Good Covid-19 News From Italy...and Sweden

(Bloomberg Opinion) -- The lifting of Covid-19 lockdowns around the world was never going to be easy. But as infections are flaring up from Spain to Australia, it's worth noting that two of the hardest-hit countries at the pandemic's peak — Italy and Sweden — are keeping the virus's spread under control. 

Daily confirmed cases in both nations are now averaging at around 200 each, well below their respective peaks, with no rebound in sight and no strain on hospitals. By contrast, the daily case count in Spain rose past 2,000 last week and France's surpassed 1,000. This is by no means a second wave, but it's worth asking what Italy and Sweden might be doing differently to manage the virus.

These countries once stood out for the wrong reasons. Italy was the first European country hit by a Covid-19 surge and the first to impose a draconian lockdown. Sweden took a more liberal and controversial approach — at odds even with other Nordic countries — that kept schools open and broadly stuck to recommendations on social distancing and self-isolation rather than forced quarantine. 

While Italy's lockdown arguably saved lives, it came late. Sweden's, meanwhile, never came at all. On a per-capita basis, Italy's death toll of more than 35,154 comes to about 600 per 1 million people, as does Sweden's 5,743.

Still, in the current post-peak phase, with Italy gradually reopening its economy and Sweden maintaining its policy, both countries seem to have found their stride in living with the virus. 

In Italy, top-down, public-health management of life after lockdown seems to be winning the day. As in other countries, social-distancing rules require people to keep one meter (3.3 feet) apart and to wear face masks in public indoor spaces or on public transit, but there's a particularly high level of enforcement and rigor. 

Taking a train or going into an office building in Italy involves having your temperature checked. Going out to dinner means giving the restaurant your full contact details to ensure a potential infection transmission can be traced. Special forms must be filled in for access to tourist hot spots like Sardinia, Sicily and Puglia. In the northern region of Lombardy, the country's original epicenter, masks have even been required outdoors. Breaking Covid-19 quarantine is a crime nationwide, with possible sanctions including fines or jail time.

The effectiveness of these rules is a testament to people's willingness and ability to follow them, says Rosanna Tarricone, associate professor in health-care management at Bocconi University. Regulations extend to how people dance in a nightclub or sunbathe on the beach. Without some level of buy-in, they wouldn't get very far. Memories of the harrowing scenes as hospitals were overloaded with Covid-19 patients are also a motivator. There's a feeling of collective responsibility mixed in with fear. 

If the lesson from Italy is that bureaucracy, enforcement and obedience are key to controlling Covid-19 outbreaks, Sweden appears contradictory at first glance. After much hesitation and questioning of its hands-off approach, especially after a grim death toll in nursing homes and a continued rise in infections in June, the country has stuck to it.

There's no mandatory mask-wearing in Sweden, social distancing is recommended rather than enforced, and people are generally advised to stay home if they're feeling unwell. That the country's curve has flattened will no doubt comfort anti-lockdown protesters in the U.S. who once exhorted: “Be more like Sweden.”

But that would miss the point. Swedes haven't benefited from simply “letting the virus rip” — their immunity levels are still low, antibody tests indicate — and they aren't being told to throw caution to the wind. Behavioral changes have taken place: The flow of human traffic is still not back to normal in many areas, according to Google mobility data, and officials have regularly warned people that failure to respect social distancing would lead to tougher rules. Some rules have been tightened, from a ban on visits to elderly care homes to the shutdown of restaurants in Stockholm that weren't following guidelines. Social distancing is paying off.

This isn't a model that can be easily reproduced elsewhere. Swedes are young, their country is sparsely populated, and a high proportion already live relatively isolated lives by working from home in single-occupancy households. But the secret here might be consistency.

That's a key component for ensuring Covid-19 policies are sustainable in the long run, according to Italian academic Giuliano Di Baldassarre, a professor of crisis management at Sweden's Uppsala University. If the aim is to live with the virus until a treatment or vaccine is found, a stop-and-go approach to rules — such as the flip-flops most everywhere on whether face masks should be worn and where — might be counterproductive and make them impossible to enforce.

So while Italy shows that alertness and intervention pay off, Sweden is a reminder that this is a marathon more than a sprint.

There's no quick fix or perfect template for Covid-19, and everyone makes mistakes. Italy's closure of schools came with a huge cost that brought little benefit, while Sweden's botched handling of care homes for the elderly probably led to deaths that could have been avoided. But as we move into a new phase of this pandemic the two countries are clearly worth watching.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

Lionel Laurent is a Bloomberg Opinion columnist covering Brussels. He previously worked at Reuters and Forbes.

©2020 Bloomberg L.P.