How does Sweden's stance on face masks compare to the rest of Europe?
Face masks have emerged as one of the polarising topics of the coronavirus crisis, with Sweden continuing to advise against their use by the general public. How does the Swedish stance stack up against the rest of the world?
What are the rules on face masks in Sweden?
Sweden's Public Health Agency says there is no need for members of the public to use face masks when in public spaces such as buses or shops.
Still, ten of Sweden's major airports have recommended the use of masks inside the terminal. All staff working closely with travellers will wear masks but members of the public are not under any obligation to follow the recommendation.
Train operator MTRX provides face masks for free to all passengers and recommends their use during travel, while public transport operator Skånetrafiken offered 50,000 free masks to ticket holders.
But there's no general requirement for mask use on Swedish public transport, and state-owned rail operator SJ and Stockholm public transport operator SL are two examples of companies that currently do not recommend their use.
The European Union Agency's for Railways recommends that transport operators provide masks for all staff, and states that for passengers, "where physical distancing cannot be ensured on board trains, use of face masks is recommended".
The European Union Aviation Safety Agency states that "the use of medical face masks should be recommended for all passengers and persons at the airport and in the aricraft, from the moment they enter the terminal building at the departure airport until they exit the terminal building at the destination airport" although exceptions may be necessary.
Photo: Fredrik Sandberg/TT
How does this compare to the rest of Europe and the world?
The Nordic countries as a group have taken a similar stance to face masks, with less than ten percent of inhabitants in Denmark, Norway, Iceland and Finland wearing them.
One big difference is that the rate of infection is far higher in Sweden than in the rest of Scandinavia.
And in neighbouring Denmark, the guidance changed in early July from recommending against mask usage to advising them in certain situations. Masks are now mandatory in airports and advised in high-risk situations such as if breaking quarantine to take a coronavirus test.
These restrictions are stricter in much of the rest of Europe and the world. In Italy masks are strongly recommended "during all social contact" alongside other measures, Spain and France require them in all indoor enclosed spaces, Switzerland mandates them on public transport and recommends them in other situations where distancing isn't possible, and the UK requires them on public transport and in shops.
The European Centre for Disease Control (ECDC), which is headquartered in Stockholm, has recommended use of face masks in environments where social distancing isn't possible, with its chief scientist saying the centre has become more convinced of their benefit as the pandemic has developed.
The World Health Organisation has also changed its recommendations on masks, advising that governments should encourage mask-wearing in environments where distancing is not possible, such as public transport or crowded indoor areas – even while stating that there is not much scientific evidence showing they prevent the spread of the disease.
Across the world, the use of masks has caused a polarised debate that has at times escalated violently. Bus drivers have been attacked in France, Germany, the UK, Switzerland and Italy for asking passengers to wear masks. In Sweden several of The Local's readers have shared stories of being verbally and even physically abused for wearing face masks in public places.
File photo: Stina Stjernkvist/TT
Why the difference?
This is the big question, and there are a few ways to answer it.
Swedish state epidemiologist Anders Tegnell said that two things could happen to change the country's guidance on face masks: an uptick in infections, or robust evidence that face masks help prevent spread of infection.
Sweden's rate of new confirmed cases, serious cases, and deaths have been sharply falling in recent weeks after a long period of widespread infection, so the Public Health Agency is focusing all its efforts on maintaining that development. This means encouraging people to continue following the basic recommendations around social distancing and hygiene.
That puts the country in a different situation to the US or parts of Spain, for example, where cases are continuing to rise fast.
The difference in interpreting the science is more complicated. The novelty of the coronavirus and the difficulty of measuring specific measures in isolation means there is no conclusive proof that masks do or don't hinder the spread of the coronavirus.
Many European countries and EU agencies have acknowledged the lack of robust evidence but suggested mask-wearing as a precaution, intended to be used alongside other scientifically proven measures.
So it's not perhaps so surprising that Sweden is an outlier, as it's a repeat of a pattern earlier in the pandemic. While many countries closed down shops, restaurants, and schools as a precaution, Sweden introduced far less strict measures, which sparked criticism as the country's death rate leapt ahead that of its Nordic neighbours.
Several countries in Asia have incorporated mask-wearing into largely successful strategies to suppress the spread of the virus, based on previous pandemics. One difference here is that residents of these countries are used to wearing masks and therefore the risk of mask-wearers using them incorrectly relaxing on other important measures may be lower than in Europe.
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What are the rules on face masks in Sweden?
Sweden's Public Health Agency says there is no need for members of the public to use face masks when in public spaces such as buses or shops.
Still, ten of Sweden's major airports have recommended the use of masks inside the terminal. All staff working closely with travellers will wear masks but members of the public are not under any obligation to follow the recommendation.
Train operator MTRX provides face masks for free to all passengers and recommends their use during travel, while public transport operator Skånetrafiken offered 50,000 free masks to ticket holders.
But there's no general requirement for mask use on Swedish public transport, and state-owned rail operator SJ and Stockholm public transport operator SL are two examples of companies that currently do not recommend their use.
The European Union Agency's for Railways recommends that transport operators provide masks for all staff, and states that for passengers, "where physical distancing cannot be ensured on board trains, use of face masks is recommended".
The European Union Aviation Safety Agency states that "the use of medical face masks should be recommended for all passengers and persons at the airport and in the aricraft, from the moment they enter the terminal building at the departure airport until they exit the terminal building at the destination airport" although exceptions may be necessary.
Photo: Fredrik Sandberg/TT
How does this compare to the rest of Europe and the world?
The Nordic countries as a group have taken a similar stance to face masks, with less than ten percent of inhabitants in Denmark, Norway, Iceland and Finland wearing them.
One big difference is that the rate of infection is far higher in Sweden than in the rest of Scandinavia.
And in neighbouring Denmark, the guidance changed in early July from recommending against mask usage to advising them in certain situations. Masks are now mandatory in airports and advised in high-risk situations such as if breaking quarantine to take a coronavirus test.
These restrictions are stricter in much of the rest of Europe and the world. In Italy masks are strongly recommended "during all social contact" alongside other measures, Spain and France require them in all indoor enclosed spaces, Switzerland mandates them on public transport and recommends them in other situations where distancing isn't possible, and the UK requires them on public transport and in shops.
The European Centre for Disease Control (ECDC), which is headquartered in Stockholm, has recommended use of face masks in environments where social distancing isn't possible, with its chief scientist saying the centre has become more convinced of their benefit as the pandemic has developed.
The World Health Organisation has also changed its recommendations on masks, advising that governments should encourage mask-wearing in environments where distancing is not possible, such as public transport or crowded indoor areas – even while stating that there is not much scientific evidence showing they prevent the spread of the disease.
Across the world, the use of masks has caused a polarised debate that has at times escalated violently. Bus drivers have been attacked in France, Germany, the UK, Switzerland and Italy for asking passengers to wear masks. In Sweden several of The Local's readers have shared stories of being verbally and even physically abused for wearing face masks in public places.
File photo: Stina Stjernkvist/TT
Why the difference?
This is the big question, and there are a few ways to answer it.
Swedish state epidemiologist Anders Tegnell said that two things could happen to change the country's guidance on face masks: an uptick in infections, or robust evidence that face masks help prevent spread of infection.
Sweden's rate of new confirmed cases, serious cases, and deaths have been sharply falling in recent weeks after a long period of widespread infection, so the Public Health Agency is focusing all its efforts on maintaining that development. This means encouraging people to continue following the basic recommendations around social distancing and hygiene.
That puts the country in a different situation to the US or parts of Spain, for example, where cases are continuing to rise fast.
The difference in interpreting the science is more complicated. The novelty of the coronavirus and the difficulty of measuring specific measures in isolation means there is no conclusive proof that masks do or don't hinder the spread of the coronavirus.
Many European countries and EU agencies have acknowledged the lack of robust evidence but suggested mask-wearing as a precaution, intended to be used alongside other scientifically proven measures.
So it's not perhaps so surprising that Sweden is an outlier, as it's a repeat of a pattern earlier in the pandemic. While many countries closed down shops, restaurants, and schools as a precaution, Sweden introduced far less strict measures, which sparked criticism as the country's death rate leapt ahead that of its Nordic neighbours.
Several countries in Asia have incorporated mask-wearing into largely successful strategies to suppress the spread of the virus, based on previous pandemics. One difference here is that residents of these countries are used to wearing masks and therefore the risk of mask-wearers using them incorrectly relaxing on other important measures may be lower than in Europe.
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