How Sweden approached the COVID-19 pandemic: Summary and commentary on the National Commission Inquiry

Abstract

Aim: Sweden initially chose a different disease prevention and control path during the pandemic than many other European countries. In June 2020, the Swedish Government established a National Commission to examine the management of COVID-19 in Sweden. This paper summarises, and discusses, its findings.

Methods: Three reports published by the Commission were analysed. The first focused on the care of older people during the pandemic. The second examined disease and infection transmission and control and health care and public health. The third updated the first two reports and also covered economic aspects, crisis management and public communication.

Results: By 25 February 2022, when the final report was published, 15 800 individuals, 1.5 per 1000 Swedish inhabitants, had died after COVID-19. The death rates were high in spring 2020, but overall excess mortality in 2020-2021 was +0.79%, which was lower than in many other European countries. The Commission suggested that the voluntary measures that were adopted were appropriate and maintained Swedes' personal freedom during the pandemic. However, more extensive and earlier measures should have been taken, especially during the first wave.

Conclusion: The Swedish COVID-19 Commission felt that earlier and more extensive pandemic action should have been taken, particularly during the first wave.

Keywords: COVID-19; Government inquiry; Pandemic; Schools; Strategy; Sweden.

FIGURE 1

Daily number of new Swedish COVID‐19 cases, cases in intensive care units (ICUs) and deaths after COVID‐19 (according to the Swedish Public Health Agency).In February 2022, public testing for the SARS‐COV‐2 virus, which causes COVID‐19, was no longer encouraged and data on the number of new cases are uncertain after this point. ICU cases and deaths should however still be reliable after February 2022. The number of deaths is discussed in more detail in the main text. The number of cases during the first wave was greatly underestimated because of a lack of testing in spring 2020

FIGURE 2

Cumulative mortality per million inhabitants following COVID‐19 in selected European countries up to 25 February 2022. Data in the figure are based on Arnarson (Sci Rep. 2021)

FIGURE 3

COVID‐19 government response (Stringency Index)* in Sweden and selected countries, according to the Blavatnik School of Government, University of Oxford, 1 January 2020 until 25 February 2022. Swe, Sweden (red line). DNK, Denmark. Fin, Finland. Nor, Norway. Bel, Belgium. GBR, Great Britain. USA, United States. A high index equals a more stringent lockdown (with the highest numbers for Great Britain (yellow) in early 2021. *The Stringency Index is a composite measure based on nine response indicators including school closures, workplace closures and travel bans