Sweden has adapted its policies as the winter Covid-19 wave hit © Jonathan Nackstrand/AFP via Getty Images

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Sweden’s coronavirus strategy has always stood out from the crowd. That distinctive approach is now coming to an end.

The government this week proposed an emergency law that would allow it to lock down large parts of society; the first recommended use of face masks came into force; and the authorities gave schools the option to close for pupils older than 13 — all changes to its strategy to combat the pandemic.

“I don’t think Sweden stands out [from the rest of the world] very much right now,” said Jonas Ludvigsson, professor of clinical epidemiology at Karolinska Institutet in Stockholm. “Most of the things that made Sweden different have changed — either in Sweden or elsewhere.”

There has been no public abandoning of its approach — which drew huge international attention for its lack of formal lockdown and use of face masks. Instead, there has been a gradual shift in various policies as the winter Covid-19 wave has hit Sweden far harder than health officials or politicians expected.

Sweden has reported more than 2,000 Covid-19 deaths in a month and 535 in the past eight days alone. This compares with 465 for the pandemic as a whole in neighbouring Norway, which has half the population. As Sweden’s King Carl XVI Gustaf said just before Christmas: “We have failed.”

Sweden’s King Carl XVI Gustaf updates the public about coronavirus on national television © AFP via Getty Images

Public confidence in Sweden’s government and various authorities has come under strain after multiple reports of ministers — including Prime Minister Stefan Löfven who has been criticised for Christmas shopping trips — appearing to breach their own guidelines on how to behave.

Dan Eliasson, head of the civil contingencies agency, resigned this week after visiting his daughter in the Canary Islands over Christmas despite authorities sending a country-wide text message just days earlier warning against all unnecessary travel.

“It’s a problem. What’s special in this country is that they trust people. I believe that the government hasn’t understood the seriousness of this disease,” said Claudia Hanson, senior lecturer in global public health at Karolinska. Mr Ludvigsson added: “I’m afraid it decreases the compliance with recommendations.”

Karin Tegmark Wisell, head of the microbiology department at the Swedish public health agency that has set much of the country’s policy, insisted that it was “a hallmark of the strategy that when the infection rate goes up that we adapt our response”.

She added that the conduct of ministers, MPs and officials such as Mr Eliasson was a “difficult question” that could affect trust in the individuals but also spark a wider societal debate about what was accepted or not.

Nonetheless, there is little doubt that Sweden’s approach has changed subtly in recent weeks. The centre-left government in Stockholm laid out an emergency law on Monday that is due to come into force on Sunday, giving it the power to close down shops, gyms and public transport among other things if deemed necessary.

Ms Hanson said the mystery with Sweden was why the government had been so reluctant to react, largely leaving policy to the public health agency. “They could have changed the law a long time ago. All countries had to bring in new laws to deal with the pandemic,” she added.

A healthcare worker disinfects an ambulance near Stockholm © Jonathan Nackstrand/AFP via Getty Images

Swedish health authorities also long held out against the use of face masks, arguing there was little evidence they helped cut infection rates and some concern that they could lead people to relax on more important measures such as keeping distance and hand hygiene. But as of Thursday, face masks are necessary in rush hour on public transport even if there will be no sanctions for not wearing them.

Upper secondary schools for 16-19 year-olds that have been closed since early December will remain so until at least January 24. This week the public health agency gave secondary schools for 13-16 year-olds the option to close if needed — but added that the default should be to remain open.

Mr Ludvigsson said it was not one-way traffic, with much of Europe moving towards Sweden’s position on some issues, not least the importance of keeping primary schools open when many nations closed them during the first coronavirus wave. He added that most countries had also switched their goal from defeating the virus to mitigating it, which had been Sweden’s official policy throughout.

That fits with the position Anders Tegnell, Sweden’s state epidemiologist, outlined to the Financial Times last month when he argued that Sweden and Europe were coming to a unified approach. “We are doing more and more the same thing,” he said.

Far from everyone is convinced that Sweden’s distinctive approach entirely explains its vastly higher death toll to its Nordic neighbours, which have similar population density and cultures. Many in Sweden point to Belgium, which has locked down twice but has far higher per capita Covid-19 deaths.

Mr Ludvigsson said more research was needed into why some countries were worse hit by the virus: “People have explained 100 per cent of a country’s success or failure based on its policies. But I’m sure there are other underlying factors that affect how the virus took hold in some places more than others.”

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