Officers in Halmstad municipality, Sweden, just lately compelled a instructor to take away their masks and prohibited using masks and all types of PPE in colleges. The municipality mentioned there was no scientific proof for carrying masks, citing the Swedish public well being company. On the time, company steering said that there have been “nice dangers” that masks could be used incorrectly. This steering has since been eliminated.
To somebody unfamiliar with the Swedish response to COVID-19, this masks ban would possibly sound surprising. In any case, whereas masks usually are not foolproof, there’s proof that signifies that they do assist scale back the unfold of COVID-19, particularly in conditions the place sustaining distance is inconceivable – equivalent to colleges.
The municipality finally backed down. However new examples of masks bans maintain popping up in Sweden. Librarians within the prosperous city of Kungsbacka, for instance, have been instructed to not put on masks.
How on earth did we find yourself on this state of affairs? Effectively, the whole lot the Halmstad and Kungsbacka officers have mentioned about masks is according to the Swedish public well being company’s statements. These native masks bans are a logical product of 9 months of constant anti-mask statements by the Swedish state, which we argue is an instance of poor threat communication.
A European outlier
Outdoors of Sweden, most Europeans are actually used to carrying masks indoors whether or not within the grocery store, on public transport or when visiting the physician. It has turn out to be such an ingrained behavior that we will simply neglect that, for the primary months of the COVID-19 pandemic, many people weren’t carrying masks in any respect. In these early days, the principle message was the quite easy “wash your fingers” and the quite tougher “don’t contact your face”.
The European Centre for Illness Management first really useful the general public use of masks as early as April, although it was not till June that the World Well being Group (WHO) adopted go well with. England waited till July, and eventually in August, Norway, Denmark and Finland introduced in masks necessities.
Sweden, as we have now seen, selected a unique path. The Swedish public well being company has persistently said that masks are ineffective and that their use might truly improve the unfold of COVID-19 – a typical view at first of the pandemic however a uncommon one now.
In July, the well being minister, Lena Hallengren, defined that the Swedish authorities didn’t have a tradition or custom of constructing choices about protecting clothes equivalent to masks, and that her authorities wouldn’t overrule the general public well being company.
Sweden’s masks coverage even went past its nationwide borders, into worldwide anti-mask activism. In April, the nation’s chief epidemiologist, Anders Tegnell, wrote an e-mail to the European Centre for Illness Management (which occurs to be primarily based in Stockholm), warning it to not advocate using masks. The reasoning was that this “implies the unfold is airborne”, which might “significantly hurt additional communication and belief”.
How did we get right here? Again in spring 2020, when SARS-CoV-2 was nonetheless a brand new and poorly understood virus, the Swedish communication round COVID-19 was a easy and constant tripartite mantra: wash your fingers, maintain distance, keep house in case you are sick. This might be acquainted to folks in lots of different nations, and is a textbook instance of efficient threat communication, which needs to be clear, easy and straightforward to behave upon.
The WHO tips for efficient threat communication in public well being crises emphasise that uncertainties needs to be explicitly said, that the data is constant and straightforward to grasp, and that the messaging accommodates particular and real looking really useful actions.
The preliminary phases of Swedish threat communication ticked two of those bins, whereas failing to speak uncertainty, which was the case in lots of nations which additionally selected quite simple messages.
As scientific understanding of the virus developed, nevertheless, the Swedish threat communication round masks didn’t change. In August, for instance, when mask-wearing was turning into widespread in different European nations, Tegnell mentioned that the proof for mask-wearing was “astonishingly weak” and that their use might improve the unfold of the virus.
A muddled masks mandate
Swedish authorities maintained their anti-mask place till December, when the prime minister, Stefan Lofven, introduced a U-turn on using masks on public transport.
However Lofven’s new coverage was not a easy rule to put on masks when travelling. As a substitute, it recommends using masks from 7am to 9am and 4pm to 6pm, for these born “in 2004 and earlier than” who shouldn’t have a reserved seat. If this sounds overly sophisticated, that’s as a result of it’s.
It’s maybe unsurprising, then, that compliance has been low, with solely half of commuters truly carrying masks throughout rush hour.
And it’s not simply most people. Two weeks after the advice was launched, the director of Sweden’s public well being company, Johan Carlson, was noticed and not using a masks on a bus throughout rush hour. When requested about his failure to conform together with his personal suggestions, he mentioned, “I merely failed to note that the time had turn out to be commuting time,” which properly illustrates the issue with overly advanced threat communication.
Complicated and sophisticated
If the pinnacle of the general public well being company is incapable of following his personal guidelines, one can hardly blame the general public for his or her lack of compliance.
Initially of the pandemic, the Swedish authorities’s preliminary threat communication (the tripartite mantra) was easy and straightforward to grasp. However by December, authorities had been warning of the dangers of mask-wearing for months. So the general public transport announcement was not solely complicated as a consequence of its complexity but additionally as a consequence of the truth that its content material instantly contradicts the masks steering from March till December.
On this context, it’s no marvel that libraries and colleges in Sweden are sending combined messages about whether or not folks ought to put on masks.
It’s the product of months of unhealthy threat communication on a easy public well being measure that has been extensively adopted elsewhere. This failure to speak might have very worrying outcomes: doubtlessly elevated an infection in a rustic which is on the point of a 3rd wave.
The authors don’t work for, seek the advice of, personal shares in or obtain funding from any firm or organisation that may profit from this text, and have disclosed no related affiliations past their educational appointment.