News & Politics

Why the 'Swedish Approach' to the Pandemic Wouldn't Work in the U.S.

People walk past election posters near the Swedish parliament in Stockholm, Monday Sept. 10, 2018, the day after general elections in Sweden. Sweden was looking at weeks of uncertainty and complex coalition talks after the country's two rival blocs failed to secure a clear governing majority in elections that saw a boost for a far-right party — considered political pariahs — amid growing discontent with large-scale immigration. (Soren Andersson/TT via AP)

Sweden is virtually unique among industrialized nations for its approach to combatting the coronavirus pandemic.

The Swedes didn’t lockdown, didn’t hunker down, didn’t button up, or any other euphemism for a shutdown of the economy. Instead, they targeted certain “hot spots” for isolation while the rest of the country went on with their daily lives.

Bars, restaurants, gyms, and other public establishments remained open. There are no restrictions on manufacturing or service industries. Social distancing is voluntary. But maybe because the government is treating its citizens like adults, almost everyone is keeping their distance from each other.

This hasn’t prevented infection. Jim Geraghty of NRO’s Morning Jolt reports that “Sweden has 24,623 cases of coronavirus and 3,040 deaths. Sweden has 2,438 cases per million people and 301 deaths per million people. The United States has 3,906 cases per million people . . . but only 232 deaths per million people.”

Testing is not much better than in the U.S. and there have been complaints about there not being enough personal protective gear for health care workers.

They were trying to achieve “herd immunity” by exposing a large percentage of their population to potential infection. The thinking is that the more people who are immune, the fewer who will be infected when the coronavirus returns for a second wave.

But it should be noted, as the Wall Street Journal reports, that Sweden’s economy is still going into recession, albeit a milder one than much of Europe and the U.S.

Even without legal prohibitions, many Swedes are voluntarily following authorities’ social-distancing recommendations and limiting travel, pushing down domestic consumption. And the country can’t insulate itself from lockdowns among its trading partners. Exports are falling.

The result: Sweden’s economy is contracting, but not by as much as some others in Europe. Meanwhile, it is recording deaths per capita from the virus that are considerably higher than in neighboring countries — though below levels seen in France, Italy and the U.K.

So why not try the Swedish approach here in the U.S.? First and foremost, it’s a question of scale.

Jim Geraghty:

Heading into a crisis like this, the United States has to ensure access to personal protective equipment, hospital beds, ICU units, tests, potential treatment drugs, for the potential treatment of 330 million people (although I suppose you could rule out the population under 18). That’s just a much more difficult task than securing what’s needed to prepare for a viral outbreak in Hong Kong (7 million people), Taiwan (23 million people), or South Korea (51 million people). All of those countries have handled the outbreak well, and significantly better than the U.S. — but we should keep the degree of difficulty in mind.

But it’s in at-risk populations where the differences are greatest.

When you compare populations, other key differences become clearer. Sweden has about 4 million citizens over the age of 60; the United States has about 150 million. With 7.6 million people living in urban areas, Sweden ranks 57th in the world in that metric. We rank third with almost 240 million. Neither of our population densities is particularly high by world standards, but ours is a little higher.

Overall health is also an issue. Sweden is the least obese country in the world. And that apparently matters a lot.

A study of coronavirus patients admitted to the intensive care unit at university hospitals at Johns Hopkins, University of Cincinnati, New York University, University of Washington, Florida Health, and University of Pennsylvania found “an inverse correlation between age and body mass index” — meaning the younger a person was in the ICU, the more likely they were to be obese. (“Obese” means a body mass index over 30; for someone who is 5 feet, 9 inches tall, that would be 203 pounds or more.)

The end result of trying the Swedish approach here in the U.S. would be a staggering number of deaths.

Now imagine Sweden’s minimalist approach in the U.S. and how that would effect not just obese Americans, but those with heart disease, high blood pressure, diabetes, asthma, smokers, those undergoing cancer treatment, bone marrow or organ transplants, HIV, kidney disease or undergoing dialysis, liver disease, lupus, any other potential immunocompromised condition, and those 65 and over. We have a lot of people who are “healthy enough” to function on a day to day basis, but who have at least one condition that would make a fight with coronavirus life-threatening. Your mileage may vary, but I look at the millions upon millions of Americans who could lose that fight with the virus and find the Swedish approach unworkable here — just too much risk to too many people.

Reopening the country is not going to be a huge problem in most states. But I don’t think there’s any doubt that there is going to be a spike in the number of deaths and infections. They could be highly localized and contained without having to shut down the entire economy.

It’s a long road back. There will be fits and starts. I guarantee that in the next week, the reopening will be declared a “failure” by Trump opponents as they seek to develop a “we opened too soon because Republicans want people to die” narrative.

Predictable — and tiresome.