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KEY POINTS: How Sweden’s Covid-19 rules have changed

UPDATED: Sweden lifted nearly all of its pandemic restrictions on September 29th, including both laws and recommendations. Here's a rundown of what the changes mean for you.

Published: 8 September 2021 09:41 CEST
Updated: 29 September 2021 07:49 CEST

KEY POINTS: How Sweden's Covid-19 rules have changed

People walking through Malmö in October last year. Photo: Johan Nilsson/TT

Bars and restaurants

All the remaining restrictions that apply to restaurants and bars are removed as of September 29th.

The rules that were in place up until this date stated that places that serve food and drink must take measures to avoid crowding, including making sure that guests are able to keep a distance of at least a metre to other groups of guests and not allowing more than eight people per group indoors. These were strict legal limits, and restaurants faced fines if found in violation of them.

Now, there are no legal limits on distancing between tables or group sizes at bars and restaurants, but be aware that some establishments may set their own rules.

Public events

Public events were one of the most strictly regulated areas during the pandemic. From September 29th, all restrictions will be removed.

Previously, seated indoor events were allowed no more than 300 attendees and seated outdoor events no more than 3,000 attendees. Other limits included a maximum of 50 people at private events organised in rented premises (Sweden has never had a pandemic limit on private events or gatherings in for example private homes).

Now, these limits are gone, paving the way for large concerts, sports matches, and other events. No proof of a Covid-19 vaccine or negative test is required for entry by law. Again, you may need to check if individual event organisers have set their own rules.

Working from home

Sweden has since spring 2020 advised everyone to work from home if the nature of their work allows.

This recommendation is lifted as of September 29th, but the Public Health Agency has advised employers to implement a return to physical workplaces “gradually”.

If an employee has symptoms, they should always work from home (or call in sick if they have to) and get tested for Covid-19, and the employer should take steps to help them work from home – note that this continues to apply even after September 29th.

For most people, the advice to work from home was only a recommendation and not legally binding, although some public sector offices were ordered to work from home during the pandemic.

Unvaccinated people should avoid close contacts

People who have not been vaccinated against Covid-19 should keep a distance from people outside their closest circle, and in particular avoid close contact with people in risk groups or aged over 70, even after September 29th.

These recommendations only apply to adults aged over 18 who have not been advised against vaccination by a doctor for medical reasons.

According to the Public Health Agency’s general director, these guidelines mean that unvaccinated people should avoid going to bars, nightclubs, and large events such as theatres, concerts, and sports events. This is because now that the previous laws ensuring distancing at those venues have been removed, it may not be possible to ensure keeping a distance there.

General recommendations for the public removed

Recommendations to avoid crowding, to meet each other outdoors rather than indoors and to practise good hand hygiene are no longer be in effect after September 29th. Note the exception for unvaccinated people as explained above.

Recommendations that applied to organisations and companies (called föreskrifter in Swedish) have also been removed, including for example rules around organised sports, rules for workplaces, and for people organising events.

The Public Health Agency said that these were no longer judged to be “motivated from the perspective of infection control or public health”.

What rules still apply in Sweden?

One recommendation which still applies to everyone in Sweden after September 29th is to stay at home, get tested, and avoid contact with others if you develop Covid-19 symptoms.

Sweden’s Communicable Diseases Act also applies, which states that individuals have a legal responsibility act responsibly to reduce the risk of spreading infectious diseases. In practice, this means that the recommendation to stay at home and get tested if you develop symptoms should not be considered optional.

Sweden’s non-EU/EEA entry ban is at the time of writing in force until October 31st, as is the requirement for certain travellers to show a vaccine pass or a negative Covid test. It has been extended several times during the pandemic, so it could be extended further or scrapped before this date.

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FACT CHECK: Did Sweden have lower pandemic mortality than Denmark and Norway?

At one point in May 2020, Sweden had the highest Covid-19 death rate in the world, spurring newspapers like the New York Times and Time Magazine to present the country as a cautionary tale, a warning of how much more Covid-19 could ravage populations if strict enough measures were not applied.

“Per million people, Sweden has suffered 40 percent more deaths than the United States, 12 times more than Norway, seven times more than Finland and six times more than Denmark,” the New York Times reported in July 2020.

An article in Time in October 2020 declared Sweden’s Covid response “a disaster”, citing figures from Johns Hopkins University ranking Sweden’s per capita death rate as the 12th highest in the world.

So there was undisguised glee among lockdown sceptics when Svenska Dagbladet published data last week showing that in the pandemic years 2020, 2021 and 2022 Sweden’s excess mortality was the lowest, not only in the European Union, but also of all the Nordic countries, beating even global Covid-19 success stories, such as Norway, Denmark and Finland.

Versions of the graph or links to the story were tweeted out by international anti-lockdown figures such as Bjørn Lomborg, a Danish sceptic of climate action, and Fraser Nelson, editor of Britain’s Spectator Magazine, while in Sweden columnists like Dagens Nyheter’s Alex Schulman and Svenska Dagbladet’s opinion editor Peter Wennblad showed that Anders Tegnell, the state epidemiologist who led Sweden’s strategy, had been “right all along”.

Excess mortality — the number of people who die in a year compared to the number expected to die based on previous years — is seen by some statisticians as a better measure for comparing countries’ Covid-19 responses, as it is less vulnerable to differences in how Covid-19 deaths are reported.

But are these figures legitimate, where do they come from, and do they show what they purport to show?

Here are the numbers used by SvD in its chart:

Where do the numbers come from?

Örjan Hemström, a statistician specialising in births and deaths at Sweden’s state statistics agency Statistics Sweden (SCB), put together the figures at the request of Svenska Dagbladet.

He told The Local that the numbers published in the newspaper came from him and had not been doctored in any way by the journalists.

He did, however, point out that he had produced an alternative set of figures for the Nordic countries, which the newspaper chose not to use, in which Sweden had exactly the same excess mortality as Denmark and Norway.

“I think they also could have published the computation I did for the Nordic countries of what was expected from the population predictions,” he said of the way SvD had used his numbers. “It takes into consideration trends in mortality by age and sex. The excess deaths were more similar for Denmark, Sweden, and Norway. Almost the same.”

Here are Hemström’s alternative numbers:

There are two basic ways of measuring excess mortality. The simplest, and the one used by SvD/SCB, is to simply compare the death rates in the relevant period with the mean of previous years, normally five years.

More sophisticated measures attempt to estimate the expected number of deaths by extending mortality trends seen in a certain country, adjusting for the age of the population and other factors. But this can lead to results to vary significantly depending on how mortality trends and expected mortality are calculated.

The issue with the analysis in the SvD graph is that compares deaths in the pandemic years to deaths over just three years, a mean of 2017-2019, and does not properly take into account Sweden’s longstanding declining mortality trend, or the gently rising mortality trend in some other countries where mortality is creeping upwards due to an ageing population, such as Finland.

“It’s very difficult to compare countries and the longer the pandemic goes on for the harder it is, because you need a proper baseline, and that baseline depends on what happened before,” Karin Modig, an epidemiologist at Sweden’s Karolinska Institute whose research focuses on ageing populations, told The Local.

“As soon as you compare between countries, it’s more difficult because countries have different trends of mortality, they have different age structures, and in the pandemic they might have had different seasonal variations.”

She described analyses such as Hemström’s as “quite crude”.

In an interview with SvD to accompany the graph, Tegnell also pushed back against giving the numbers too much weight.

“Mortality doesn’t tell the whole story about what effect a pandemic has had on different countries,” he said. “The excess mortality measure has its weaknesses and depends a lot on the demographic structures of countries, but anyway, when it comes to that measure, it looks like Sweden managed to do quite well.”

Do the numbers match those provided by other international experts and media?

Sweden’s excess mortality over the three years of the pandemic is certainly below average worldwide, but in most other analyses it remains higher than those of Norway and Denmark.

A ranking of excess mortality put together by Our World in Data for the same period as the SvD/SCB table estimates Sweden’s excess mortality between the start of 2020 and the end of 2022 at 5.62 percent, considerably more than the 4.4 percent SvD claims, and above that of Norway on 5.08 percent and Denmark on 2.52 percent.

The Economist newspaper also put together an estimate, using their own method based on projected deaths. In this estimate, Sweden also has a higher rate of excess deaths than Denmark and Norway (but not than Finland).

Our World in Data uses the estimate produced by Ariel Karlinsky and Dmitry Kobak, who manage the World Mortality Dataset (WMD). To produce the estimate, they fit a regression model for each region using historical deaths data from 2015–2019, so a time period of five years rather than the three used by SCB.

What’s clear, is that, whatever method you use, Sweden and the other Nordic countries are among the countries with the lowest excess mortality over the pandemic.

“Most methods seem to put Sweden and the other Nordic countries among the countries in Europe with the lowest cumulative excess deaths for 2020-2022,” Preben Aavitsland, the Director for Surveillance and the Norwegian Institute of Public Health, told The Local.

So if Sweden had similar excess mortality to those of the other Nordics over the period, does that mean it had a similar Covid-19 death rate?

No. Sweden’s per capita death rate from Covid-19 over the period covered by the SvD/SCB figures, at 2,249 per million people, is still more than double Norway’s 959 per million, 60 percent more than the 1,409 per million who died in Denmark, and more than 50 percent more than the 1,612 per million who died in Finland.

Sweden’s death rate is now much closer to those of the other Nordic countries than it was at the end of 2020, however, something Aavitsland put down to the higher number of Covid-19 deaths seen in his country in the later years of the pandemic.

“The most striking difference between Sweden and the other Nordic countries is that only Sweden had large excess mortality in 2020 and the winter of 2020-21,” Aavitsland explained. “In 2022, the field levelled out as the other countries also had excess mortality when most of the population was infected by the omicron variant after all measures had been lifted.”

So why, if the Covid-19 death rates are still so different, are the excess mortality rates so similar?

This largely reflects the fact that many of those who died in Sweden in the first year of the pandemic were elderly people in care homes who would have died anyway by the end of 2022.

About 90 percent of Covid-19 deaths were in people above 70, Aavitsland pointed out, adding that this is the same age group where you find around 80 percent of all deaths, regardless of cause, in a Scandinavian country.

“My interpretation is that in the first year of the pandemic, say March 2020 – February 2021, Sweden had several thousand excess deaths among the elderly, including nursing home residents,” he said. “Most of this was caused by Covid-19. In the other [Nordic] countries, more people like these survived, but they died in 2022. The other countries managed to delay some deaths, but now, three years after, we end up at around the same place.”

So does that mean Sweden’s state epidemiologist Anders Tegnell was right all along?

It depends on how you view the years lost by the several thousand elderly people who caught Covid-19 and died in Sweden in the first wave because Sweden did not follow the example of Denmark, Norway, and Finland and bring in a short three-week lockdown in March and April 2020. Were those two years worth the greater restrictions imposed in Sweden’s neighbours?

Tegnell himself probably said it best in the SvD interview.

“You’ve got to remember that a lot of people died in the pandemic, which is of course terrible in many ways, not least for their many loved ones who were affected, so you need to be a bit humble when presented with these kinds of figures.”

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