As White House eyes 'herd immunity,' Sweden's no-mask approach is failing to contain COVID-19

As White House eyes 'herd immunity,' Sweden's no-mask approach is failing to contain COVID-19

20 Oct    Finance News

BARCELONA — Fresh from arrival at Spain’s El Prat Airport, the bald, middle-aged man strode across the terrace of a popular Barcelona restaurant, giving bear hugs and dramatically kissing old friends as well as new acquaintances. “He was touching everybody and spit-talking,” said Carmen Oko, a teacher, “and he kept coughing in everyone’s faces.” When Oko yelled across the terrace demanding that the visitor cover his mouth when he coughed, he told her to stop being paranoid, everyone would eventually get COVID-19 anyway. 

When another witness to the spectacle asked why he was blatantly defying public health recommendations, he said that Spain, where face masks are mandated (except for in restaurants, now believed to be a major source of spread), has it all wrong. The correct approach, he said, was that of his home country of Sweden, where the government has taken a laissez-faire attitude, strongly discouraging mask use, emphasizing personal responsibility and giving at least the appearance of encouraging herd immunity by allowing some to get sick until a base immunity is established. It is a concept gaining favor in the Trump administration, whose policies increasingly reflect the minority views of the president’s coronavirus adviser, Dr. Scott Atlas, a radiologist with no expertise in epidemiology or public health.

Dr. Scott Atlas, member of the White House Coronavirus Taskforce, walks at the White House in Washington, DC, on October 12, 2020. (Nicholas Kamm/AFP via Getty Images)
Dr. Scott Atlas, a member of the White House coronavirus task force, at the White House on Oct. 12. (Nicholas Kamm/AFP via Getty Images)

But in hard-hit Spain, which has the highest cumulative number of COVID-19 cases in the European Union and where, with national cases surging over 13,000 a day, capital Madrid is again under lockdown and new restrictions are going into effect all over the country, that behavior was considered outrageous, driving at least one patron out of the restaurant and home, he said, to shower.

“Now Sweden has the lowest COVID rate in all Europe,” the visitor boasted, though statistics refute his claim. Not to mention that he was ignoring even the recommendations that the Swedish Public Health Agency did make, including social distancing, frequent washing of hands and coughing into elbows. 

With infection rates now rising in Sweden — though not to the extremes of countries such as Spain, France, Belgium and the U.K. — the Swedish prime minister himself recently implored his countrymen to stop hugging and kissing their friends, and for youth to stop partying, all factors blamed for the uptick in cases to more than 600 a day, up from around 100 at summer’s end.

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A country larger than California in size but with a mere 10 million residents, Sweden is the renegade country that’s turned into an internationally observed lab experiment in COVID-19 control. In the early days of the pandemic, the Swedish government was slammed for being reckless, even by Trump — refusing the lockdowns adopted by its Scandinavian neighbors and keeping most everything open, businesses, restaurants and schools (except for students older than 15, whose classes went online). But with the ascendancy of Atlas, who has praised the Swedish model, it’s getting another look.

The Public Health Agency has denied that it ever sought to achieve herd immunity by letting much of its society get sick (although that assertion is contradicted in the agency’s emails) but rather tried to balance the impact on hospitals with concerns about the economy. Whatever its original motives, it remains unconventional in its policies, including dismissing the use of face masks, saying they give false security, a contention that one vocal group of Swedish health and science researchers and professionals, calling itself Vetenskapsforum (Science Forum) COVID-19, takes issue with, along with most of the Swedish government’s approach. 

A woman stops to look at fabric face masks on sale in a shop in Stockholm, Sweden, on August 31, 2020. (Tom Little/AFP via Getty Images)
Face masks in a shop in Stockholm in August. (Tom Little/AFP via Getty Images)

In a video titled “You Should Be Protected,” the group says the Swedish government’s anti-mask messaging, and the idea that the face coverings themselves are dangerous because they are so difficult to use correctly, have become so ingrained that public employees, from teachers to ophthalmologists to nurses, have been badgered, even fired, for wanting to wear masks. The group also contends that anti-face-covering policy may be linked to unnecessary deaths.

“Mortality in Sweden has by far exceeded the mortality observed in the other Nordic countries,” the group states on its website. “Sweden is actually today among the highest countries in the world when it comes to deaths per capita from COVID-19.” In fact, according to data from Johns Hopkins University, Sweden’s death rates put it at No. 17 among the world’s 191 countries.

With nearly 6,000 deaths — about half of those in its eldercare facilities, where 7 percent of residents have died — the Swedish mortality rate (58.12 per 100,000), adjusted for population, is five times as high as neighboring Denmark’s (11.83 per 100,000), nearly 12 times as high as Norway’s (5.23 per 100,000) and only a little better than the U.S.’s (67.28 per 100,000). The country’s coronavirus infection rate also remains far higher — twice that of Denmark and three times as high as Norway’s, both of which encourage mask use. 

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Vetenskapsforum COVID-19 asserts that due to a paucity of testing at the start of the pandemic and the types of tests used in Sweden, the number of cases could actually be far higher than reported.

Whatever the actual numbers, with a second wave slamming Europe — leading France to impose a nationwide 9 p.m. curfew, and Belgium and the Netherlands to shutter bars and eateries — the Swedish government appears to be backpedaling, or at least considering modifying its hands-off stance. Last week the national health agency handed localities the right to decide their own policies, which may lead to municipal mask mandates, even partial lockdowns of hard-hit cities like college town Uppsala.

The rising rates in Sweden have compelled Denmark to flag it as a no-go zone. “We Danes always admired Sweden as a good society,” says Peter Julius, who is training to be a hypnotherapist. “But since coronavirus, and their no-mask policy, we’re like, ‘What are you doing?’” 

People wearing protective masks wait on a platform in Aarhus, Denmark August 10, 2020. (Ritzau Scanpix/Bo Amstrup via Reuters)
People, most wearing protective masks, at a train station in Aarhus, Denmark, in August. (Ritzau Scanpix/Bo Amstrup via Reuters)

But polls show that the government’s policies, while declining somewhat in approval, still remain popular in the country, with 58 percent supporting the policies of the Public Health Agency. And though the Swedish “it’s up to you” model may well not work in other countries, Swedes are quick to point out that their situation is unique. “Sweden is sparsely populated, and nearly half the population lives in one-person households,” notes Helena Centerwall, a Swede running a bed-and-breakfast in Spain. “It’s easier to isolate if you’re already isolated.”

“Swedes socially distance by nature,” says Ann Sjostrom, who works as a substitute teacher in a town an hour’s drive from Stockholm. “We stay at home. When we go out, we go for walks in nature.” 

And the transportation authorities are encouraging Swedes to avoid mass transit. “Why not ride your bike?” asks the website of one regional bus service. “Or do you really need to go out at all?”

“I like the Swedish way more,” says psychotherapist Ulf Hedqvist, who divides his time between Barcelona and Västeras, Sweden. On a recent trip to Barcelona, he noted two behaviors that have certainly contributed to the rising numbers in Spain. While most locals wore masks, “many failed to cover their nose — some even wore the masks on their throats,” he says. And it’s easier to socially distance in Sweden. “Here, we’re not kissing and hugging all the time like they do in Barcelona,” he says. Yet another factor for the surge in Spain, say commuters: jam-packed rush-hour metro cars — a situation that has prompted protests in Madrid.

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MADRID, SPAIN - OCTOBER 20: Spanish healthcare workers take part in a protest against work conditions, getting heavier due to coronavirus (COVID-19) pandemic, and privatization in the health sector outside the Ramon y Cajal State Hospital in Madrid, Spain on October 20, 2020. (Burak Akbulut/Anadolu Agency via Getty Images)
Spanish health care workers protesting on Tuesday outside a hospital in Madrid to demand better working conditions. (Burak Akbulut/Anadolu Agency via Getty Images)

Former heart surgeon Gunnar Brandrup-Wognsen, who volunteered in the ICU of a Göteborg hospital during the peak of Sweden’s outbreak, likewise supports his government’s approach. He’s been dismayed when he travels to other countries, such as France, and sees many using “cheap, ineffective masks” that they put on, then pull off and keep reusing, giving a sense of false security. “You think you’re safe, so then you don’t adhere to social distancing,” he says. Despite a slowness to test and trace, and the loss of so many seniors, he believes Sweden has done a fine job of balancing public health and hospital concerns with the economy and society. “Of course we won’t know if this was the right approach until we can look back in the rearview mirror.”

But dissent in the country where very few don face coverings can be found in surprising places. Take, for instance, Jack Sjöstrom, a high school senior. “The World Health Organization recommends wearing masks,” he says, “and I’m going to listen to them.” The civics major finds the Swedish approach “pretty worrying,” wants more “evidence-based” policies and is concerned about Sweden’s relatively high death rate. The only one in his family to wear a face mask, which he uses whenever he leaves home, he’s also the only one in his school to wear one in class, which has led to some mockery. “Some kids fake-cough whenever they see me in my mask,” he says. But, being good Swedes, they fake-cough into their elbows.


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