Pandemic control: Norway or Sweden?

pandemic control - Oslo - Norway

Photo: Ilan Kelman
Business as usual: pre-pandemic physical distancing in Oslo.

Agder, Norway

Sweden or Norway? I don’t pose the old question for vacation or language preference, but the life-and-death decision of how to act on the coronavirus. The Great Pandemic of 2020 led to the Great Lockdown of 2020. But Sweden deviated from much of Europe.

Rather than mandating that people stay indoors, Sweden adopted more of a trust-based approach, asking people to stay away from others voluntarily, while banning large gatherings. Latvia and Iceland also implemented variations.

In contrast, Norway adopted much stricter measures in mid-March. More than a month later, some of the restrictions have started to ease.

Comparing different approaches is not straightforward. On what basis should countries’ success or failure be measured?

Numbers commonly used are deaths, and preferably death rates to account for different population sizes. Here, Sweden appears to far exceed Norway. Except that if a person is not tested, then we do not necessarily know whether or not they died from COVID-19. Countries report different data, sometimes focusing on in-hospital deaths and sometimes not including deaths in long-term-care homes.

Knowing the number of infections and infection rates is similarly confusing. Widespread testing across the entire population, rather than just the most vulnerable or health-care workers, is a rarity. Testing biases toward more populated areas with health-care staff available could be a concern.

Furthermore, this new coronavirus has so many unknowns. Does recovery from COVID-19, or infection without symptoms, confer immunity? How often does the virus mutate? How does it interact with pre-existing health conditions? What percent of the population must have had the virus for the entire populace to become effectively immune? Even with close to 100% testing, infection rates might not direct a specific management strategy.

But comparing Norway and Sweden is not just about the virus. It is also about responses, such as lockdown approaches. While gratefully accepting the numerous lives saved because people stayed home, we do not know how many died because of lockdown.

We do know that people have been trapped in abusive situations, mental health impacts including self-harm are being exacerbated, and substance use rates are likely to have increased. How many stress-induced heart attacks or suicides have been seen from those losing their job or feeling caged?

On the other hand, how many deaths have been prevented by fewer vehicle crashes and by not rushing around at full-tilt all the time? Air pollution has dropped substantially, improving our health.

Many of these rates should be calculable in both Norway and Sweden, once we have the data. Even if we accept these as valid comparison points, many other confounders pop up.

A major one for Sweden is that its neighbors, and countries farther beyond, implemented much more stringent measures. One certain and large factor in limiting COVID-19 cases around the world was closing international borders.

Would voluntary physical distancing have worked if all countries had adopted Sweden’s approach? Or imagine no travel restrictions, merely requests by governments not to travel unless necessary and to do our best to stay away from people in airports and on board airplanes, trains, and buses. Even if the number of travel tickets sold were capped to enforce distancing, what would have been the COVID-19 infection and death rates?

Sweden and Norway have further advantages over others in that their cities have lower population densities than many European counterparts. London under lockdown still presents difficulties in maintaining a 6-foot distance from everyone in the streets. This was often possible in Oslo before the pandemic.

Lower numbers of people per household in Scandinavia compared to southern Europe give the northern countries an advantage in pandemic control. Norwegian and Swedish households average 2.0-2.1 people compared to Italy’s 2.6 and Spain’s 2.8. Even these statistics vary, with some sources listing Sweden as having fewer than 2.0 people per household. Nevertheless, in Europe, the northern countries are always lower than the southern in household density.

And while Sweden and Norway have many governance and ideological similarities, social care and health care are not the same in both. Differences in resources per capita, availability of protective equipment, and how medical practices and hospitals are run must all be accounted for. Dissimilarities in disaster response structures and the availability and role of the military also affect death tolls.

And this is the crux: Pandemic prevention is fundamentally much more about long-term actions than crisis response. Countries with poor health-care systems, crowded streets, lack of running water and soap, and an already unhealthy population will inevitably fare worse when new diseases emerge.

Globally, we underinvest in research and monitoring of emerging infections. Countries have an incentive to cover up diseases, as China tried to do at the beginning of this pandemic, in case restrictions are imposed on a single place.

So Norway or Sweden for coronavirus response? Instead, we could prioritize pandemic prevention to avoid the need for such a comparison in the first place.

This article originally appeared in the May 22, 2020, issue of The Norwegian American.

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Ilan Kelman

Ilan Kelman is Professor of Disasters and Health at University College London, England, and Professor II at the University of Agder, Norway. His overall research interest is linking disasters and health, including the integration of climate change into disaster research and health research. Follow him at and @ILANKELMAN on Twitter and Instagram.