A year and a half after Sweden decided not to lock down, its COVID-19 death rate is up to 10 times higher than its neighbors

• Sweden decided not to implement a full-scale lockdown during the pandemic.
• It now has up to 10 times as many COVID-19 deaths per capita as its Nordic neighbors.
• Sweden also didn't fare much better economically, suggesting its gamble didn't pay off.

Months before the first COVID-19 cases were detected, public-health experts ranked Sweden as one of the most prepared countries to handle a pandemic. But in March 2020, Swedish health authorities surprised the world with their unorthodox approach: Rather than locking down and requiring masks, as many countries did, Sweden let residents decide individually whether to take those precautions.

The gamble, Swedish authorities predicted, would pay off in the long run. Ideally, vulnerable people would choose to stay home, the economy wouldn't suffer too much, and healthy people might get mild COVID-19 cases that ultimately contributed to the population's collective immunity.

But a year and a half into the pandemic, it's clear that bet was wrong.

Sweden has recorded more COVID-19 cases per capita than most countries so far: Since the start of the pandemic, roughly 11 out of every 100 people in Sweden have been diagnosed with COVID-19, compared with 9.4 out of every 100 in the UK and 7.4 per 100 in Italy. Sweden has also recorded around 145 COVID-19 deaths for every 100,000 people - around three times more than Denmark, eight times more than Finland, and nearly 10 times more than Norway.

Had Sweden implemented tighter rules, experts told Insider, the country might have seen a COVID-19 death toll more similar to those Nordic neighbors.

"They underestimated the mortality tremendously," Claudia Hanson, an associate professor at Sweden's Karolinska Institute, told Insider.

"Sweden became a dream for many people to think one can do it differently," Hanson added. But in retrospect, she said, "it was maybe not a good idea."

Sweden's approach: allow residents to move freely

Life didn't look much different in Sweden last year: As coronavirus cases tore across the country, residents went to bars, attended school in person, and walked around maskless.

Many disease experts warned that the lax approach would result in unnecessary death. But Anders Tegnell, the chief architect of Sweden's coronavirus strategy, was wary of depriving residents of income or personal freedom.

"You can't open and close schools. That is going to be a disaster," he told the Financial Times in September. "And you probably can't open and close restaurants and stuff like that either too many times. Once or twice, yes, but then people will get very tired and businesses will probably suffer more than if you close them down completely."

Tegnell compared lockdowns to "using a hammer to kill a fly."

So Sweden became one of the few European nations that did not implement a full-scale lockdown. Its population mobility from March to May of last year went down the least out of 28 countries examined by the Organization for Economic Cooperation and Development. Public transport and leisure activities dropped just 22% during that time, compared with 66% in Spain (the country that saw the highest reduction in mobility).

Masks weren't required, either. A recent analysis from Arash Heydarian Pashakhanlou, an associate professor at the Swedish Defence University, found that Sweden's Public Health Agency decided against a mask mandate even when burgeoning evidence supported it - and long after the scientific community had overwhelming encouraged the practice.

Sweden did, however, still take some precautions: It closed high schools and universities in the spring of 2020, required social distancing in bars and restaurants, and asked the sick and elderly to stay home. Public gatherings were also limited in size to varying degrees over the course of the pandemic.

Sweden's strategy would 'likely result in a massacre' in a different country

When Sweden opted for a no-lockdown strategy in March 2020, scientists were still sorting out how deadly and contagious the virus was. But already, according to email exchanges published by freelance journalist Emanuel Karlsten and the Swedish newspaper Expressen, Tegnell was considering allowing the virus to infect young, healthy people as a means of increasing immunity in the population.

Hanson said she was "absolutely disgusted" by Tegnell's approach because it presumed knowledge that scientists didn't have at the time.

"Is he God, or even above?" she said. "That's what was terrible with the Swedish approach: the supremacy."

In a paper published in September 2020, philosophers Mirko Farina and Andrea Lavazza argued that many lives could have been saved if Swedish health authorities had followed the strategy of their Nordic neighbors.

"On paper they're all good scientists, but de facto in practice, most of them end up missing some basic human values," Farina told Insider.

Their paper also argued that Sweden's low density and small population - combined with residents' trust in national authorities - likely prevented a deadlier outcome. If a denser, more populous country like Italy were to adopt Sweden's strategy, they wrote, it would "likely result in a massacre."

Sweden didn't fare much better economically than its neighbors

Farina said one benefit of Sweden's approach, however, may have been less stress, anxiety, or depression among its residents.

The latest World Happiness Report showed that Sweden remained one of the happiest countries in the world in 2020, based on how residents rated their quality of life and reported experiencing positive or negative emotions. But the report also found that prioritizing an open economy wasn't conducive to overall happiness.

"Driving community transmission to zero and keeping it there has been better for all the pillars supporting happy lives: good health, good jobs, and a society where people can connect easily with each other in mutual trust and support," the authors wrote.

Plus, Sweden's economy still shrank 8.6% from April to June of last year - its largest quarterly fall in at least 40 years. By comparison, Denmark's economy shrank 7.4% during that time, Norway's 5.1%, and Finland's just 3.2%. (None of these economies shrank by more than 4% over the course of 2020, though.)

Sweden's unemployment rate also rose from 6.6% in March 2020 to 9.5% in March 2021. Norway, Denmark, and Finland all saw unemployment rise by smaller margins: around one percentage point, on average.

"We live in highly interrelated world," Farina said. "If something major strikes, it's going to be affecting everyone everywhere, irrespective of the national measures that you take."

Swedish scientists lamented their country's approach

Scientists called for changes to Sweden's strategy as early as April 2020. In an open letter that month, more than 2,000 experts criticized the government's decision not to lock down. Two months later, 23 Swedish doctors and researchers publicly questioned the nation's laissez-faire mask policy.

Eventually, after Sweden's daily COVID-19 cases, hospitalizations, and death skyrocketed from October to December, the country closed non-essential public spaces, such as gyms, pools and libraries, and recommend masks during rush hour on public transport.

"Countries that had mandatory restrictions have done better than us," Lars Calmfors, a member of the Royal Swedish Academy of Sciences, told the Wall Street Journal in December.

"We like to think of ourselves as being very rational and pragmatic," he added. "I can't recognize my country anymore."

Hanson, too, lamented the fact that Swedish authorities failed to course-correct sooner.

"Some people saw this tsunami coming," she said. "So why didn't we run?"