Sweden's former health chief says the country's coronavirus strategy 'hasn't been the smartest' and it should've spent at least a month locked down

• Sweden's lockdown-free pandemic strategy is a global outlier.
• The country has recently seen its coronavirus death rate soar, with many of the oldest, frailest people left vulnerable to catching the virus.
• Former state epidemiologist Annika Linde said recently in an interview with Swedish newspaper Dagens Nyheter that the country, in hindsight, probably should've instituted a lockdown.
• "I think we're starting to see that the Swedish model maybe hasn't been the smartest in every respect," she said.

Sweden was the only country that remained fully open as the novel coronavirus tore through Europe.

Now, it seems the nation is paying a deadly price for its choice.

Sweden has one of the highest coronavirus death rates of any country — per capita, it's now worse than any other in Europe.

Open letters signed by more than 2,000 Swedish scientists in April urged the country to reconsider a lockdown. But so far, it has not. Swedish people are simply urged instead to frequently wash hands, stay home when sick, and generally use common sense.

The man in charge of this comparatively lax coronavirus-fighting strategy is Swedish state epidemiologist Anders Tegnell, who has run the country's public health strategy since 2013.

"The death toll really came as a surprise to us," he recently told The Daily Show. "We never really calculated with a high death toll initially, I must say."

But it appears Tegnell's predecessor would've run things differently if given the chance.

"I think we're starting to see that the Swedish model maybe hasn't been the smartest in every respect," former Swedish state epidemiologist Annika Linde, who served from 2005 to 2013, recently said in a Swedish-language interview with the daily Stockholm newspaper Dagens Nyheter.

The retired public servant laid out what she thinks has gone wrong in Sweden, and how, if she were to rewind time, she would've reserved at least a month to lock down the country and better prepare for life with the coronavirus.

Lockdowns save lives, and Linde says Sweden should have used one

"If we had to do this over again, I think we should have imposed significantly tougher restrictions from the beginning," she told DN. "We should have known how underprepared we were in healthcare, and elder care. A shutdown could have given us a chance to prepare ourselves, think things through, and radically slow the spread of infection."

She suggested a month-long closure might have bought the country some time to prepare.

Nearly half of Sweden's 3,871 deaths have been clustered in elder care homes, and among some of the oldest, and thus most coronavirus-vulnerable, people. Many older Swedish people are not wearing masks, and neither are their caregivers.

Linde said a Swedish strategy where sick caretakers simply stay home until they're better, and regular handwashing is encouraged, doesn't fully take into account how well people can transmit this virus without feeling sick, and how easily it spreads with close contact.

"That turned out to be totally insufficient in light of all the possible vectors of transmission that go hand-in-hand with the kind of work you have to do when you're caring for people," she said. "It was a clear misjudgment."

Now everyone is bent on "blaming someone else" for Sweden's high death rate, she said.

"At its core, it's the government that allowed this to happen, " she said in the interview. "I do not think that our strategy will result in the best outcome in the long run."

Linde says there's still more Sweden could be doing now to control the virus, especially in hot spots

As children continue going to school, and people fill parks, bars, zoos, and gyms, Linde said in the interview that it may be too late now for the country to drastically reverse course, but Sweden could still keep an eye on where the virus is impacting people the most and pay extra attention there.

"I don't know if at this point we'd gain anything from adopting a different strategy," she told DN.

Finland and Norway, both geographically, economically, and culturally similar countries to Sweden, issued harsher lockdowns, and have kept their case fatality rates (roughly 5% and 3%, respectively) at a fraction of Sweden's 12%.

At the same time, the latest Swedish studies suggest that far less than 10% of the country's population has been exposed to the virus, in line with infection rates in the rest of the world.

Staying open, as Sweden has, has long-term benefits

Linde is acutely aware of both the human and the economic cost shutdowns can prompt.

This is where, she argues, Sweden may be able to provide a model to the rest of the world for what comes next.

"No country can handle being closed too long, regardless of how many deaths there have been," she told DN. "I have to give credit to our Swedish strategies there, our strategy is more sustainable in the long-term, I think. At the same time, it's maybe given us an unnecessarily large spread of infection, severe morbidity and death, and we still haven't achieved herd immunity."

If she could go back in time, Linde would do things differently than Tegnell has, but she remains sensitive to the fact that the benefit of hindsight gives her an edge.

"I don't want to say that I, when it started, would have been wiser than Sweden's leadership has been," she said in the interview. "There are so many things about this virus that we still don't understand that it's impossible to say what's going to happen. Part of being wise is being brave enough to question your own assumptions, and own up to that fact."

Translations from Swedish by Sarah Wyman.

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