How Did Scandinavians Get Their Pre-Pandemic Lives Back?

All three Scandinavian countries — Denmark, Sweden, and Norway — have fully lifted COVID-19 restrictions and are, for the most part, back to a “normal” way of life.

“We have returned to the lives we lived before the pandemic by 99%,” Filip Knop, MD, PhD, of the University of Copenhagen’s Gentofte Hospital, told MedPage Today. “You still see more sanitizers around, but it’s rare to see people use them. It is such a relief.”

Denmark lifted all restrictions in mid-September, followed by Sweden and Norway, which ended restrictions at the end of the month. Despite that, the virus appears to be on the retreat in all three countries. The latest 7-day averages for cases were 552 (Denmark), 499 (Sweden), and 432 (Norway), with a 7-day average of one death in each country — and falling.

While all three nations have similarities that contributed to their success — such as high vaccination rates and high trust in government — they’ve all taken somewhat different approaches. Notably, Sweden has the highest case count (1.2 million) and deaths per million (1,460), while Denmark (364,000 cases, 459 deaths per million) and Norway (194,000 cases, 159 deaths per million) fall far below that mark.

In Denmark, vaccination rates are excellent, at 86% for all those eligible (ages 12 and up), and 96% for all those over age 50, said Michael Bang Petersen, a political scientist who advised the Danish government on its pandemic approach.

No vaccine mandates were needed, he said, because of high trust in the authorities’ management of the pandemic. “This trust has been incredibly high and completely stable” in Denmark, Petersen said on Twitter.

Knop echoed these sentiments, noting that Denmark’s relatively high tax rates (most Danes pay around 50% in income tax, he noted) and low governmental corruption rates, along with its comprehensive provision of services and benefits to all citizens, such as free healthcare, education, and elderly care, narrows inequality to beneficial effect.

“This means that differences between rich and poor are small, the educational level of the general population is high, the general standard of living is high, and people trust each other and the authorities,” he said. “This, combined with a high degree of societal solidarity, makes it logical for the vast majority of Danes to follow governmental recommendations.”

He added that Danes rely on facts and are “not easily excited by conspiracy theories.”

“Furthermore, information from the government has been transparent and we have a physical and digital infrastructure that provides an extremely effective framework for different kinds of interventional and preventive strategies, and allows everyone to monitor the effects of interventions,” Knop told MedPage Today. “And when you see that the government-based recommendations are effective, it makes you trust and follow them.”

While Sweden also has a similar baseline level of societal equality and trust in government, the latter during the pandemic has been lower there, Petersen said.

“What authorities do during the pandemic matters too,” he noted, alluding to Sweden’s initial decision to forgo large-scale lockdowns, at a cost of a higher number of deaths among the elderly, particularly those in care homes. Knop also believes a “different initial handling of the pandemic” led to the divergent outcomes between the countries.

Nonetheless, life looks normal in Sweden these days, too. Mozhu Ding, PhD, an epidemiologist at the Karolinska Institute in Stockholm, told MedPage Today that people actually stopped social distancing and wearing masks (Sweden never mandated the latter) “way before the restrictions were lifted.”

Nearly 80% of people in Sweden ages 16 and up are fully vaccinated, with about 84% getting at least one dose, she said.

“Because of the high trust in the governmental agencies and institutions, the Swedish population got vaccinated en masse,” Ding added. “Lifting restrictions is simply the government holding up its side of the bargain.”

In Stockholm, many companies have returned to in-person work, and restaurants “are now fully packed and people eat happily together and chat without a worry. On the subway, mask wearers are few and sometimes get looks because it can be assumed that one didn’t vaccinate and thus needs the protection.”

While trust in officials’ initial response to the pandemic may have wavered, trust in the country’s vaccination program did not.

“Every Swede has the benefits of having free healthcare and a solid welfare package that they can call upon if they fell ill,” Ding said. “Swedes have a genuine feeling that the social institutions are working for them and not exploiting them. Trust in government agencies and the healthcare system is a big part of Sweden’s vaccination drive.”

“Currently, people are experiencing the freedom that comes with getting vaccinated,” she added. While that can change “if there are frequent breakthrough infections that erode confidence in vaccines,” that’s not currently observed and Sweden plans to introduce third doses to vulnerable populations.

In Norway, around 90% of eligible people are vaccinated, said Anne Spurkland, MD, a professor of immunology at the University of Oslo.

While her university still relies on some virtual learning, and commuter crowds are still smaller than they were before the pandemic, much of life is back to normal, with bars, restaurants, and concert venues fully open. Schools are fully open, and rapid antigen testing among children is common.

“I concur with the idea that we have to reopen and start to live our lives more like in pre-pandemic times, and just accept that COVID-19 exists and that we may contract it sooner or later,” Spurkland told MedPage Today. “Since the majority of Norwegians are now vaccinated, in Norway the disease can now be compared more with the seasonal flu in terms of disease burden. Hopefully it will remain like that, but it remains to be seen.”

All three Scandinavian nations are prepared for the possibility that the virus may not be through with them, and that a new variant could wreak havoc if it gets around the high levels of vaccinated immunity. Even if that happens, Scandinavians seem to be assured that their governments will get them through.

“Will the lifting of restrictions go well? Who knows,” Petersen tweeted, noting that Sweden and Denmark didn’t have a third wave. “New variants may emerge & restrictions reappear. Yet, from a behavioral perspective, I am optimistic about the future. Even with a 3rd wave, mutual trust should be high enough to pull thru.”

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    Kristina Fiore leads MedPage’s enterprise & investigative reporting team. She’s been a medical journalist for more than a decade and her work has been recognized by Barlett & Steele, AHCJ, SABEW, and others. Send story tips to k.fiore@medpagetoday.com. Follow

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