Stockholm: Sweden has been an outlier in the coronavirus pandemic: It eschewed lockdowns and kept restaurants, bars, schools, movie theatres and gyms mostly open. And while death rates were high compared to its Nordic neighbours, they were comparable to those of larger European countries.

Now, a second wave has brought a new surge in infections and Stockholm’s emergency services are overrun, forcing the authorities to recalibrate their approach. They imposed new restrictions at the end of November that bring the country’s response somewhat more in line with the rest of Europe. They include drastic cutbacks on the size of public gatherings and some school closures.

But with ski lifts, restaurants and bars all remaining open, Sweden’s tougher restrictions still pale in comparison to the rest of Europe and there are mounting concerns that not enough is being done. Intensive care beds in hospitals in the Stockholm region are all currently occupied, regional health director Bjorn Eriksson said at a news conference on Tuesday.

“We are far beyond 100% of capacity in intensive care. We are approaching almost double the number of available spaces,” he said.

Since the pandemic began, a debate has raged both inside and outside of Sweden over how to curb the virus. As other countries went into lockdown in the spring, Sweden stayed open out of concern that keeping everyone holed up at home would have long-term detrimental effects on children and adults and could lead to depression, suicide, postponed health care and job losses.

On Monday, the Swedish prime minister, Stefan Lofven, said the country’s experts had underestimated the likelihood of a second wave. It was the first time an official criticised, even obliquely, the Public Health Agency of Sweden, the expert group tasked with making coronavirus policies, and the public health researcher who leads it, Anders Tegnell.

In October, Tegnell said that he hoped that the spread of immunity in the population would help Sweden get through the fall with a low level of cases.

“I think that most in the profession did not see a second wave coming,” Lofven said in an interview with Swedish newspaper Aftonbladet.

Deaths high among elderly

Tegnell’s agency is no longer calling all the shots on virus policy and he is having to increasingly share the stage with Swedish politicians who have taken on a more active role.

During the first wave, deaths were high, especially among the elderly. On Tuesday, a special commission concluded in an initial report that the government had failed to protect the elderly and was unprepared for the pandemic. That said, death tolls among those above 80 have been high all across Europe.

Infection numbers and deaths have been rising steadily since October. By Tuesday, Sweden had reached a total of 320,098 cases since the beginning of the pandemic, while neighbouring Finland, with a population about half of Sweden’s, has 31,110 cases, less than 10% of Sweden’s.

Criticism for not doing enough

And now the government is coming under criticism for not doing enough.

“I was hoping this grave situation would change things, but yesterday they opened the ski lifts in Sweden,” said Fredrik Elgh, a professor of clinical virology at Umea University and a well-known critic here of the official coronavirus response. “Taking such actions into account, I don’t think the government is taking the firm action I had hoped for.”

Lofven’s government, in an attempt to stop the spread of the virus, issued new recommendations at the end of November that banned gatherings of more than eight people.

While schools for children under 16 have stayed open throughout the pandemic, some are now being closed after outbreaks. A ban on serving alcohol after 10pm has been implemented. On Monday, a state agency sent out mass text messages warning people to limit Christmas gatherings to a maximum of eight people.

But officials are asking, not ordering.

Under Swedish law, the government isn’t allowed to force people to stay home or fine those who flout the recommendations.

The Netherlands, with lower infection rates than Sweden, went into a full lockdown on Tuesday. Germany closes down most of the country on Wednesday.

Restaurants, coffee shops and bars in Sweden continue to be open.

Face masks not recommended

Face masks aren’t recommended in Sweden because the Public Health Authority says there isn’t enough scientific evidence that they work.

So, on Monday afternoon the “Chic Konditori,” which sells coffee and sweets in Stockholm, was full of customers. Tea Kagstrom, an 18-year-old university student with feathered blond hair, sat with two friends enjoying a cup of coffee. Asked why she wasn’t wearing a face mask, she replied because it’s not obligatory.

“The Public Health Authority hasn’t said that we should wear masks in public places,” she said.

The government is drafting an emergency law that would give it powers to order lockdowns and close down businesses when the virus is spreading.

Still critics are calling for harsher measures.

“We need a few weeks of lockdown to get the numbers down,” said Tove Fall, a professor of molecular epidemiology at Uppsala University near Stockholm. “Other countries are taking much higher precautions at lower transmission levels.”

Some are upset that face masks aren’t used in Sweden.

“We are the only democracy in the world that does not recommend the use of face masks. There are more than 170 countries in the world that recommend using masks. But here they are saying there is not enough science behind that. That is nonsense,” said Elgh, the virology professor.