Sweden’s top virologist has a message on how to defeat coronavirus: Open schools and no masks

August 5, 2020, 10:00 AM UTC

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Just a month ago, Sweden was labeled the “world’s cautionary tale” for its laissez-faire approach to fighting the coronavirus. It famously decided not to close its schools, restaurants or bars, and it told its citizens that there’s no need to mask-up. When the death toll surged in late April, and the country looked overmatched by the fast-moving virus, its officials sounded defensive.

The country’s Public Health Agency developed and implemented Sweden’s approach, and its chief epidemiologist, Anders Tegnell, became the face of the crisis. 

While other countries were locking down shops, schools, and public life, Sweden was the outlier, trying to manage the disease with the least possible impact on the economy. The prominent Swedish virologist Lena Einhorn, for one, called the Sweden approach “madness.” Seeing the mortality rate climb in Sweden, Norway decided to close its border with its chief trading partner. 

By a per-capita basis, the coronavirus outbreak in Sweden has been one of the world’s deadliest—worse than the United States, France, or any Nordic neighbor. But in the past six weeks, Sweden has seen a remarkable turnaround. New daily cases are down to multi-month lows. Hospital admissions are close to zero, and just 44 Swedes died of COVID-19 in the past seven days, official numbers show. At the same time, coronavirus cases are spiking around continental Europe. 

New COVID cases in Sweden have been consistently flat over the past month while spikes in Spain and the UK have alarmed politicians and medical professionals.

Tegnell feels vindicated by the latest batch of promising data. 

Last week, he told reporters that masks are not necessary in Sweden. In an interview with Fortune this week, he doubled down on that message, saying the sustained flattening of the curve tells him to not change a thing about the country’s mask strategy—or anything else for that matter.

“We don’t have to introduce masks right now. Because, with a down-going trend,” he said, “it’s not the time to introduce new measures.”

Better than nothing

The mask debate is dividing lawmakers and scientists alike, even as a wave of new studies show that some kind of mouth-and-nose covering is better than nothing in protecting against infection and/or spreading the virus to someone else in the vicinity.

Tegnell has reviewed the body of research and isn’t convinced the mask is an effective tool in a public health threat like the coronavirus. The flaw in the mask strategy comes down to you and me, he says. 

“The mask,” he allows, “is complicated. You have to decide when to use them, who should use them, and then try to find out if will you be able to use them properly in a context. I mean, we’re talking about masks in restaurants, and, of course, you cannot eat with a mask on.” And, he pointed to Spain, which has a relatively strict mask rule but where cases have spiked lately.

He adds: “I’m telling people it’s much better to keep a social distance. This is really the best thing you can do in trying to lessen the risk of [infection]—keeping distance. Try to work from home, cycle to work instead of taking the bus if you can. There are plenty of things you should do before you start with a mask [policy].”

Swedes in Stockholm take part in the Ascension Day Church Service at Gustav Vasa Church on May 21, 2020, doing their best to maintain social distancing advice. Wire photography: Linnea Rheborg/Getty Images
Linnea Rheborg—Getty Images

Never mind that in, say, the New York metropolitan area, which has a population double that of the whole of Sweden, it’s not easy to maintain social sufficient social distancing. On either side of the Hudson, the Sweden model—as it pertains to masks, at least—won’t be all that applicable.

Stay in school

Tegnell believes Sweden could serve as a model on another thorny issue: schools. 

In the spring, Sweden opted not to close its daycare centers or schools, and, Tegnell contends, it had little bearing on infection rates. The Public Health Agency compiled the data on its schools-policy decision and shared its results. Sweden reported 1,124 cases of school-aged children contracting COVID-19 in a period spanning from March, when the outbreak began, to the close of the school year in mid-June. That number equals 2.1% of all COVID cases in the country during that period. Of those, 14 had to be hospitalized in an intensive care unit. 

Sweden contrasts those numbers with those of Finland. 

“Finland kept the schools closed, and we kept them open. And it seems like, at least in our context, it didn’t make a huge difference, neither to the pandemic, nor to the number of children falling ill,” Tegnell told Fortune.

“It seems like children do get infected,” he continued. “They very seldomly get seriously ill, and they don’t seem to spread the infection very much to other parts of the society.”

The comparative data bears this out. Partly. Even though they were at home much of the final three months of the school year, Finnish school-aged children, on a per-capita basis, caught the coronavirus at a rate that was nearly four times higher than their counterparts in Sweden. But just one Finnish child was admitted to the ICU compared to 14 in Sweden.

As most parents would tell you, just 14 kids in the ICU is hardly reassuring data. 

Still, Tegnell believes school kids are low-risk virus vectors who ought to be in classrooms, not at home distance-learning. “Keeping schools open is quite possible to do without having any negative effects,” he said.

Medical professionals elsewhere are not so sure. Researchers in the United States last week, for example, found that COVID-infected children under five were major carriers of the virus.

Flowers and cards

Tegnell mentioned more than once the “ethics” of Sweden’s public health policy. For example, the public health experts decided early on that a policy of achieving herd immunity, as was discussed in Great Britain, was out of the question in Sweden. “Of course, we will not let people fall ill just to achieve herd immunity. That’s not the way we’re working,” he said. Besides, he later said, sufficient herd immunity is neither achievable nor would it be sustainable with coronavirus.

And yet the “Swedish model” has become synonymous with a leave-the-people-alone approach to managing a public health crisis, a strategy advocated by small government advocates around the world. This puzzles Tegnell. The objective in Sweden was the same as everywhere else, he says: to get the infection numbers down.

“When I talk with my colleagues in the UK, for example, we could see that we were able to achieve in Sweden almost the same kind of things that they were able to achieve by legal measures—that is, to encourage people to maintain social distance and so on,” he said.

How Sweden achieved this wasn’t through a strict set of rules, it was by winning the people over. “We have a very high level of trust among the population,” he said.

Each week, the health agency collects survey data from thousands of Swedes. In it, they asked a big question: How are we doing? The approval rate has been sky high.

“It seems 80% of the people, when asked, ‘Are you following the advice of the agency?’ responded, ‘Yes, we are following the advice of the agency.’ And that’s been consistent all the way through,” he said. “The trust for the agency is high. People continue to follow our advice. I think that’s really important.”

“It’s rather unusual that an agency in Sweden gets flowers from the population—flowers and cards.”

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