Chapter Four - Dr. Tegnell or: How I Learned to Stop Worrying about the Virus and Love the Daily Press Conferences
The title of the chapter should be taken with a pinch of salt. I was definitely worried about the virus, but I really like riffing on Dr. Strangelove...
I'm not sure when I first heard of Anders Tegnell, but it's fair to assume that I became aware of his existence just as belatedly as I started having opinions about how to deal with the pandemic. However, by the time the Danes announced they would close their borders on March 13 it had dawned on me that Sweden were doing things differently, so by then I would at least have known that Sweden had a public health agency and a state epidemiologist whose name was Anders Tegnell. As I've already said, my knowledge of pandemics was extremely limited, in fact, I didn't even know what epidemiology was at this stage (when I did learn, I was surprised to learn just how broad a field it is).
Because I was abroad, the uproar Tegnell had caused in certain quarters when he, contrary to his own advice, coughed into his hands at a press conference on March 5 passed me by entirely.
While I'm on about things I didn't know or didn't understand, I also initially thought that the idea of flattening the curve, which, as we've already seen, was all the rage at the early stage of the pandemic, seemed misguided. Why not just get it (i.e the pandemic) over with as soon as possible? When I read a bit more about it I realised the reasoning behind it was to make sure hospitals weren't overwhelmed. Once I had grasped that, I though it made sense.
From March 21 onwards, when I was back in Timrå with dad, watching the press conferences became part of our daily routine. Anders Tegnell quickly became our favourite. We thought he was calm, composed, knowledgeable and also had a dry, somewhat nerdy sense of humour, while at the same time not taking himself too seriously. I think we both felt a certain patriotic pride - here was a guy who embodied the best Swedish traits - egalitarian, down to earth, plain old "Anders", but still a very competent doctor and civil servant. He was the guy we were rooting for. (By the way, does anyone remember Anders Wallensten? Apparently he's still the deputy state epidemiologist...)
My recollection of the first press conferences we watched, apart from the graphs of new cases and deaths and Tegnell's repeated message of keeping your distance, staying at home if you felt any symptoms, washing your hands and working from home if possible, was the repeated questions about the supply of
personal protective equipment for health care workers from the journalists present at the public health agency's premises in Solna. The representatives from the National Board of Health and Welfare - including the very attractive Taha Alexandersson, the no-nonsense Johanna Sandwall and the stoic Thomas Lindén, all of whom also made a good impression on us in the sitting room in Timrå - had to repeat on a daily basis that they were scouring the market to buy, vet and distribute any and all PPE they could find. It might be good to put this in context, this is what was happening in Europe at the time:
While I thought Tegnell handled most questions from the journalist very well, the one issue where I felt he was floundering was when he tried to explain what PPE healthcare staff needed to use. The guidelines from the Public Health Agency seemed arbitrary and unnecessarily complicated, with various types of PPE to be used, depending on the situation. I don't know if this was motivated by the supply problems, but this was one of the aspects the critics of the Swedish strategy jumped on. One of these critics was Björn Olsen, professor of Infectious Diseases at Uppsala University, who was often invited on the TV news to comment on the developments. I remember he described how unreasonable it would be for a nurse to have to go change PPE while looking after a patient if the patient's condition suddenly deteriorated and the nurse needed to make some more invasive procedure, which called for more PPE to be used. I thought this particular criticism seemed reasonable.
Apart from that, things seemed to be going reasonably well, all things considered. The curve remained fairly flat, hospitals worked hard to scale up their ICU capacity and most people adhered to the general advice from the public health agency to curb the spread of the virus. Personally I stayed at home and only went to the grocery shop just before closing time to make sure I came into contact with as few people as possible. Then came the reports about the virus spreading in nursing homes, where people most vulnerable to the virus lived. I remember a journalist asking Tegnell in an interview after one of the daily press conferences if this was a failure and without beating about the bush, he said "yes, that's probably how you should look at it". In hindsight, it was probably naive to think that the virus could be kept out of nursing homes. As Johan Giesecke, of whom there will be more to say at a later stage, in his customary laconic manner said in a Zoom interview: "We all failed"; it seemed there was no country which had managed to keep the virus out of its nursing homes. I remember reading about a Canadian nursing home where the staff had simply abandoned the residents. Gruesome stuff. This might be what I was thinking of: https://www.cbc.ca/news/canada/montreal/quebec-coroner-extends-hearings-herron-security-footage-1.6186819 It seems the residents weren't completely abandoned, "She added that she would also like to view video surveillance footage to determine whether employees at the facility abandoned their posts on March 29, 2020, leaving residents alone. The inquiry has heard that regional health authorities arrived at the severely understaffed facility on that day to find residents dehydrated, unfed and soiled."
To the best of my knowledge there was no such incidents in Sweden, but there were still reports of dreadful conditions and how the virus was tearing through some nursing homes, many in the Stockholm region. There was one TV news item where the scruffy looking owner of a nursing home was interviewed and he complained that all or most of the residents had been infected and that they had been "abandoned" by the public health agency. He didn't seem to think that as the manager, he had any responsibility for the situation. To me it seemed like quite a brazen attempt to deflect from his own failures. One of the reasons the nursing homes were badly affected seems to have been that many members of staff were on hourly contracts, meaning that if they stayed at home because they had symptoms they wouldn't get paid. In Sweden if you call in sick, there's a one day qualifying period before you get sickness benefit (in Swedish, "karensdag"). This was introduced in 1993 and was supposed to be temporary to save money during the fiscal crisis at the time, but it was never abolished and it is still there. However, a moratorium was introduced by the government on the 11th of March 2020 (originally the moratorium was only supposed to last for 1,5 months, but it was extended more than once and was in place until April 2021, reintroduced in December 2021, and finally removed in April 2022), making it possible for people to stay at home if they felt symptoms and still get sick pay from day one. However, this doesn't apply if you get paid by the hour. Overall, working in geriatric care is a pretty thankless job, the pay is lousy and staff turnover is generally very high. In the 10 years that dad has become home care services there have been hundreds of people who have come and gone, which is quite frustrating as he has to explain again and again how he would like things to be done. Having lived in Ireland for seven years, where family is held in much higher regard, I had come to view the Swedish attitude to family as quite deplorable and I think this also manifests itself in how Swedes think about and look after their elderly relatives.
The press conferences also exposed the conformism of Swedish culture. There was a German journalist at the press conferences who kept asking critical question and this caused quite a stir among his Swedish counterparts. What might have worked in Sweden's favour regarding the adherence to the pandemic guidelines from the public health agency made the Swedish press corps look quite toothless and naive: articles in DN and Aftonbladet referring to "the mysterious German" (see for example: https://www.aftonbladet.se/nyheter/a/EWMQGl/mystiska-tysken-om-tegnell-som-en-tall-istormen) certainly won't go down in history as worthy of Woodward and Bernstein. I'm also nearly certain Tegnell thought the questions were warranted and reasonable and he seemed quite happy and comfortable answering them - using the experience of having lived and worked in less conformist cultures to his advantage. It then turned out that the journalist, whose name is Christian Stichler, was actually sympathetic to the Swedish strategy, he was merely doing his job: asking important and critical questions.
Almost all of the press conferences are available here: https://share.mediaflow.com/se/?SDFE9O7K3O. I believe they were uploaded by someone who was/is very critical of the public health agency and uploaded them as some kind of "gotcha"/"smoking gun". I'm not sure they have a case. Just as an example, at the press conference on March 5, Tegnell said there would be a peak in cases in the next few days. This was picked up by the press and made for eye-catching headlines, e.g https://www.dn.se/nyheter/sverige/antalet-coronafall-i-sverige-kan-ha-natt-toppen-kommer-snart-att-klinga-av/, which was later used as an example of how wrong Tegnell had been. What the critics conveniently and completely ignore is what Tegnell says about this at the very next press conference on March 6: https://share.mediaflow.com/se/?SDFE9O7K3O
(about 5 mins in) "Yesterday I said that we'll see a gradual reduction of it [i.e. cases from people infected in Italy during the winter holidays of the last week of February]. What I meant then and what I mean today is that the incubation period for people who've been to Italy is coming to an end, i.e. those who were infected in Italy should have shown up already. Therefore we have reason to believe we will see fewer cases from Italy during the next few days. This does not in any way mean that we think this is over or that we think that the corona epidemic in the world is over, but how things will develop will to a large extent depend on what happens in the rest of the world". This is just one of many examples of how critics of Tegnell and the public health agency took things out of context and/or wilfully misconstrued them. Rather than listening to what they said about complex and constantly changing and developing situations, they resorted to using tabloid headlines and more or less accurate quotes. Note that this does not mean Tegnell and the public health agency were right about everything, this paragraph should rather be considered a very short introduction to the unwarranted (and warranted) criticism of him and the agency. Before we delve further into this topic, there are other aspects that need to be discussed. First up: that group of scientists in Sweden who were very active and vocal in their objections to the Swedish strategy.
