Comment by jlundborg | Hacker News Reader

Comment by jlundborg | Hacker News Reader

Swede here. There is lots of disinformation about the Swedish approach to the epidemic. Sweden is following the same basic strategy as other countries, which is to slow down the spread by mitigating actions so the health care system can cope and to protect people in risk groups. The primary difference in Sweden compared to outher countries are:

* Sweden decided early on that an evidence-based approach should be followed. Many policies that are implemented in other countries do not have a lot of evidence showing their effectiveness

* Policy is still primarily dictated by the experts at Folkhälsomyndigheten (where Anders Tegnell is from), and not by politicians. Most actions taken by the Swedish government has been pretexted by "as requested by FHM we have...". State epidemiologist Anders Tegnell is generally seen as "being in charge" of the actions taken, even though technically he has very little legal authority.

* Sweden has a very strong history of indepenent government bodies. In Sweden, there is specific legislation preventing government officials from intervening in specific cases if there is a government authority in charge of the issue. The legal term for this is "ministerstyre", "ministerial rule", and even if an action is not technically in violation of this legislation, it is often used if politicians try to intervene in cases without creating general legislation.

* Being a high-trust society some measures that have been implemented as strict laws in countries other than Sweden are instead communicated as recommendations with a very high compliance rate.

Can you expand upon the policies that have little evidence of effectivness that are being done by other countries. are Swedes also aware why the other countries are doing this?

Is it fear / politics / bad science etc?

I'm on mobile so can dig up links later. But one of the things I see mostly cited in foreign press is the decision to not shut down all schools.

Universities and what would be equivalent to high schools are doing distance learning, but lower grades are mostly open. The department of health has mostly cited two things for not closing lower grades.

1. Little evidence that younger people are the main vectors spreading the virus.

And 2. That if we shut down schools parents would need to stay home (and are encouraged to stay home via our social programs), and that would include a lot of healthcare workers placing our system under too much stress.

I think the most obvious examples are:

* Closing borders when we already have a pandemic in all countries. Swedish borders are still open.

* Closing schools when most evidence shows that it is not effective. Swedish schools are still open.

There is of course lots of debate about this in Sweden, some are worried that Sweden is not taking enough decisive action. There is however a wide-spread general support that the more measured approach in Sweden is a good one. Anders Tegnell has become a very popular public figure for his low-key bureaucratic but yet humoristic way of explaining the uncertainties involved and why Sweden is doing things this way.

I believe that the reasons these measures are taken in other countries is because it is a way to show strong political leadership in a time of crisis. I think this approach works less well in Sweden because people have very high trust in experts and (well-managed) authorities.

Aren't high schools and universities still closed in Sweden?

Edit: Run remotely, to be clear.

There is a strong recommendation that high schools and universities handle their education remotely.

This recommendation is followed. The Swedish government cannot order schools to be closed (a law was quickly put in place in the case that this be necessary. I'm not sure that it pertains to universities, though).

Some think that the Swedish state epidemiologist is confusing scientific approach and emergency management.

Children are typically main disease vectors in influenza epidemics. In Covid-19 they seem to be nonsymptomatic. It is not known yet if they are important vectors.

Two policy choices based on the information above:

(1) We don't close the schools until we have the information.

(2) We close the schools to buy time to find out. It's too late to act when the evidence comes in.

There is evidence sufficient to make predictions, and evidence sufficient to prove something beyond doubt. When you say Sweden is taking a more "evidence based" approach, what you're really saying is that they're denying evidence of the first kind. What ever happened to the precautionary principle? Does Sweden still practice that in other areas, relative to the US (for example)? If so, then suddenly getting all conservative about what evidence to consider and calling the result "evidence based" is not only insulting to scientists and policy makers in other countries but a bit hypocritical as well. The arrogance astounds.

I would add some pointers:

* Sweden doesn’t have anything equivalent to martial law.

* the government have in general very weak power to enforce rules that effect the population and all changes to current law must pass through their parliament. (This has though due to the current situation been relaxed in certain areas, a decision that went through the parliament).

> Sweden doesn’t have anything equivalent to martial law.

This may be true, but is there nothing resembling any emergency governance procedure, either?

No, apparently they had to construct a emergency procedure for this particular incident by going through and change the laws necessary to handle this pandemic. The whole opposition was in on those changes. Though most of it is to be able to circumvent laws like: they wanted to build a field hospital but to do that they need to have a permit which they didn’t have/get when they needed it. That delayed things. This is a just an example. Also these those changes have a time limit, but could be extended through parliament.

I'm sure most countries would like to think they are taking an evidence-based approach. A lot of the evidence is not very clear though, there are many unknowns. If you think you understand all the mechanisms, just listen to one of the prominent virologists. It's not any different to other areas: the more you learn, the more you realize how much you don't know. If anyone claims otherwise, they probably don't deserve your trust.

In such an environment, it's impossible for politicians to take decisions that are good in all aspects, but at least regarding health, assuming that's a priority, they can either err on the cautious or on the risky side.

Compared to most other countries, Sweden is clearly taking the latter approach.

That's not at all clear, and won't be clear for a long time. When it comes to optimizing long term public health there are more factors to consider than just coronavirus.

Taking the "evidence-based approach" in the case of Sweden has so far meant being late (in comparison to other countries) with every counter-measure. Yes, that might mean avoiding a counter-measure which would have been ineffective. But it also means having missed out on the positive effects of a counter-measure which - based on later evidence - proved effective.

I'd argue that the evidence-based approach is great when enough evidence is available. When that is not the case however - as with the new coronavirus - it certainly is imaginable that the evidence-based approach actually is a weakness, not a strength.

It’s really not about “evidence-based approach” per se, it’s more because of the notion of “expert authority”. The notion is that the government are heavily relying on the “expert authority” related to the current situation, in this case, FHM. This means that they follow what the experts are saying, which is by design not as mere information or guidance. This happens pretty much in any government body, like Swedish prison and probation services. The prime minister have very little to say about details of what they do (“minister rule”). The decisions are based on science rather than pure politics because they rely on that current government body for that. That does mean that they are late, which to I agree isn’t optimal but a trade off. The other reason is because the government have been slowed down due to the fact that they have to follow the current law. There’s no way for them to circumvent that as it is.

This has nothing to do with the government. FHM could have made suggestions/recommendations earlier than when they did it, when it comes to physical distancing, maximum group size, behavior in restaurants, public transport, care homes, or even the usage of masks in public (which still isn't even close to be encouraged). I've been following the situation in various countries, and it became strikingly evident how FHM was late with pretty much every single eventually recommended counter-measure - presumably because they didn't see evidence yet (or, alternative explanation: On purpose, as part of the high-risk herd immunity strategy, which does obviously require many people to get infected).

It's a beautiful thing that recommendations (instead of law enforcement on the streets threatening with fines) work good enough for large parts of the Swedish population. But then everything still comes down to the quality and effects of the recommendations.

An interesting point regarding the "ministerial rule" is that the other Scandinavian countries don't have the same restriction on politicians, at least not in law/constitution.

This is an excellent example, the chief epidemiologist in Denmark had a clash with the Danish PM about this, because evidence does not support closing borders as an effective policy when we already have a pandemic. In Denmark, the measure was intruduced despite this, presumably because the government wanted to demonstrate forceful action. Sweden still has open borders (not that it makes much difference since most other countries have closed them :) ).

We have partially closed borders but still open to EU countries, Norway, Iceland, Switzerland, Lichtenstein and the UK.

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