Covid 19 coronavirus: Is Sweden breaking its own loose restrictions?

On Thursday night the local indie duo Bells fell Silent will take to the stage at Malmö's Plan B club to perform plaintive, atmospheric songs in what may be the only music gig in Europe.

It is nearly two weeks since Sweden's Civil Contingencies Agency warned that Swedes' adherence to even the light, mostly voluntary, restrictions issued by its Public Health Agency, is relaxing. But Carlo Emme, the venue's Italian manager, is adamant that the gig was not a sign of slippage.

"Tonight we've sold 36 tickets, and between the band and sound engineer, and the audience, we will have 45 people in the room," he says.

"I don't think what we're doing is worse than having 300 people drinking beers in a restaurant in town."

Sweden has over the last seven days reported the highest coronavirus death rate in the world, with an average of 6.05 deaths per day per million inhabitants.

That recent death rate still falls far short of the 28 deaths per day per million inhabitants reported by Belgium in mid-April, and over the course of the pandemic, Sweden's total per capita death rate remains behind that of Belgium, Spain, Italy, the UK and France.

But it has nonetheless thrown further doubt over its decision to leave schools, restaurants and bars open, to allow public gatherings of up to 50 people, and in general to trust to the public's good sense, rather than imposing restrictions.

Annika Linde, Sweden's former state epidemiologist, this week became the first high-ranking member of the country's public health establishment to judge Sweden's strategy a mistake in hindsight.

"I think we should have locked down much harder in the beginning," Linde, initially a supporter of the no-lockdown approach, told the Dagens Nyheter newspaper. "A lockdown would have given us a chance to prepare, think things through, and minimize the spread of infection."

People hang out in Kungstradgarden park in central Stockholm. Photo / Getty

Sweden's no-lockdown strategy is also based on the idea that voluntary guidelines are more sustainable than imposed ones. But if even adherence to voluntary guidelines is starting to slip, might that also be a misjudgment?

"We're seeing that the numbers [of people who are changing their habits] are falling," Svante Werger, a special advisor at the Civil Contingencies Agency, warned at a press conference in Stockholm earlier this month.

"There are fewer who are following the news more than usual, fewer who have reduced their participation in social activities, and fewer who are limiting their travel on public transport."

A Swedish family eats dinner together despite the fear around the world of spreading the Coronavirus. Photo / Getty

Earlier this week, Sweden announced plans to fast-track a law allowing council officials to close restaurants and bars without first going through infectious disease doctors, a sign they recognise that the current system is not managing to prevent crowding.

And as spring turns to summer, the temptation for Swedes to stop keeping their social distance, to travel more, to drop good hygiene practices will only grow.

Werger acknowledged that slippage might be a problem.

"I think that's a risk that could occur everywhere, not only in Sweden, that people get fatigue, or people think 'now I have to take the risk'," he told the Telegraph.

But he said that the drop in adherence reported earlier this month now looked like it might be a blip, and that otherwise Swedes' following of the restrictions seemed to have been improving.

The Public health Agency would in the coming weeks issue new restrictions tailored to the summer months, he said.

"People want to go out and have fun, and I think it's important that we have recommendations that are possible to follow, that make sense to people, so they feel, 'ok, we cannot do this and that, but we can actually do this in a good way from a pandemic perspective'," he said.

He said that his agency still believed in the voluntary approach. "We are very sceptical of hard policies against people's behaviour. We have a lot to gain from being able to co-operate with the general public, so that everyone can feel actively that 'I'm part of the solution' and not just an object for the government's measures."

This is a sentiment Emme at Plan B would agree with.

Ahead of Thursday's gig, the latest in a string of gigs he has put on over the past six week, he is adamant the audience will adhere to the guidelines issued by the Public Health Agency.

"When we opened we were afraid that we would have like 20 cops coming in and shutting everyone down, but we've had police at our place several times, and nobody has said we're doing anything wrong."

Frode Forland, Norway's state epidemiologist, told the Telegraph that what had made Sweden's strategy different from that of other countries was less some special insight and more that its public health authorities had stuck to a pandemic strategy set long before the crisis began.

"We always had in mind that a new pandemic would spread like an influenza epidemic: that 25 per cent of the population would get seriously ill and that the spread would eventually cover maybe 70 percent of the population until you get herd immunity," he told the Telegraph.

"I think Sweden has maybe stuck to that kind of scenario for a bit too long. They were thinking too much in line with what has happened before."

With influenza, which has negligible asymptomatic spread, a strategy like Sweden's, which relies on people self-isolating if they feel sick, might work, he explained.

But even by March, it was clear that coronavirus was not like influenza. Those infected were spreading the virus days before showing symptoms. "It was also much more contagious, and much more serious, with a fatality rate maybe five times as high and infectiousness maybe three times as high."

Sweden has charted an unorthodox course through the pandemic. Photo / AP

That's why Forland's team decided at the very last minute that an influenza strategy - which like Sweden, they had prepared ahead of the pandemic - would have meant too many deaths.

As a result, only 234 people have died with coronavirus in Norway, while 3831 have died in Sweden, a per capita death rate nearly nine times as high.

Now Sweden has reported the results of its first coronavirus antibody tests, based on the analysis of 1200 samples per week over an eight-week period, Norway's strategy seems smarter still.

The Public Health Agency of Sweden reported on Wednesday that in the week ending May 3rd, 7.3 per cent of the samples from people in Stockholm were positive.

While Sweden's state epidemiologist Anders Tegnell said that his modelling suggested that over the following 17 days, the number of people with immunity in the capital would have grown to "somewhere around 20 per cent plus", Forland was sceptical.

Even in Spain, one of the hardest hit countries in Europe, Forland pointed out, only about 5 per cent of the population appeared to have been infected. "That's extremely far away from something which can be called herd immunity, and I think the danger of letting this slow until we get to herd immunity is that you are causing a lot of people to die."

• Covid19.govt.nz: The Government's official Covid-19 advisory website