Dr. Vilis Pavulans

Coronavirus in Sweden

The coronavirus in Sweden has resulted in a very different experience for its citizens than for most people in Europe and America. Dr. Vilis Pavulans, 42, a doctor and surgeon, lives in Karlskrona, the main city of Blekinge. His wife, Katarina Skogman Pavulans, is also a doctor: She has an M.D./Ph.D., with a specialty in child psychiatry. Vilis Pavulans’ experience on the front-line provides a compelling look at how one country has been going about this pandemic in a very different way.

Karlskrona, in the southern part of Sweden, has been taking common-sense precautions to combat COVID-19. Like elsewhere in Sweden, the schools did not close, businesses were not shuttered, children did not stop having play time with other kids. 

Southern Sweden has seen very few cases of COVID-19. Karlskrona, a city of approximately 66,675 people, has been almost entirely spared. Blekinge County, where Karlskrona is located, has a population of 160,000. It has had only 200 confirmed cases of the virus and 3 deaths. (The coronavirus in Sweden statistics can be found here, in Swedish.)

Unlike other countries in Europe, coronavirus in Sweden did not result in the country closing its borders or taking extreme lockdown measures. Sweden’s effort to slow the spread of coronavirus did not include forcing public life to come to a screeching halt. 

It’s very hard to get accurate statistics. Deaths from coronavirus may be grossly underreported or over-reported, depending on the analysis you read. 

According to USA Today, between 20 and 30 percent of death certificates in the United States list an incorrect cause of death. So, we can’t assume that the reported coronavirus death rates in the United States or any other country are correct.

But as of this writing, coronavirus in Sweden has killed fewer people than in at least five other countries in Europe where extreme lockdown measures were taken. In fact, Belgium, the hardest-hit country in Europe, has had nearly double Sweden’s number of deaths per million. Spain, the United Kingdom, Italy, and France have also had markedly worse outcomes than Sweden. 

I spoke with Pavulans by phone to get a Swedish doctor’s thoughts on coronavirus in Sweden and find out more about Sweden’s response to the outbreak.


Coronavirus in Sweden caused ‘nervous anticipation’

When Pavulans first heard about an outbreak of coronavirus, he reserved judgment. He was curious about the outbreak in Wuhan, China but not afraid. Let’s see what happens here, he thought to himself. He and his medical colleagues watched and waited with what Pavulans describes as “nervous anticipation but not fear.”

In early March 2020, cases of COVID-19 started turning up in Sweden and other countries in Europe. A death from coronavirus in Sweden was reported on March 11.

“It is a strange feeling when something that’s potentially serious turns real,” Pavulans says. “You feel a little bit of fear, but at the same time you think, ‘OK, it’s time to do your duty.’”

Pavulans says his hospital and the local government acted swiftly. They cut down on elective surgeries and they reorganized the triage process so they pre-screen people entering the hospital at an outdoor triage station and isolate potentially contagious people and people with the illness. At the same time, the country banned gatherings of more than 500 people.


An early, unidentified case of COVID-19?

At the beginning of March, Pavulans was with his wife and two children (ages 9 and 11) on vacation in Austria. They were just 50 kilometers from Italy when cases first started being reported in Europe. He thinks he and his family may actually have had the virus.

“When we got back home, we got a cough and a fever and we were not feeling well at all,” he says, “This was just before they started testing. We weren’t tested. But I know of four colleagues who have had COVID, who tested positive. There are quite a lot of hospital staff who have had it. People at the ER have gotten it and an ICU doctor, and one of my surgical colleagues as well.” 

Pavulans says the unknown infection was worse for him and his wife than for his kids. His children had a “mild cough” that was barely noticeable. He had what he describes as a “man cold.” He was tired, experienced muscle aches, a bit of a sore throat, and quite a lot of coughing, he says. 

His wife didn’t cough much but had a sore throat and muscle aches. The illness—whatever it was—only lasted five or six days.


Social distancing, Swedish-style

Life in Karlskrona has changed very little since coronavirus in Sweden became a reality, Pavulans says. Most people have tried to adhere to social distancing. Those who could started working from home. Restaurants implemented wider spacing between tables, and fewer people have been going out to eat. But other than that, and the extra triage tent set up outside the hospital to identify and isolate people with coronavirus, life in Karlskrona since coronavirus in Sweden was first identified has not really changed.

“No one is wearing a mask,” Pavulans says. “There has been no recommendation of trying to use masks.” 

Other notable absences in Sweden have been the panic, hostility, and violence that we have seen in the United States and other countries. 


Different points of view

So, what does this Swedish doctor think? Pavulans wished the Swedish government had done more early on to protect the elderly in Stockholm. But other than that, he has nothing but praise for the way his country, and his region, have handled the crisis.

“I must say that for me personally I’m really happy that I’m living in Sweden and the policies are the way that they are,” Pavulans tells me. “I think they’ve been great.

“People on the whole are behaving normally, being polite, and trying to give each other space.”

Pavulans says there are very different points of view in Sweden. He says even with these milder measures, there are quite a lot of people complaining about feeling isolated and at the same time lots of people who are angry that Sweden did not subject the country to an extreme shutdown like much of the rest of the world.

Though Sweden was soundly criticized by some for not taking extreme lockdown measures, the World Health Organization recently praised Sweden as a potential “model for other countries.” 

“As surreal as things are here in Sweden, it seems so much more surreal in the U.S. and U.K.,” Charlotta Stern, a professor of sociology at Stockholm University, told ABC News.  “Swedes don’t realize how oppressive other countries have become. What is their exit strategy? The more we learn about the disease the more it seems that they have overreacted.”

Lockdowns, Stern and her colleagues explain in an article for Foreign Affairs, simply aren’t sustainable. 

Minna Pavulans Sherwood was born and raised in Sweden. She currently lives in Lane County, Oregon. A former academic (her Ph.D. is in Comparative Literature and Geography), she currently works as a freelance translator and a homeschooling mom.

I asked Pavulans Sherwood, who is Vilis Pavulans’ cousin, her thoughts about coronavirus in Sweden.

“I think Sweden has taken a balanced, science-based, established-practice approach to the COVID-19 situation, an approach that consists of strong recommendations, not legally binding decrees,” Pavulans Sherwood explained in an email. “The public knows what’s expected of them and have adjusted their daily routines accordingly without having life come to a standstill. Not disrupting elementary schooling has been a key component of this. Children through grade 9 have not had their learning or social networks interrupted, which in turn has enabled parents to adjust to altered working conditions a bit more smoothly.

“The various administrative authorities in charge of public health policy and crisis preparedness hold daily informative press conferences to de-brief the public on the status quo, to present any ‘signals’ in disease patterns (national and regional) and to give full transparency to the response efforts.

“Alongside the daily number of deaths, authorities make sure to acknowledge positive trends and developments. The overall goal is to instill respect for the gravity of the situation but to also affirm a core Swedish welfare value: Trygghet, that is a special kind of security ensconced in comfort and trust.

“The independent epidemiologist in charge, Anders Tegnell, emits knowledge, level-headed calm, and patience as he explains what’s going on and what the situation requires. The Swedish policy recognizes that in order to be sustainable for the long haul, the guidelines and restrictions need to be realistic. Tegnell often reminds the public of the need for temporal perspective, that we won’t really know how this will play out until at least a year has passed. They make continued adjustments to policy based on what is observed on the ground—what is actually playing out is more important than what we thought we would see. That is, they are not driven by the early hypotheses and models. Fear-mongering doesn’t figure into the Swedish handling of the COVID-19 situation.”

Pavulans Sherwood follows the news in Sweden carefully. She also tells me that the daily press briefings have become a place for the Swedish public to go, not only for up-to-date information, but for consistency, community, and support.


Widespread protests erupt in America

Meanwhile back in America, our economy has been devastated and our suicide rates seem to be at an all-time high. Yesterday I received an email from my daughter’s college that Hannah Mead, a computer science major who just graduated, died by suicide after a struggle with depression.

Despair, joblessness, loneliness, and homelessness are crippling our citizens. 

Since last Friday there have been scores of protests in response to the brutal murder of an unarmed black man, George Floyd, by a white police officer who kneeled on his neck for nine minutes. Violent riots and clashes with police have resulted in devastating property damage in Minnesota, Atlanta, New York City, and across the United States. While there have also been hours of peaceful protesting, many have turned violent.

People are so angry they’re no longer social distancing. It’s more than just George Floyd: this ongoing quarantine and the draconian measures police have been using to enforce it have made Americans sick, lonely, and frustrated.

Sweden may not be perfect, but the response to coronavirus in Sweden has been much better than ours.