of alarm. I love Sweden and I have made it my new home, but I thought it was better than this. I hope we all thought it was better than this.

These aren’t just insane numbers, these are people. These are Swedish people who worked hard, paid their dues and trusted the government to protect them. They didn’t deserve for it to end like this.

Skogskyrkogården
Skogskyrkogården, 2021

Footnotes: Check my math

Here are the data and calculations I used to write this article and to create the charts.

Deaths per MillionPopulationPopulation size (x) compared to SwedenConfirmed deathsShare of population deadDeaths in Sweden at this country’s rateLives saved if Sweden had followed this country’s responseConfirmed casesShare of population infectedCases in Sweden at this country’s rateAvoided Covid infections if Sweden had followed this country’s response
Germany1,03983,166,7110.12487486,3861 in 96310,7873,4883,608,3201 in 23450,585586,541
Denmark4305,843,3471.7772942,5021 in 2,3354,4479,828266,6381 in 22473,894563,232
Norway1455,391,3691.9262917741 in 6,9661,49112,784119,5001 in 45230,192806,934
Finland1695,536,1461.8759169331 in 5,9341,75012,52590,2491 in 61169,300867,826
Sweden1,38810,385,347114,2751 in 72814,27501,037,1261 in 101,037,126-0

Population figures from Wikipedia. Covid data from Our World In Data, Statista and The New York Times.