Coronavirus: Sweden has banned confinement, but for what assessment?

Within the European Union, one country still resists confinement: Sweden. The Scandinavian country has never imposed strict travel restrictions on its population to fight the Covid-19, preferring to bet on the confidence given to the inhabitants and on collective immunity. At the same time, the rest of the continent - first and foremost France - was under cover.

At first glance, the results are less serious than the absence of confinement might have raised fears. This Friday, May 15, 3646 people died and 29 207 confirmed cases were identified in the country of 10 million inhabitants, according to official figures from the Swedish Public Health Agency.

This is much more than the neighboring countries, Norway, Denmark and Finland, which each have between 200 and 600 deaths for a population two months higher than in Sweden. But, compared to the number of inhabitants (with the limits linked to the sometimes different methods of census of official deaths), this is roughly equivalent to the balance sheet in France (around 27,500 deaths per 67 million inhabitants, this 14 may).

"What will be interesting will be to see how the number of new cases will evolve in Sweden, knowing that the peak was on April 24, and to compare with the neighboring countries which started their deconfinement", indicates Anne Sénéquier, doctor and co-director from the World Health Observatory at Iris. In the meantime, we can still learn a few lessons from the Swedish experience.

Different culture and way of life

First of all, it should be noted that life has not been the same as normal in Sweden during the past two months. Without imposing anything, the government has made several recommendations, such as respecting physical distance, favoring telework, and limiting visits to the elderly. Restaurants and bars that flouted sanitary measures were even closed. "We must not believe that the Swedes were not confined. In reality, they are self-confined ”, underlines the epidemiologist Antoine Flahault.

In Sweden, the inhabitants are indeed known to be more disciplined - and with a different way of life - than in the countries of Western and Southern Europe. This would have limited the circulation and spread of the virus between residents. "A lot of people live alone, we don't have the same way of gathering as a family as in Latin countries like France, Spain or Italy," says Pegha, a 34-year-old Swedish woman who works in the finance. "We are not very Latin or very tactile at the outset, but on the same level as the Italians when they respect social distancing measures," added smiling Magnus Falkehed, journalist for the daily Expressen.

If Sweden is right about its coronavirus approach, the rest of the world is wrong https://t.co/s6Q5BuLC9Q via @BW

This is all the more important since "the human factor is the essential link in the management of an epidemic", underlines Anne Sénéquier. Nevertheless (and not surprisingly), the Swedes are the Europeans who have continued to travel the most by car, on foot, or by public transport since mid-March, according to Apple's geolocation data.

Fear for the elderly

However, the situation is not as good, especially with regard to the elderly. Half of the deaths recorded were in institutions for the elderly. Many employees reported very poor working conditions and a glaring lack of protective equipment. The residents are generally very old, more than in France, and therefore more vulnerable. "Many of them are over 90," notes Pegha.

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The government has just recognized failures in the management of these establishments, which the doctor in infectious diseases at the university hospital of Uppsalaa, Erik Salaneck, qualified as "criminal". "We had months to prepare, but the authorities only said that this was not going to happen here," he said in the daily Expressen.

This situation in retirement homes would explain why Sweden still has an excess of "moderate" mortality the week of May 4 compared to normal, after several weeks with a "high excess mortality", according to the Euromomo database. The other large European countries examined (France, Spain, Italy) returned to the category "no excess excess mortality", except the United Kingdom. "If Sweden's goal was to have as few deaths as possible in the first two months, it is obviously missed," said Antoine Flahault. 186 new deaths were still recorded in 24 hours this Friday.

Hope for collective immunity

If Sweden took this gamble not to impose confinement, it was in the hope (not officially announced at the outset) of achieving collective immunity. This happens when 60 to 70% of the population, regionally or nationwide, has been infected. These inhabitants produced antibodies which could, in theory, make them immune for an as yet unknown period.

On April 26, the Swedish ambassador to the United States estimated that 30% of the inhabitants of Stockholm, the capital, had been infected. "We believe that up to 25% of people in Stockholm have been exposed to the coronavirus and may be immune," said two days later the chief epidemiologist of the Swedish Public Health Agency and champion of this strategy, Anders Tegnell, in USA Today. Several forecasters believe that collective immunity could be reached in late May in Stockholm and its suburbs.

For comparison, in France, a study by the Institut Pasteur unveiled on May 13 estimates that only 4.4% of the French population has been infected, with a peak of less than 10% in the Paris region. However, containment has severely curtailed the circulation of the virus, which explains why this rate is much lower than in Sweden.

A still uncertain impact on the economy

One of the arguments of the Swedish authorities for not imposing containment was to limit the economic impact which was to be gigantic, as in all the countries affected. According to the latest national data, the country's GDP fell by only 0.3% in March. But over the whole of 2020, the European Commission predicts that it will fall by 6.1%.

"It is too early to say that we will do better than the others. In the end, we think Sweden will end up more or less at the same (downward) level, "said Christina Nyman, former deputy director of monetary policy at the Bank of Sweden, quoted by the Financial Times.