How Sweden and Denmark Handled the COVID-19 Pandemic Differently

In many ways, the Nordic countries are well-equipped to deal with external stressors such as a global pandemic. We have historically strong democracies with high levels of political participation and well-functioning welfare systems. Compared to other countries, gender-equality is high (although by no means perfect), and unemployment is low. Because higher education is tuition-free, the thresholds to enter universities are lower than in countries where getting an education might be dependent on your family’s wealth, or put you in life-long debt. Healthcare is available to everyone and is either free, or heavily subsidised by the state. Perhaps most important to pandemic regulations, Nordic citizens listen to what the government says.

Yet in spite of these similarities, when the coronavirus hit, there was one country that chose a wildly different path than the rest of the Nordic countries: Sweden.

At the time of writing this article, more than 12,500 people have died from the virus in Sweden, compared to Denmark’s 2,300 and Norway’s 607. Since many countries measure death rates differently, comparing numbers is a tricky business that should be done cautiously.

But the fact remains that Sweden’s numbers raise some justified eyebrows. Sweden’s (in)famous strategy has made the headlines of most major global news publications and the world has been scratching their heads trying to understand why Sweden opted for such a different path than its neighbors. Looking at the way Sweden is governed in comparison to the other Nordic countries, this dissimilarity starts to make more sense. Let’s use Denmark as an example.

Although both countries are currently governed by the Social Democratic Party, fronted by Mette Frederiksen in Denmark and Stefan Löfven in Sweden, the two countries have different ways of governing.

The difference can partly be traced back to the role of public ministries. In Sweden, ministries are run independently and if a minister decides to actively govern the agencies, they would be accused of “ministerstyre,” which literally translates to “ministerial governance.” In fact, in Sweden “ministerstyre” is illegal and could lead to trial before The Committee on the Constitution. In Denmark the same word simply describes how the country’s ministries are governed, namely by the government’s ministers. In contrast to Sweden, Danish ministers wield far-reaching power and can direct the ministries at-will.

In terms of the pandemic, this means that in Sweden, ministers have not been able to control the details of what their departments are doing. Led by the now world-famous state epidemiologist Anders Tegnell, Sweden’s measures have thus been largely based on what the Public Health Agency sees as being in the public’s best interest. In Denmark on the other hand, Prime Minister Mette Frederiksen and the Minister of Health and Elderly Affairs Magnus Heunicke have been shouldering the burden of steering Denmark through the pandemic, rather than their ministries.

In theory, not allowing ministerial governance ensures that specific decisions affecting society are made by experts within their field, and not by politicians, who might (let’s face it) not always know what’s best. But in combination with a de-regulated market for health and elderly care, the lack of decisive political governance in Sweden has resulted in a power vacuum, where attribution of responsibility is being bounced around like a virtual hot potato between the government, the Public Health Authorities, the regions (who are in charge of the provision of health care), and the municipalities (who are in charge of the elderly care).

The conditions for the elderly population in Sweden has attracted global attention in particular. More than 12,500 people have died from COVID-19 in Sweden, and at one point in time, Sweden’s per capita death rate was the highest in Europe.

In Sweden, many of the private companies running the elderly care facilities have been accused of not paying their staff properly, having too many employees on hourly contracts (which means there’s a lot of people coming and going), and not providing their employees with adequate protective gear.

Controversies have also arisen as decisions about providing palliative care have been made without elderly patients ever seeing a doctor. In Denmark on the other hand, the death toll is lower, but the government has also faced harsh criticism for over-reaching. It’s difficult to forget the millions of minks that were put to death, a decision that now has been deemed illegal.

Face masks or not? Closing schools or not? Rules and regulations, or relying on people following unenforced recommendations? In Sweden, the opinion of Anders Tegnell has consistently been to not recommend rolling out rules that are not based on conclusive scientific evidence. For example, the effectiveness of using face masks has been contested, and only the future will tell the effects on the economy of locking down whole countries. Studies have already shown how women have lost out economically, professionally, and socially in a situation where children are kept at home.

But all the while politicians, epidemiologists, and armchair-experts on Twitter have been big mouthing the effects of this or that measure, the people working at the frontline, caring for the sick and the elderly, have been carrying the weight of the pandemic on their shoulders. And in the EU, 76% of care workers are women.

How did healthcare workers in both Denmark and Sweden experience these policy differences in real time? Julie Valentin Schepelern works as a nurse at Rigshospitalet’s infection clinic in Copenhagen. Moa Zickermann is a nurse at Astrid Lindgren’s Children’s Hospital in Stockholm. Both started working in 2020, facing coronavirus directly upon graduating.

Although the clinics at which they work do not work with coronavirus cases only, they are meeting the pandemic on the frontline every day. They are absorbing the shock waves that COVID-19 is sending throughout the whole health care system. Reallocation of resources, lack of clear instructions, and worry about not being able to provide patients the treatment they need has become part of their daily lives.
 

In many ways, the Nordic countries are well-equipped to deal with external stressors such as a global pandemic. We have historically strong democracies with high levels of political participation and well-functioning welfare systems. Compared to other countries, gender-equality is high (although by no means perfect), and unemployment is low. Because higher education is tuition-free, the thresholds to enter universities are lower than in countries where getting an education might be dependent on your family’s wealth, or put you in life-long debt. Healthcare is available to everyone and is either free, or heavily subsidised by the state. Perhaps most important to pandemic regulations, Nordic citizens listen to what the government says.

Yet in spite of these similarities, when the coronavirus hit, there was one country that chose a wildly different path than the rest of the Nordic countries: Sweden.

At the time of writing this article, more than 12,500 people have died from the virus in Sweden, compared to Denmark’s 2,300 and Norway’s 607. Since many countries measure death rates differently, comparing numbers is a tricky business that should be done cautiously.

But the fact remains that Sweden’s numbers raise some justified eyebrows. Sweden’s (in)famous strategy has made the headlines of most major global news publications and the world has been scratching their heads trying to understand why Sweden opted for such a different path than its neighbors. Looking at the way Sweden is governed in comparison to the other Nordic countries, this dissimilarity starts to make more sense. Let’s use Denmark as an example.

Although both countries are currently governed by the Social Democratic Party, fronted by Mette Frederiksen in Denmark and Stefan Löfven in Sweden, the two countries have different ways of governing.

The difference can partly be traced back to the role of public ministries. In Sweden, ministries are run independently and if a minister decides to actively govern the agencies, they would be accused of “ministerstyre,” which literally translates to “ministerial governance.” In fact, in Sweden “ministerstyre” is illegal and could lead to trial before The Committee on the Constitution. In Denmark the same word simply describes how the country’s ministries are governed, namely by the government’s ministers. In contrast to Sweden, Danish ministers wield far-reaching power and can direct the ministries at-will.

In terms of the pandemic, this means that in Sweden, ministers have not been able to control the details of what their departments are doing. Led by the now world-famous state epidemiologist Anders Tegnell, Sweden’s measures have thus been largely based on what the Public Health Agency sees as being in the public’s best interest. In Denmark on the other hand, Prime Minister Mette Frederiksen and the Minister of Health and Elderly Affairs Magnus Heunicke have been shouldering the burden of steering Denmark through the pandemic, rather than their ministries.

In theory, not allowing ministerial governance ensures that specific decisions affecting society are made by experts within their field, and not by politicians, who might (let’s face it) not always know what’s best. But in combination with a de-regulated market for health and elderly care, the lack of decisive political governance in Sweden has resulted in a power vacuum, where attribution of responsibility is being bounced around like a virtual hot potato between the government, the Public Health Authorities, the regions (who are in charge of the provision of health care), and the municipalities (who are in charge of the elderly care).

The conditions for the elderly population in Sweden has attracted global attention in particular. More than 12,500 people have died from COVID-19 in Sweden, and at one point in time, Sweden’s per capita death rate was the highest in Europe.

In Sweden, many of the private companies running the elderly care facilities have been accused of not paying their staff properly, having too many employees on hourly contracts (which means there’s a lot of people coming and going), and not providing their employees with adequate protective gear.

Controversies have also arisen as decisions about providing palliative care have been made without elderly patients ever seeing a doctor. In Denmark on the other hand, the death toll is lower, but the government has also faced harsh criticism for over-reaching. It’s difficult to forget the millions of minks that were put to death, a decision that now has been deemed illegal.

Face masks or not? Closing schools or not? Rules and regulations, or relying on people following unenforced recommendations? In Sweden, the opinion of Anders Tegnell has consistently been to not recommend rolling out rules that are not based on conclusive scientific evidence. For example, the effectiveness of using face masks has been contested, and only the future will tell the effects on the economy of locking down whole countries. Studies have already shown how women have lost out economically, professionally, and socially in a situation where children are kept at home.

But all the while politicians, epidemiologists, and armchair-experts on Twitter have been big mouthing the effects of this or that measure, the people working at the frontline, caring for the sick and the elderly, have been carrying the weight of the pandemic on their shoulders. And in the EU, 76% of care workers are women.

How did healthcare workers in both Denmark and Sweden experience these policy differences in real time? Julie Valentin Schepelern works as a nurse at Rigshospitalet’s infection clinic in Copenhagen. Moa Zickermann is a nurse at Astrid Lindgren’s Children’s Hospital in Stockholm. Both started working in 2020, facing coronavirus directly upon graduating.

Although the clinics at which they work do not work with coronavirus cases only, they are meeting the pandemic on the frontline every day. They are absorbing the shock waves that COVID-19 is sending throughout the whole health care system. Reallocation of resources, lack of clear instructions, and worry about not being able to provide patients the treatment they need has become part of their daily lives.

We spoke with Swedish nurse Moa and Danish nurse Julie about how Sweden and Denmark’s varied approaches to coronavirus continues to shape their work:

We spoke with Swedish nurse Moa and Danish nurse Julie about how Sweden and Denmark’s varied approaches to coronavirus continues to shape their work:

I think I’m a pretty caring person, so it ended up feeling natural for me to go into that direction.

Two weeks after I graduated from nursing school this summer, I started working at the infectious disease clinic at Rigshospitalet in Copenhagen.

We deal with all sorts of infections, including coronavirus, but also sexually transmitted infections like HIV, infections in the back, brain abscesses, and tropical diseases.

My plan is to continue my education to become a midwife, but to do that I first need some work experience. I wanted to work with something that is related to that field, which is how I ended up at the children’s hospital. Now that I’ve started working, I love my job. Working with children is so much fun! They’re really amazing; they’re funny and so patient, you wouldn’t believe it. Many of them are very ill when they come to us, but they power through all the tests and examinations we have to do.

And the people I work with are also incredible.

We’re a group of young women, many of us are recent graduates, and we’ve become good friends. I’ve never enjoyed working this much at any other job.

I think I’m a pretty caring person, so it ended up feeling natural for me to go into that direction.

Two weeks after I graduated from nursing school this summer, I started working at the infectious disease clinic at Rigshospitalet in Copenhagen.

We deal with all sorts of infections, including coronavirus, but also sexually transmitted infections like HIV, infections in the back, brain abscesses, and tropical diseases.

My plan is to continue my education to become a midwife, but to do that I first need some work experience. I wanted to work with something that is related to that field, which is how I ended up at the children’s hospital. Now that I’ve started working, I love my job. Working with children is so much fun! They’re really amazing; they’re funny and so patient, you wouldn’t believe it. Many of them are very ill when they come to us, but they power through all the tests and examinations we have to do.

And the people I work with are also incredible.

We’re a group of young women, many of us are recent graduates, and we’ve become good friends. I’ve never enjoyed working this much at any other job.

The truth is, when coronavirus first came, no one knew how to deal with it. So no one knew exactly what protection to wear, or how to interact with the patients in a safe way. Everyone thought: “okay, they’ve got this.”

Then when we were hit by the second wave. They shut down one of our floors and took all the staff to work specifically with coronavirus patients. This obviously meant that there were less nurses working with our other patients. A couple of weeks ago, they re-opened the floor again, staffed it with other nurses and started taking in additional coronavirus patients again. But now, luckily it’s been shut down again because there aren’t enough cases.

I think this re-allocation of staff back and forth has been quite challenging, especially because it takes a lot of energy to deal with coronavirus patients. When they’re really sick, they need a lot of care, and you need to have a lot of energy and focus.

We’re used to having a few complicated or complex cases at the time. Around Christmas, out of 14 hospital beds, half of them were complex cases. We just didn’t have the staff to properly deal with that. Downsizing from two floors to one just really increased the work burden on all of us who were left to treat the patients on our floor.

This situation really sucks, and it has sometimes made me feel like I’m letting the patients down. We just can’t keep up, because we’re so understaffed. I love my job when I can actually spend some time with the patients.

When you are hospitalised at the infection clinic, you are only allowed one visitor, and if you have coronavirus, you are not even allowed one. So I think the patients start feeling lonely quite easily.

I can also imagine it’s been quite confusing for the patients, because the staff have been quite confused about the rules and regulations that change all the time.

One day it’s okay to do this thing but not that thing, and then the next it’s the other way around. And then we just have to say, “sorry, new restrictions again, the thing I told you was okay last night is apparently no longer okay now.”

Even though there’s been so many articles about nurses being stressed out dealing with the coronavirus, I think at least at my clinic, we’re doing a really good job. We’re keeping our heads high, we’re trying to maintain light mood and stay positive.

Sometimes it’s not possible; we for sure have very bad days. But I still really like my job.

What’s happened as the second wave rolled in is that we had to send personnel to other departments, which affected our work a lot. Everyone had to take extra shifts, we were completely over-run and had way too many patients for the amount of staff.

For about three weeks, every day was more or less chaos: everyone was overworked, we didn’t have any time, and everyone was feeling terrible.

Now things have started to improve.

What worries me is the uptick of patients with something called MIS-C, or Multisystem Inflammatory Syndrome in Children, which has been linked to coronavirus. The kids who come to the clinic with this syndrome are very, very ill. It’s been said for a long time that kids aren’t that affected by coronavirus, and it’s true that the infection itself is usually quite mild. But then a couple of weeks later they come to us with high fever and rashes, and their whole bodies are swollen and aching. When we run tests we can see that their organs are attacking themselves and start to fail.

This spring, we didn’t even know about this long term effect of the virus, but thankfully we do now. When we get patients like this, we now know what to look for, so we test them for anti-bodies. We’re also very good at treating MIS-C, so in Sweden, I think all children have recovered. I don’t know what the situation is like in the rest of the world. If these children don’t get the treatment they need, they can die. It’s that bad.

Facing these children and their parents can be challenging. Not a lot of people know about what MIS-C is because it hasn’t been talked about a lot. So of course people worry and get confused. And when it comes to the kids, they just want their parents close, and instead they are faced with a bunch of strangers wearing full protective gear who want to run tests on them.

I was treating this little guy; for the first couple of days, all he did was scream. He couldn’t sleep, everything was hurting, and he had a constant high fever. Then after the treatment kicked in, I saw him walking around in the corridor, he was smiling and he was so happy, and I just felt like, “Wow! You screamed at me for a whole week, and now you’re happy! What a difference!” Nothing beats that feeling.

The truth is, when coronavirus first came, no one knew how to deal with it. So no one knew exactly what protection to wear, or how to interact with the patients in a safe way. Everyone thought: “okay, they’ve got this.”

Then when we were hit by the second wave. They shut down one of our floors and took all the staff to work specifically with coronavirus patients. This obviously meant that there were less nurses working with our other patients. A couple of weeks ago, they re-opened the floor again, staffed it with other nurses and started taking in additional coronavirus patients again. But now, luckily it’s been shut down again because there aren’t enough cases.

I think this re-allocation of staff back and forth has been quite challenging, especially because it takes a lot of energy to deal with coronavirus patients. When they’re really sick, they need a lot of care, and you need to have a lot of energy and focus.

We’re used to having a few complicated or complex cases at the time. Around Christmas, out of 14 hospital beds, half of them were complex cases. We just didn’t have the staff to properly deal with that. Downsizing from two floors to one just really increased the work burden on all of us who were left to treat the patients on our floor.

This situation really sucks, and it has sometimes made me feel like I’m letting the patients down. We just can’t keep up, because we’re so understaffed. I love my job when I can actually spend some time with the patients.

When you are hospitalised at the infection clinic, you are only allowed one visitor, and if you have coronavirus, you are not even allowed one. So I think the patients start feeling lonely quite easily.

I can also imagine it’s been quite confusing for the patients, because the staff have been quite confused about the rules and regulations that change all the time.

One day it’s okay to do this thing but not that thing, and then the next it’s the other way around. And then we just have to say, “sorry, new restrictions again, the thing I told you was okay last night is apparently no longer okay now.”

Even though there’s been so many articles about nurses being stressed out dealing with the coronavirus, I think at least at my clinic, we’re doing a really good job. We’re keeping our heads high, we’re trying to maintain light mood and stay positive.

Sometimes it’s not possible; we for sure have very bad days. But I still really like my job.

I wasn’t that worried about it when I started working this summer. It was a bit of a limbo between the spring and whatever was coming next; people were still questioning if a second wave was coming. So I got to start gently. Of course it took time getting used to all the protective gear with both masks and visors, and many of us have gotten wounds and headaches from them. I’m constantly out of breath because I’m always breathing in my own expelled air. But you get used to that as well. It’s just become part of my job and my uniform.

What’s happened as the second wave rolled in is that we had to send personnel to other departments, which affected our work a lot. Everyone had to take extra shifts, we were completely over-run and had way too many patients for the amount of staff.

For about three weeks, every day was more or less chaos: everyone was overworked, we didn’t have any time, and everyone was feeling terrible.

Now things have started to improve.

What worries me is the uptick of patients with something called MIS-C, or Multisystem Inflammatory Syndrome in Children, which has been linked to coronavirus. The kids who come to the clinic with this syndrome are very, very ill. It’s been said for a long time that kids aren’t that affected by coronavirus, and it’s true that the infection itself is usually quite mild. But then a couple of weeks later they come to us with high fever and rashes, and their whole bodies are swollen and aching. When we run tests we can see that their organs are attacking themselves and start to fail.

This spring, we didn’t even know about this long term effect of the virus, but thankfully we do now. When we get patients like this, we now know what to look for, so we test them for anti-bodies. We’re also very good at treating MIS-C, so in Sweden, I think all children have recovered. I don’t know what the situation is like in the rest of the world. If these children don’t get the treatment they need, they can die. It’s that bad.

Facing these children and their parents can be challenging. Not a lot of people know about what MIS-C is because it hasn’t been talked about a lot. So of course people worry and get confused. And when it comes to the kids, they just want their parents close, and instead they are faced with a bunch of strangers wearing full protective gear who want to run tests on them.

I was treating this little guy; for the first couple of days, all he did was scream. He couldn’t sleep, everything was hurting, and he had a constant high fever. Then after the treatment kicked in, I saw him walking around in the corridor, he was smiling and he was so happy, and I just felt like, “Wow! You screamed at me for a whole week, and now you’re happy! What a difference!” Nothing beats that feeling.

I guess that’s because the government think that if you’ve chosen to work at the infection clinic, there’s always the chance you’ll get infected by something, so dealing with coronavirus is not something out of the ordinary. We picked this job, so we don’t get that pay boost.

Money is not why I chose this job. If I wanted a high salary, I would have done something else. Instead, I’d say that what would help us as nurse is to have more staff.

If there were more nurses, we would have time not only to treat people, but also to care for them. I wanted to become a nurse to give people care, but now I feel like I don’t have time for that at all.

Having a stable staff situation would be great, but I think lack of personnel is not necessarily a COVID-only problem.

Having to send staff to other clinics has definitely not helped our situation.

I guess that’s because the government think that if you’ve chosen to work at the infection clinic, there’s always the chance you’ll get infected by something, so dealing with coronavirus is not something out of the ordinary. We picked this job, so we don’t get that pay boost.

Money is not why I chose this job. If I wanted a high salary, I would have done something else. Instead, I’d say that what would help us as nurse is to have more staff.

If there were more nurses, we would have time not only to treat people, but also to care for them. I wanted to become a nurse to give people care, but now I feel like I don’t have time for that at all.

Having a stable staff situation would be great, but I think lack of personnel is not necessarily a COVID-only problem.

Having to send staff to other clinics has definitely not helped our situation.

The frontline needs to be better staffed, and the people working to fight the virus need more stable working conditions and a significant pay raise. As a society, we need to rise to the occasion and support those who are supporting us.

Find out about the differences in how Sweden and Denmark approached the #MeToo movement.

The frontline needs to be better staffed, and the people working to fight the virus need more stable working conditions and a significant pay raise. As a society, we need to rise to the occasion and support those who are supporting us.

Find out about the differences in how Sweden and Denmark approached the #MeToo movement.