As Covid death toll soars ever higher, Sweden wonders who to blame

By Richard Orange

“Thanks for reminding me,” Sweden’s state epidemiologist Anders Tegnell replied deadpan when the Observer asked in late March how he handled the knowledge that he would be to blame if Sweden’s decision to forego a lockdown were to go badly wrong.

“But seriously,” he continued, “I might look like a figurehead but agencies in Sweden are very much working as a whole. This isn’t something I decide alone in my office every morning.”

The message was clear. He didn’t think he would be held responsible if the light-touch Covid-19 regime associated with his name failed.

On Friday, as Sweden recorded 9,654 new cases and 100 deaths, the country’s prime minister, Stefan Löfven, suggested he might be right.

“This number of casualties – of course we wanted to avoid that. It’s nothing that you want to see,” he said, announcing the end to Sweden’s long hold-out against recommending face masks. “But … the responsibility here is not so easy, to point at exactly one person [and say] ‘you are responsible’.”

When Tegnell briefed Boris Johnson at the end of September, it still seemed possible that the high spread of infection in Sweden in the spring might grant enough immunity to make a second wave easier to control.

Now those hopes have been dashed, with the level of new daily cases, hospitalisations and deaths once again far above that seen in the country’s Nordic neighbours, Dr Tegnell and his former boss Johan Giesecke are no longer granted near daily interviews from herd immunity advocates in the British and US media.

Anders Tegnell, state epidemiologist at the Public Health Agency of Sweden.
Anders Tegnell, state epidemiologist at the Public Health Agency of Sweden. Photograph: Pontus Lundahl/AFP/Getty Images

But the shift in opinion within Sweden is even more marked. This is partly due to the failure of Tegnell’s Public Health Agency to anticipate the severity of the second wave, partly due to damning reports from the country’s health watchdog and coronavirus commission, and partly due to a more critical media.

Even the country’s king, Carl XVI Gustaf, described the country’s handling of the pandemic as “a failure” in the royals’ Christmas review of the year.

“Opinion in Sweden has really changed: there’s a broad criticism of the strategy and [a sense] that we have really failed,” said Jenny Madestam, an associate professor in politics at Stockholm’s Södertorn University.

In March and April, the media tended to defend rather than criticise the authorities, with dissident researchers who raised the alarm at the start of April branded “corona scandal-mongers” and “a shame for Sweden”, in the debate pages.

Eva Burman, chief editor for the regional Eskilstuna-Kuriren newspaper, remembers how its shocking revelations in May about how elderly people in care homes were being denied hospital treatment were ignored.

“That story never got published in the other papers: I think that maybe it was such a big story that they couldn’t take it in. They thought it might not be true,” she said. “I don’t know why the Swedish media have been so slow in asking critical questions.”

But, according to Marina Ghersetti, an associate professor of journalism at Gothenburg University, this is typical of how the Swedish media operates in a crisis. “This is a pattern we’ve seen before. In the beginning, when everything is uncertain and chaotic, the focus is … on transmitting the information that public authorities give to media, without really questioning that information very much,” she said.

“A possible explanation for this is that even those in the media share the big confidence we have in public authorities.”

It is only once the situation becomes more stable that the Swedish media – almost as one – becomes critical and begins to investigate. “We have this expression, ‘herd behaviour’, a sort of consensus: when one person really starts to scrutinise and investigate, the others also do so,” said Ghersetti.

“Every large newspaper, the radio, and television, has really started to dig into this, and not only on the conditions in elderly homes, but also into the strategy.”

This month, Sweden’s health and social care inspectorate reported “serious shortcomings” in the treatment of the elderly, confirming Burman’s paper’s story.

Sweden's death rate

As few as one in 20 suspected coronavirus patients had physically seen a doctor. Several regions had issued guidelines ordering that no care home residents should receive hospital treatment for any illness or injury at all. Some doctors had recommended palliative care without even looking at patient records.

Then first report from the country’s coronavirus commission, released on Tuesday, levelled scathing criticism both at the government and the Public Health Agency, saying they had “failed” to shield the elderly.

Despite a very narrow remit, limiting it to investigating deaths in care homes, the commission criticised the strategy, arguing that “the single most important factor behind ... the high number of deaths in residential care is the overall spread of the virus in the society”.

Public confidence in Tegnell has now fallen to 59%, the lowest level since the pandemic began, according to an Ipsos poll last week. In October he enjoyed the support of 72% of respondents.

Asked whether she or anyone else should resign, health minister Lena Hallengren pointed to how fragmented Sweden’s health system is. Responsibility for day-to-day healthcare rests with the 21 regions, for elderly care with the municipalities. The opposition parties, she added, had supported the strategy during the spring and summer.

“It would be easy to say, ‘it’s me, or it’s him or it’s her’, but we’re in the middle of a pandemic, and to try to make this extremely easy solution [demanding resignations], which is not a solution and doesn’t give us a better elderly care sector, I don’t know.”

But both Burman and Madestam, said resignations would come eventually, with Madestam predicting that Tegnell’s boss, Johan Carlson, who is due to retire in October, might step down.

“We haven’t seen the end of this,” Burman agreed. “I think Christmas is going to bring an even steeper curve, and we’re going to have even more deaths. I think someone will have to resign. Otherwise, we’re sending a very strong signal out to our society that no one takes responsibility.”