New report: 'Mild and tardy measures' led to Sweden's Covid death rate

The Royal Swedish Academy of Sciences' Expert Group on Covid-19, responsible for the report, had a number of critiques of the Swedish pandemic response.

'Inadequately prepared'

The report criticises actions taken early on in the pandemic, stating that organisations were "inadequately prepared" when infection started to spread - in terms of knowledge as well as equipment such as face masks - and that high death rates during the first two waves of the pandemic were due to "mild and tardy" measures to prevent the initial spread of infection.

Face masks for those in regular contact with the elderly are also highlighted in the report as an important protective measure which should have been implemented. However, the Expert Group does not solely place blame on individual care providers and organisations, highlighting that crisis management responsibilities lie with the government, and that individual care providers were not supported enough by authorities, leaving them "unable to take the responsibility expected of them for their clients' safety".

Imported infections

The Expert Group criticises the fact that authorities did not try and limit imported infections at an early stage, despite the fact that researchers in China were warning of a global infection risk as early as February 2020. It also states that authorities should have considered the importance of "counteracting local outbreaks, or of testing and quarantining people who had been exposed".

'Unclear and contradictory' information

Authorities' decision to place responsibility for reducing the spread of infection on individuals also came under fire, with the Expert Group stating that information provided by the authorities was "often regarded as unclear and contradictory", referencing decisions not to recommend face masks for public use during the early stages of the pandemic, as well as early dismissal of the risk that people not experiencing symptoms could also be infectious.

Furthermore, the report criticises the fact that different authorities were responsible for different aspects of the pandemic response, stating that this made it "more difficult to push through consistent measures", leading to confusion and making it more difficult for individuals to follow authorities' advice.

Sweden's delay in getting testing up and running was criticised, with the Expert Group describing this as "slow to start" with conditions varying between different regions, who were not prepared for testing the number of samples required.

Failure to apply lessons learned

Finally, the Expert Group states that Sweden's pandemic response strategy has "probably contributed to Sweden’s considerably higher rates of infection, illness and death compared to Denmark, Norway and Finland," further continuing to say that Sweden failed to apply lessons learned in other countries when responding to more infectious variants such as Alpha and Delta.

Some aspects which have affected the scope of the pandemic according to the Expert Group include "socioeconomic circumstances, such as how and where people live and travel, their level of education, language skills and how their working life is organised," although the Expert Group does not suggest how these circumstances could be mitigated.

Crisis plan for future pandemics

According to the report, Sweden should prepare for future pandemics in "pandemic 'peace time'", by developing, testing, and rehearsing a crisis plan - which should then be activated if a pandemic occurs. Similarly, once a pandemic has been resolved, the pandemic response should be evaluated and used to adapt the crisis plan for the future. The report further stated that the risk of future pandemics will increase in the near future, citing factors such as growing population density, more travel, deforestation, climate change and increased resistance to antibiotics as risk factors.

The Expert Group identifies 16 needs and proposals for managing future pandemics from a Swedish perspective. Some of these proposals include: carrying out a review of current pandemic legislation - adapting this so it can be activated at short notice, if needed; establishing a pandemic plan as well as a contingency plan ensuring that vital medicines, protective equipment, and food will be available; and enabling greater coordination between regions on disease control, testing and vaccination.

Additionally, the Expert Group proposes measures such as greater involvement in international pandemic preparedness and management - such as with the World Health Organisation (WHO) and the European Centre for Disease Prevention and Control (ECDC), as well as greater Nordic cooperation on disease control; investments in relevant epidemiology fields; environmental work to improve indoor air quality, as well as the establishment of an independent expert group made up of scientists with expertise in relevant areas, which would be able to provide authorities with information and advice in future pandemics.