Sweden’s coronavirus strategy – three systems views of an internal observer

I. First View - POSIWID

POSIWID stays for the “Purpose Of the System Is What It Does”. The principle was introduced by Stafford Bear; it allows to analyze a system without knowing or paying attention to what was the rational, if any, behind the system design. Following this principle, we will consider only which kind of rules/constraints exist in Sweden that are aimed at managing the current pandemic situation. The rules are changing, I might have missed some, but the main ones, hopefully, are caught.

1.  Strict measures to limit disease transmission: (1) All universities are in online mode; (2)  All high schools (gymnasium in Swedish) are in online mode; (3) Formal closure of borders. Entrance from outside EU is forbidden, but there are many exceptions, e.g. people looking for a refugee status, which creates a potential source of the disease transmission from outside.

2. Strong recommendations to limit disease transmission: (1) Observe social distance (2 m); (2) Observe the rules of hygiene (wash your hands often); (3) Stay at home in case of any symptoms. Seek leave is allowed without a certificate from a doctor up to 3 weeks (was one week before); (4)  Work online if possible; (5) Do not travel inside (and outside) Sweden if not absolutely necessary.

3. Some limitations, which still leave possibility for transmission: (1) Official gatherings are allowed with limitation of 50 people participating; (2) Restaurants can stay open, but they are required to ensure distance between the guests behind different tables; (3) Shops are open, but there are some requirements on the number of people in the shop simultaneously, and the distance between people in the queues; (4) Schools (from 1st grade to 9th grade) and daycare institutions are open, but some measures to observe physical distance are required. Municipalities and school rectors can close public and private schools on their own, but it happens rarely; (5) Workplaces introduce some measure to shield their employee, e.g. closing the front door in the buses.

 4. Measures in place that allow transmission: (1) Masks are not recommended for private use (considered as useless); (2) Masks and other preventing transmission gear are not recommended for and are not used by the employees engaged in the elderly care services (nursing homes and private help). There can be exceptions, but they are not many. Masks and other preventing gear are only used in the hospitals; (3) A person without symptoms should work, even if a member of his/her family is ill, possibly, with corona; (4)  A symptom free child should go to school even if somebody in his/her immediate family is ill. Not abiding the rules equals to breaking the law of mandatory education and can have consequences.

Based on the POSIWID principle, we can conclude that the so-called Swedish strategy is not directed at stopping the disease transmission, it can continue through schools, daycare and elderly care services, as well as through minor gathering, restaurants, shops, and places of work. The only people who can substantially reduce their chances of getting seek are people who do not work or can work remotely, do not have children of school age, and do not require external service for their everyday life. People in this category can undertake a number of risk reduction measures, e.g. buying food online for delivery, if they invest some time and effort for this end. For everybody else possibilities of considerable reduction of the transmission risk are more limited.

The measures taken are aimed at slowing down the speed of disease transmission in order to reduce the load on the healthcare system, which already is on its knees. They also allow the rest of economic activities in the country to continue, though with limitations due to illnesses, lost of incoming orders, especially from outside Sweden, or lost of spare parts and materials coming from the outside.

II. Second View – Dimensions of Strategy

This view is based on book “Patterns of Strategy” by Patrick Hovrestadt and Lucy Loh. The book deals with the strategy on the enterprise level, but it includes general principles applicable in other contexts. According to the authors, implementing a certain strategy requires the system to possess some properties. Properties are classified according to several dimensions, two of which could be relevant for our case, namely, Power and Time.

1. Power. Roughly speaking, this dimension is about the system having material resources to execute a chosen strategy. For example, to impose a lockdown, or even a strict quarantine, the state needs enough of police forces, or, in the worst case, a standing army. In the current situation, the Swedish society does not have much power. Police force is undermanned and has no reserves to complete additional tasks, as it already struggles to cover the growing level of criminality, which does not diminish in the pandemic time. There is not much of an army to speak of, it was gradually disbanded, especially during the last 10 years. There is no real border control, as it was gradually disbanded after joining the Schengen. There are no state-level reserve warehouses, even the medical ones, which were dismantled in connection to cancelling the state’s pharmaceutical monopoly. The degree of self-reliance is quite low, in comparing to, say thirty years ago, when the high degree was mandated by law. It was substantially decreased after joining EU. The large chunks of production is outsourced, many Swedish enterprises are owned by international corporations based outside Sweden, and the Swedish society cannot exercise full control over them.

2. Time. Roughly speaking, this dimension is about the speed of taking and implementing a decision. Roughly, this dimension has three components: (a) time spent for detecting and understanding situation (corresponds to Observe + Orient in Boyd’s OODA cycle), (b) time spent for making a decision (corresponds to Decide in OODA), and (c) implementing the decision (corresponds to Act in OODA). All three components together determine the level of organizational agility. It looks like the Swedish system is quite slow in regards to all three components. This slowness does not concern only government, but the whole society. Sweden still have quite huge production capacity, but it cannot quickly reorient itself to manufacture things needed for the moment, like medical tests, protective gear for the hospitals, masks for private usage, hand and surface disinfectants, etc. All this stuff is in high demand, and though the reorientation has started, it is far from being completed.

Considering lack of power and low level of agility, it is not clear whether Sweden could have chosen a strategy radically different from the current one.

III. Third View – Luhmann theory of organizations

According to Nicklas Luhmann, an organization can be viewed as a decision generating machine. An important point of this view is that the decision-making process is not arbitrary, but it is highly restricted by the decisions made in the past. Therefore, a decision taken today, might substantially reduce the choices for future decisions. As an example, borrowed from Ivo Velitchkov’s presentation, a bad decision made by an employee can be traced to the decision in the past of hiring this employee.

One way of past decisions influencing the future ones in an organization is connected to the human desire of not accepting wrong decisions made in the past. This leads to new decisions being made just to justify decisions made previously. Returning to the situation in focus, at the beginning of the community spreading of the virus in Sweden, the Swedish authorities assumed that asymptomatic transmission did not happen. This view is, partially, still in place, as in the official guidelines, asymptomatic transmission is called “theoretically possible”. Not accepting the asymptomatic transmission – a decision - lead to a chain of other decisions, like not requiring wearing a mask in closed public places, e.g. public transport, or not requiring staying home if another family member has symptoms consistent with the disease.  

There are other decisions that can be traced back to much older decisions. For example, lack of recommendations on wearing protective gear by elderly care employees might be traced to the decision of dismantling the medical reserve warehouse (taken some years ago). Due to this decision, there is not enough gears for the hospitals, and the slowness of the system does not help in obtaining enough protecting gear for the elderly care.

Concluding this view, it seems that the Swedish strategy can be classified as an emergent strategy (term introduced by Henry Mintzberg), i.e. a strategy that emerges from a number of decisions taken in the near and distance past. Tracing them down is outside this short opus.

IV. Concluding remarks

The Swedish strategy of aiming at herd immunity while slowing the process of transmission includes high risks, as has been pointed out by a number of risk management specialists, including Nassim Taleb. The risks named are as follows:

1. Not enough is known on whether immunity is obtained, and on how long the immunity could last.

2. High cost in terms of the number of deaths, especially in high-risk groups – elderly and people with underlying conditions, which are not excluded from the paths of the disease transmission.

3. High cost of rehabilitation after disease. This can include human suffering and economic costs; the latter can be greater than the economic resources released by premature death of elderly and members of other risk groups.

It does not look like the strategy has been chosen from a number of alternatives; it seems to be a consequence of the current state of the Swedish society and the chain of previous decisions. Choosing this strategy for other countries, if they have alternatives, is not mandatory, and may not lead to the same results (which are still unknown). Even if with some good luck, the strategy somehow work in Sweden (e.g. if the virus mutates to a less aggressive form), it might not work in other countries. After all, Sweden is not a densely populated land, except Stockholm where the situation is much worth than in other parts of the country.