Sweden’s Surprise

Sweden’s Surprise

Sweden offered many positive surprises. The first surprise was this fox near our cabin the first morning. Many wonderful surprises followed.

We have observed, firsthand, the various approaches and initiatives of at least 20 countries during the outbreak since January 2020 (we were in Asia at the time). We have been interested in the various public responses along with clinical bio-psycho-social outcomes. We have also been interested in how the media ‘paints’ the pictures for the general public not currently in the various countries. We were particularly interested in a comment by the media earlier this year “the virus sweeps through the townships” when we were present in the townships and observed the exact opposite with many asking “why do people in townships not get sick”. Microbiology and virology colleagues comment that this is likely due to ongoing and regular exposure to various agents and pathogens which promote a strong immune system, whilst child psychiatrists also comment that the mental state and attitude in townships often promote a strong immune system.

Many have not travelled during this time, entered or exited through borders, so are unaware of the different approaches, policies, procedures and processes, along with responses by staff, leaders and the general public.

We have documented the various patterns and we have shared some of our observations and concerns in confidence with organisations, such as health ministries and public health departments, who have requested to remain on our mailing list.

We have been very interested in the clinical outcomes, including increase in social risk, for children and vulnerable adults in various countries.

We requested to meet with children’s social workers in Sweden to discuss Sweden’s unique approach (compared to many countries in Europe and the UK) and the clinical outcomes identified.

Based on our firsthand observations and experiences, Sweden’s approach is more similar to the approach of Singapore and South Korea where evidence-based clinical initiatives are prioritised (these countries have experience in the relative successful management of previous similar viral outbreaks).

As a colleague in Sweden commented, “the general public is asked rather than told, that is the difference”, liberty, autonomy and normalcy are respected as protective factors for mental health as well as general health; “important for remaining calm and positive which support a healthy immune system”. The general public is “very calm, very positive, very happy to be in Sweden” and engages in behaviours that reduce risk consistently such as remaining at home when sick, or covering nose and mouth when coughing or sneezing, or washing hands regularly and effectively (without overdoing it). He reports “no one is scared, no one feels trapped, no one is told what to do, people feel supported as if we are working together”.

A comment from a colleague in South Korea recently “the difference is no one was forced to do anything in Korea such as wear face masks, close shops or stay at home, but people are given information and options, nothing would have worked if people were forced, now people rather prefer to work together, but if they were forced, nothing would have worked out well, and now people are calm and they feel positive because their rights are not threatened”.

As mentioned Singapore recommended during the first months of the outbreak that face masks not be worn unless in certain contexts, such as when a person has symptoms. We observed, firsthand, calm and positive thoughts, feelings and behaviours in Singapore. Singapore prioritised education and normalcy as protective factors, which is an evidence-based approach for this particular viral infection. Many countries in Asia followed this approach the first few months of 2020. Many agree with a colleague from Asia, “too much pressure from the West means we all have to do what the West does, although we know it won’t work”.

Statistics in these nations support these initial approaches.

Children benefit significantly from calm parents, calm carers, calm communities and calm leaders. A systemic approach is important, which implies that everything is connected: A calm leader leads to calm communities, which leads to calm adults, calmer households and this benefits children’s safety, well-being, health, mental health and development.

Mental state is very important in the environment for children. A mental state of calm, positive thoughts, hopefulness, enjoyment of life and activities (not ‘feeling’ trapped, but ‘feeling’ free to make choices), and so forth, is one of the significant factors that create positive change and maintain mental health and general health for children. We have written about other factors such as safety, normative activities, positive relationships, education, food choices and so forth.

Social risk, such as alcohol and drug abuse, general violence, domestic violence and child abuse can be limited and reduced significantly by simple initiatives inspiring calm such as education regarding infections, viruses, vaccines and general health or hygiene, however, initiatives have to be evidence-based (based only on good clinical evidence). Many report that they don’t believe their country’s general public has been educated regarding viruses or vaccines.

We appreciated the very significant degree of normalcy, autonomy and liberty in Sweden. These are longstanding evidence-based protective factors for general health and mental health (and this often reduces social risk). These experiences benefited our health personally, and we were interested to see the general public’s absolute compliance with recommendations (from what we observed). A colleague commented, “it makes sense, if you force someone to do something, most adults won’t do it, you have to treat adults like adults or you get defiance, depression and violence in independent adults with normal attachment styles”.

There is still currently no good clinical evidence that supports the wearing of face masks for the general public as a generalised rule. This statement is supported by the WHO and European-CDC. These organisations offer advice regarding when face masks might be helpful and of benefit. We have provided links of these statements previously. We have been informed that the CDC (USA) now states that face masks are not (or do not have to be) mandatory on cruise ships where 95% of the passengers are vaccinated. Some states in America, such as Florida, have no compulsory face mask initiatives for the general public, whilst California takes an opposite approach. Please see relevant statistics.

It is also relevant to know that face masks are not mandatory in Sweden, which is also an initiative based on good clinical evidence, because there is no good clinical evidence to support mandatory face mask wearing for the general public. We observed that more or less 10% of individuals wore face masks indoors and less outdoors. People do however respect the importance of ventilation and a reasonable degree of social distancing.

We have not experienced more normalcy and more following of evidence-based research in general approaches or initiatives in any country compared to Sweden since August 2020. We are very grateful for these valuable experiences. We thank you.

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