from The Herd
by Johan Anderberg
Translated by Alice E. Olsson
On 2 December 2021, critically acclaimed authors Johan Anderberg and Jessica Schiefauer join Swedish Book Review for a panel on the theme of writing pandemics, responses to fear and uncertainty, and the different roles that fiction and non-fiction can play in approaching crises that are still unfolding.
In connection with this event, we are delighted to present an excerpt from Johan Anderberg's The Herd. Chronicling the Swedish strategy to battle COVID-19, the book explores the choices faced by decision-makers at the Swedish Public Health Agency on a daily basis, and how these led the country to take such a different path through the pandemic. The book will be published in English by Scribe in April 2022, in Alice E. Olsson's translation.
You can also read an excerpt from Jessica Schiefauer's The Carriers here.
from The Herd
The Gym and the Cookie Jar
The European Centre for Disease Prevention and Control had a view overlooking both an eight-lane highway and the Royal Palace’s expansive Haga Park.
It was a relatively new institution. After the SARS outbreak in 2003, the bureaucrats in Brussels had sped up their plans for a European infectious-disease agency. Like most projects the union undertook, it had quickly deteriorated into a tug of war between member states about where the agency should be located. After all, there were many jobs involved.
It was partly thanks to Johan Giesecke that it ended up in the Swedish capital. First, he’d run around the corridors of the Government Offices, lobbying for Sweden to apply. Then he’d fought those who, for reasons of regional policy, wanted to situate the agency somewhere other than Stockholm.
And, finally, he’d ascended the throne as the newly formed agency’s first chief scientist.
Since 2014, that post had been held by a Brit named Mike Catchpole.
Catchpole went to a gym. It was run by the Norwegian company SATS, but it had been closed because of the pandemic. The publicly listed chain had closed all its gyms in Sweden, Norway, and Finland on 12 March.
But on 23 March, a cheerful message popped up in Catchpole’s inbox.
‘We’re re-opening,’ it said. ‘Welcome!’
In its message, SATS referred to the Swedish Public Health Agency’s recommendations.
Catchpole was perplexed. He reached out to Anders Tegnell. Could this really be true?
It was. The next day, the agency sent out a media release with the headline ‘Go Work Out but Do So Safely’.
‘Physical activity is good for public health,’ it said. ‘Sports and exercise should therefore continue.’
Of the 271 people working at the ECDC, around three quarters had immigrated from the rest of Europe. These foreign officials and scientists were like paratroopers airdropped into the small Scandinavian country, and now they were greatly surprised at the way their temporary home country was handling the crisis facing the world.
A few of them tried to conduct small personal crusades against this perceived indifference. One employee even emailed their child’s preschool, demanding that it shut down.
Over the past two weeks, Catchpole had watched with his own eyes as Sweden diverged from the other European countries.
And now his gym was about to open its doors again?
It wasn’t just officials at the EU infectious-disease agency who were surprised at the Swedish approach. Most people who knew anything about the country were just as baffled.
Up until the spring of 2020, the image of Sweden in the rest of the world had remained the same as in the past few decades: here was a well-organised, boring welfare state. Swedes were ‘Germans dressed up as human beings,’ as the Danes liked to say.
Anyone taking a guided tour at the National Museum in Copenhagen might even be offered a condensed explanation of why Swedes had become so uncool: they’d been subjected to a much stricter version of Martin Luther’s teachings. In Denmark, it was said, the congregation was more important than the Bible. In Denmark, the priest didn’t come into people’s homes and interrogate them about their knowledge of the Bible and Luther’s Small Catechism.
Swedes were much more bound by rules. How else to explain their strict drug laws and the fact that they always wore bicycle helmets, were forced to buy their alcohol from special state-run shops, and built roundabouts everywhere?
When authors described Swedish society, they would sometimes claim that it had been overcome with something like a panic disorder. Like a patient seeing threats in anything that could be dangerous but rarely was, Sweden had an excessive need for safety and control.
‘Zero tolerance’ and ‘zero vision’ were distinctively Swedish terms. They were used across both traffic and drug policy. No one should have to die in a car — no one should be taking drugs.
Over the years, Swedish politicians at all levels had proposed — and often managed to pass — zero-tolerance plans for bullying, drowning, suicides, unemployment, as well as radon in people’s homes.
And yet, with Sweden so close by, the Danes knew it wasn’t just a classroom governed by prefects. The classic counterexample was the fact that it was unlawful to jaywalk in Denmark, but not in Sweden.
Moreover, since the 1990s Swedish society had been caught up in a swift liberalisation. Everything from its school system to immigration policy lay closer to a neoliberal dream state than to a European Social-Democratic party platform.
But that hadn’t changed the world’s image of Sweden.
They seemed to be a cautious people.
At the beginning of March, when the Public Health Agency began to invite journalists to the northern parts of the Swedish capital, where Stockholm seamlessly gives way to Solna, everything changed.
It all started with a cookie jar.
Outside the press room where the daily briefings were being held was a spartan table of refreshments: a coffee thermos, a pitcher of tap water, some plastic mugs — and a tin jar.
The jar contained stale Swedish butter cookies. A few journalists plunged their fists into the jar and fished out a couple of cookies. Others looked on, wide-eyed. A dangerous virus was sweeping across the world — and the government agency in charge of protecting the Swedish people hadn’t even thought to provide a spoon?
A week later, Anders Tegnell took a Danish journalist out to lunch in the agency’s cafeteria.
‘The buffet is delicious,’ the state epidemiologist said.
Another Danish journalist — from the newspaper Information — looked on in surprise: ‘Seen from Denmark, it was almost like diving into an episode of German Big Brother. You almost expected the state epidemiologist to invite the journalist to sip champagne from his bellybutton.’
Tegnell’s boss — Johan Carlson — also seemed unfazed by the pandemic. Every day, he commuted from his home in Uppsala by train, Metro, and bus. He even let the local paper follow along on a trip to work. When he went to restaurants, other guests looked at him in surprise.
But most extreme was Johan Giesecke. He gladly informed the papers that he saw his grandchildren often. He went on TV several times a week. When someone asked him how he could be doing these things despite having turned 70, he replied: ‘I usually say I’m 69.’
Tegnell received letters from people who were furious. How could Giesecke be allowed to go on TV night after night when, according to the agency’s own guidelines, he was supposed to self-isolate?
In just a few weeks, these three men alone managed to change a century-old image of Sweden.
The strategy taken by the small country had many names in the foreign press: ‘Laissez-faire strategy’, ‘Take-it-on-the-chin approach’, ‘Russian roulette strategy’. There were many ways to describe this contempt for death.
For anyone with knowledge of the history of infectious-disease control in Sweden, the choice seemed even more surprising.
Sweden’s strictness was a chapter of its own in medical history. The quarantine law introduced in the country as early as 1806, after an outbreak of yellow fever, had been characterised by historians as ‘furious’. Sea captains on ships violating its provisions could be punished by death. Suspected vessels had to dock at Känsö outside Gothenburg, and patients were forced to shave their heads and have their bodies washed in vinegar.
A few decades later, in 1853, smallpox vaccination became mandatory in Sweden. While other countries in Europe balanced the state’s needs against the free will of its citizens, it wasn’t until 1916 that Swedish parents were given any opportunity to except their children from vaccination.
In the fight against sexually transmitted diseases, the Swedish state clamped down with equal force. Requirements that were imposed only on sex workers in other countries were applicable to the entire Swedish population. A law named ‘Lex Veneris’ was passed in 1918, meaning that any person infected with a sexually transmitted disease was obliged to seek medical attention and participate in treatment and contact-tracing.
The Swedish system garnered great interest abroad. The New York City mayor Fiorelli LaGuardia was impressed, and in 1935 he sent a committee to suss out whether anything they were doing there could be replicated. But the resulting report was criticised by The Lancet: the Swedish policy wasn’t the way to go. Having to answer questions about who could have spread the disease was considered deeply offensive, and stigmatising, to people.
Others piled on. British authorities at this time considered contact-tracing a fascist means of control, proven by the fact that it was practised in both Italy and Germany.
Sweden’s hard-line strategy was still going strong when the world went through the HIV epidemic of the 1980s. Once again, Sweden stood out as an exceptionally harsh country. As one of very few democratic states, Sweden allowed the forced isolation of individuals infected with HIV.
Now — in 2020 — the country had moved to the other end of the spectrum. Its public-health paternalism, safety addiction, and somewhat ‘fascist’ measures of infectious-disease control had been replaced by extreme liberty.
What had happened?
A few of the researchers who had followed the history of infectious-disease control in Sweden ventured a guess that perhaps this historical strictness was the cause. In the decades that had passed since the HIV epidemic, the hard line had been hashed over in books and TV shows, as well as in legal and historical dissertations. Society seemed to have reached a consensus that politicians and infectious-disease specialists had gone too far.
Was that why the hard line had been exchanged for its opposite?
The controversial cookie jar was eventually removed and replaced with candy that was carefully wrapped, if perhaps somewhat hard to chew.
At the press conferences where the candy was handed out, Anders Tegnell tried to hammer home the message that Sweden wasn’t so different from other countries. The big distinction, he said, was that Swedish measures were voluntary. So even though they’d had few decrees from their decision-makers, the Swedish people had reduced their activity significantly.
There was a large grain of truth in that description. Once the agency recommended that Stockholmers work from home, the central, office-dominated parts of the capital had been transformed into a ghost town.
The effects of social distancing — the awkward, misleading concept that should really have been called physical distancing — could be seen in various ways. The annual winter vomiting bug ceased abruptly; cases of seasonal influenza were dropping fast.
But the difference between Sweden and other countries was visible to the naked eye. While states in the US were issuing one stay-at-home order after another, while the Belgian police monitored their parks with drones, while Germans and Brits were allowed to gather in groups of no more than two, Swedes continued to go to spinning classes, drink beer in bars, and take ski trips to the mountains.
Now the most famous tourist town in the Swedish mountain range — Åre — was nicknamed ‘the next Ischgl’ by the German newspaper Süddeutsche Zeitung. Typically, when a destination in Sweden was adorned with the adjective ‘next’ in the foreign press, this was good news for the Swedish hospitality industry. But the analogy to the Austrian ski town had nothing to do with an extensive lift system or exciting off-piste opportunities. Instead, it suggested that the northern Swedish municipality now risked becoming an epicentre of the same proportions as Ischgl had been a few weeks earlier.
Compared to several European countries, the Swedish death toll remained low. For this reason, there was still something both foreboding and admonishing about the media coverage.
But, so far, the Swedish authorities chose not to heed the warnings.
The company SkiStar, which owned several ski resorts across Sweden and Europe, had been forced to close its resorts in St Johann, Austria and Trysil, Norway — but was still keeping its Swedish destinations open.
Regardless of what Anders Tegnell was trying to argue in the daily press conferences, it was becoming increasingly clear both to Swedes and to the outside world that Sweden had, in fact, chosen a very different path.
This raised the stakes significantly for both the government and the Public Health Agency.
Screwing up in the company of others is rarely a problem. Screwing up on your own, however, is an entirely different matter.
On 25 March, the most widely read political commentator in the country — Viktor Barth-Kron at Expressen — wrote that both the Public Health Agency and the government were playing a dangerous game.
‘Either we come out of this crisis in better shape than comparable countries, or at least not worse. If so, Anders Tegnell is set to become the new Hans Rosling, and Stefan Löfven will look to be the coolest prime minister in Europe — the one who achieved the best outcome per effort, causing the least injury to both the economy and individual liberties in proportion to what was achieved.
‘Or Sweden will do worse than its more restrictive neighbouring countries. If so, to put it mildly, a very different debate awaits.’
That day, the media reported that a total of 42 Swedes had died.
‘It Provides a Somewhat Bleak Picture’
On 25 March, Neil Ferguson testified before the Science and Technology Committee in the UK parliament. Among other things, he said that the British healthcare apparatus would be able to weather the storm of COVID patients, and that the death toll would come in below 20,000 people.
The magazine New Scientist ran a commentary on his testimony, which was subsequently quoted in a Twitter thread by the journalist and lockdown-sceptic Alex Berenson.
That thread, in turn, was pasted into an email from Jan Albert to both Johan Giesecke and Anders Tegnell. The subject line read: ‘Ferguson makes a U-turn?’
‘Interesting!’ Giesecke replied.
‘For sure,’ wrote Tegnell.
Anyone reading the original testimony would have had a hard time finding evidence of Ferguson changing his position — even less to support his making a ‘U-turn’. But the enthusiasm in Solna was telling in the last week of March.
A lot of things seemed to be going the Swedish public servants’ way.
The curve showing the number of new intensive-care patients looked flat — a lot flatter than in other countries. Tegnell said the situation ‘remained serious’, but also that the increase in hospitalisations was happening ‘relatively slowly’. The healthcare system seemed ready, too. It was ‘as prepared as it could be’, according to Tegnell.
‘This looks so very different from what we’ve seen in many of the countries that have truly struggled,’ he said to TT News Agency on Sunday 29 March.
The agency’s image had improved, too. The foreign media had begun to take a different kind of interest in the Swedish strategy. Flower deliveries were pouring into Anders Tegnell’s office and home.
In the email threads, they also noted that deaths in Lombardy were reaching a plateau at around 5,000.
The question was why. Was it the lockdowns that were halting the deaths? Or was this a more permanent mortality figure due to herd immunity?
Johan Giesecke felt it was time to lift some of the restrictions that had been introduced. On 27 March, he emailed Anders Tegnell and Johan Carlson, suggesting that upper-secondary schools and universities be allowed to return to in-person teaching. The epidemiological value in keeping students at home was non-existent. Besides, it would be a signal that brighter days were coming.
‘I feel especially sorry for everyone currently in their [final year] — it’s a shame not to get to celebrate one’s graduation after 12 years at school.’
By now, around 200 Swedish deaths due to COVID-19 had been reported. That figure could be interpreted in several ways. So far, the death toll wasn’t remarkably high compared to, say, Italy. But, at the same time, the Swedish curve was beginning to tick upward compared to its Nordic neighbours.
On Sunday night on 29 March, Tom Britton sent around a new model he had been working on. It simulated the spread of infection among the two million people living in what he called Greater Stockholm.
Among the recipients were Anders Tegnell, Johan Giesecke, and Jan Albert.
‘It provides a somewhat bleak picture,’ he wrote.
For a mathematician, knowing the infection fatality rate, or the share of infected people who died was valuable. Slowly, an unknown variable in the equations began to be replaced by actual numbers.
Now he could reverse-engineer the scenario. He already knew the number of people that had died from Covid; that was reported in the news every day. With his guesstimate of how many infected Swedes it took to kill one Swede, he could calculate how many Swedes had been infected so far. No one knew for certain how high the infection fatality rate was, but that variable, too, was becoming less uncertain with each passing day. The way Britton interpreted the literature, the mortality measures were being steadily adjusted downward.
He now assumed an an infection fatality rate of 0.3 per cent.
So he divided 200 by 0.003, and rounded up the numbers.
Sixty-seven thousand — that’s how many people might have been infected in early March.
There were many uncertainties involved. The timeframe of three weeks may just as well have been 2.5 or 3.5 weeks. And the infection fatality rate could be 0.15 or 0.6 per cent.
Yet the picture remained bleak.
Moreover, those 67,000 infected people — whether there were a little more or a little fewer — had been waltzing around the capital unrestricted for some time. In Britton’s model, as in the real world, restrictions had only been introduced from the middle of March.
They had taken the Metro, gone shopping, travelled by bus.
Now, Tom Britton’s guess was that between 15,000 and 20,000 Swedes would die before the epidemic was over.
‘Naturally, I won’t be sharing this with anyone other than yourselves,’ Britton ended his email.
At nine in the evening, Tegnell replied: ‘Mulling this over and letting Lisa have a look.’
When he was interviewed by the media, Anders Tegnell continued to sound optimistic. Things were quietening down, he said.
But beneath the surface, a degree of uncertainty had begun to take root.
Albert Bonniers Förlag, 2021/ Scribe 2022
Foreign rights: Ahlander Agency
We are grateful to Scribe and to Johan Anderberg for permission to publish this translated extract.
Johan Anderberg is a journalist and writer from Helsingborg, Sweden. As a journalist, he has written on a regular basis for a number of Swedish and international media outlets. He has previously written the non-fiction book Cannabusiness as well as a political thriller.
Alice E. Olsson is a literary translator, writer, and editor working across Swedish and English. From 2018 to 2019, she served as the Cultural Affairs Adviser at the Swedish Embassy in London. She is currently pursuing a PhD in Comparative Literature at University College London, specialising in speculative fiction and human rights law.