Sweden’s decision to keep schools open through pandemic was correct, says former senior health official

The former head of epidemiology at the Public Health Agency of Sweden has said a decision regarded by many as highly controversial – not to close schools in his country during the Covid-19 pandemic – remained the one with which he was most pleased.

Dr Anders Tegnell said there were many misconceptions internationally about the way Sweden handled the crisis, especially in its early phase, but his country had one of the lowest rates of excess death during the pandemic.

Speaking with former Nphet member Prof Martin Cormican, at an event at the University of Galway organised as part of the EU’s programme of research to prepare for any future pandemic, Pandem-2, Dr Tegnell said that although Sweden had not introduced some of the more restrictive lockdown measures seen in many countries, many of the same approaches had been recommended and, due to high levels of trust in the authorities, had resulted in high levels of observance.

Mobile phone data, he said, showed Swedish people had restricted movement more than in other Nordic countries.

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He said the authorities had to grapple with the same Covid-related issues experienced in other countries and suffered similarly poor outcomes in some areas but overall, he said, the data firmly suggested the country had one of the lowest excess death rates recorded internationally.

A key area in which he believed Sweden’s approach had been correct was the decision to keep schools for under-15s open as the benefits of doing this far outweighed the risks.

“We took the very conscious decision not to close schools for children under 15. And I think if there’s one decision I’m happy that we took it’s this one because I think it’s going to make a lot of difference to those children,” he said.

“All the indications we had were that children were very, very seldom sick,” he said. “The Chinese, the Italians, all the data told us that, so we were not really worried about the children. And the data also told us that children very seldom spread the disease.

“And we had people in our agency who worked with schools. And there was plenty of evidence of how bad it is, especially for disadvantaged children, not to be able to go to school for many different reasons, not only because of education but also because of school lunches, social context and all of these things.”

The evidence was not complete, he acknowledged, but he said drawing on evidence from the country’s experience of flu, swine flu and other respiratory viruses, the conclusion had been that “there was very little evidence ... that it makes much of a difference to close schools”.

“I think another difference between different countries was a really long-term vision ... the whole time we said ‘this is not going to go away’. I don’t think anybody was thinking about three years but we realised it’s going to take a long time ‘so we’re not talking closing schools for a week or two’.”

Prof Cormican, meanwhile, said he would very much like see the establishment of an Institute of Public Health in Ireland, which could potentially share the burden of decision making during any future health emergency.

He said he accepted it was the Government’s responsibility to make the key decisions about the handling of the pandemic and said sometimes decisions that were not based on medical advice were correct because political considerations were also important.

But, he suggested, there had been a misapprehension among many members of the public that Nphet had been making decisions on restrictions when “Nphet didn’t have the authority to make you put a lamp on your bicycle. Nphet was an advisory body.”

Prof Cormican has previously expressed the view that Ireland’s response to the crisis depended too much on fear and limited basic freedoms for too long. This failed to take adequate account of the “collateral damage” to health and wellbeing, especially on those who were already vulnerable or disadvantaged.

“There is an uncomfortable feeling that mask use in schools, like so much else that deprived children of their education and childhood, was done to placate powerful interest groups at the expense of the children’s fundamental rights,” he said in a paper to the Irish Society of Clinical Microbiologists.