What criteria is the Swedish government using to decide when to relax Covid-19 restrictions?

Although many of the restrictions are based closely on advice from the Public Health Agency, when it comes to law changes it is the government that makes the decision.

In a detailed plan unveiled on May 27th, the government said: "The government's starting point has always been that restrictions should not go beyond what is absolutely necessary, the right measures should be introduced at the right time. Furthermore, it has always been the government's starting point that the restrictions should be lifted as soon as possible." 

The aim of the plan, it said, was to "create increased transparency and clarity around when and how future adaptations and relaxations of the restrictions will happen, in what order these will be prioritised and why".

The government listed nine key factors in the decision-making process:

• Constitutional rights, such as the rights to gather and to demonstrate
• The spread of infection and burden on healthcare
• The Public Health Agency's expertise
• The restrictions should be proportionate and not go further than is necessary to safeguard lives and health
• Constitutional freedoms, and children and young people, will be prioritised, and public health in general, so that for example sports activities can be carried out. Equality will also be a taken into account
• Schools should stay open as much as possible, for the benefit of children and for gender equality reasons
• Education should take place on-site to the greatest extent possible from the autumn term onwards
• Restrictions should be relaxed for outdoor environments before indoor ones
• Relaxation of restrictions should happen in an "infection-safe, predictable and sustainable way"

The Public Health Agency has set out three levels, each one based on a different situation:

Level 3: A Level 3 situation means the healthcare system is under severe pressure, with several regions declaring themselves to be in a catastrophic situation (katastrofläge), in need of reinforcements (förstärkningsläge), or a crisis situation (stabsläge). Non-urgent operations and other healthcare need to be put on hold to make way for Covid-19. At Level 3, a majority of regions have a high number of daily cases (more than 200 new cases per 100,000 residents over the preceding two weeks) which is either on a plateau or rising. 

Level 2: Sweden would reach Level 2 when the healthcare systems of most regions have a good chance of caring both for the number of Covid-19 patients and of all others who require care. There should be fewer than 300 people needing hospital care due to Covid-19, and fewer than 70 requiring intensive care for Covid-19. Infection rates would need to be below 200 new cases per 100,000 residents over the preceding two weeks and must have been steadily declining for at least two weeks. At least 50 percent of the adult population should be vaccinated with at least one dose. 

Level 1: For the Covid-19 situation to be classed as Level 1, the agency says there should be few patients in any region being treated for Covid-19, and the healthcare systems in all regions have no constraints on treating patients. At this stage, the infection rate of Covid-19 should be low (less than 50 new cases per 100,000 residents over the preceding two weeks) with only small outbreaks, and should have been steadily declining for at least two weeks. There should be fewer than 100 people needing hospital care due to Covid-19, and fewer than 25 requiring intensive care for Covid-19. At least 70 percent of the adult population should be vaccinated with at least one dose. 

• KEY POINTS: Sweden’s five-step plan for ditching pandemic restrictions

Something that may be confusing is that the government's plan has five stages rather than three, with two steps corresponding to each of Levels 3 and 2. 

This is because restrictions will not be automatically lifted as a whole once the criteria of a new level have been reached, but this will happen step by step, taking into account the nine principles listed above. For example, measures that are judged to have a lesser effect on the spread of infection, or that have negative consequences for public health, will be lifted first.

The government states: "This is to ensure that the spread of infection does not increase with adapted measures and that the phasing out of the restrictions takes place in a controlled manner."

Step one, which happens on June 1st, means Sweden remains in Level 3.

Step two, currently estimated to take place on July 1st, is expected to happen only once the criteria for the Public Health Agency's Level 2 have been met, with further relaxations within this level planned for mid-July (Step three) if the healthcare situation allows.

Step four corresponds to Level 1 of the Public Health Agency's plan, and is currently expected to happen around September, again depending on the healthcare situation. And Step 5, the removal of almost all remaining restrictions, has the most uncertain timeframe of all.