Our aim was to investigate how the perception of threat due to the COVID-19 pandemic and people’s trust in the authorities’ management of the pandemic differed between Norway and Sweden, and to what degree the pandemic affected daily life in the two countries. This survey provides a snapshot of people's opinions, fears and attitudes towards preventive measures during the COVID-19 pandemic in Norway and Sweden in March and April 2020. We found that people had a high degree of trust in the health systems and authorities in both countries. Although the countries’ authorities have taken different approaches to the pandemic, most people support their authorities’ COVID-19 preventive measures. The large majority of people respond that they comply with the advice or regulations given by their governments and health authorities, and are provoked by people who do not comply.
Norway and Sweden are neighboring countries, and have a long history of close collaboration. Many Norwegians study and work in Sweden and vice versa. The culture and the languages are very similar. Both countries are parliamentary democracies with a strong social democratic profile: Both have mainly public health care systems, solid social welfare programs, and all education, including university, is free of charge. Despite the similarities during normal circumstances, the two countries have responded differently to the COVID-19 pandemic. The main difference is the closing of borders and the closure of schools and kindergartens and different businesses in Norway, which remained open in Sweden.
Our results indicate that there is a high degree of trust in government and health services in both Norway and Sweden. Few disagree with their governments’ measures or were provoked by them, even though the preventive measures varied substantially between two countries. Most of the Norwegian participants felt that the closure of kindergartens and schools were appropriate, while in Sweden, most people thought it was inappropriate to close schools and kindergartens.
The Nordic countries have the highest levels of generalized trust and social capital in the Western World under normal circumstances, and these high levels have been stable for decades (11, 12). Social capital can be defined as “the ability to cooperate without written rules and extensive contracts” (13), and may therefore be linked to a population’s commitment to follow guidance from the authorities. Both Norway and Sweden have a long history of successful volunteer infection preventive measures, such as child vaccinations, where both countries reach a coverage of more than 95% (14, 15). According to both countries laws – volunteer preventive measures should be applied first, whenever possible (16, 17).
According to our survey, the Norwegians and the Swedes seems so far during the pandemic to be loyal to their authorities, and trust that their respective governments’ decisions are based on scientific evidence. In both countries, people reported a high level of compliance to social distancing and hygiene, although these measures have been introduced through regulations in Norway in contrast to guidance in Sweden.
More than 70% of the study population in both countries are proud of how they cope with the situation. Thus, our results indicate that both the Norwegian and Swedish government’s call to people's solidarity and to join forces as a national virtue, seem to work so far.
Over the last months, the people in Norway and Sweden have been told to work from home if possible, and to limit all travel. In Norway, people travelling into the country are mandated a 14 day quarantine (18). Many people are laid off work, and as of April 21, 2020, the level of unemployment is 10.2% in Norway, and 15% are seeking employment (19), the highest number since Second World War. In Sweden, the proportion of unemployed has to date increased only slightly compared to previous years (20, 21). In Norway, all sports and cultural events are banned and gyms are closed, while in Sweden, gyms and training facilities are open and organized children’s sports arrangements are encouraged, based on a judgment that the benefit of socializing and being physically active outweighs the potential risks of COVID-19 for children. The Swedish Communicable Diseases Act specifies that when infection preventive measures affects children, particular attention must be paid to what the child's best interests require (16), whereas no similar statement is found in the Norwegian law (17).
It is natural to think that the consequences of the pandemic and the preventive measures can have a negative impact on people's lives and health (22). In our survey, more than 80% in both countries say that they do not live their lives as usual. Some ate more, many are exercising less, and some drink more alcohol than they do usually. Many feel that their lives are on hold and many people, especially in Norway, feel sad and depressed. Possible negative health consequences as a result of measures to prevent the spread of the coronavirus must be taken into account when considering the duration and usefulness of infection prevention measures.
Strengths and limitations
Our study sample was collected using the snowball method and the responses may not be generalizable to the general population in Sweden and Norway. The method is frequently used in surveys, especially when there is a need to quickly document a situation that changes over time (9). Our sample did not include children below 15 years of age, and we had few participants below 29 and 70 years and older. The majority of the participants were women, and we had an overrepresentation of the age group 30 to 49 and of people with higher education, compared to the general population (23). We present only descriptive, unadjusted data, and any difference observed between the countries may be biased due to an unbalanced selection of respondents. However, cross-tabulation revealed small differences across subgroups of age, gender, municipality size, and education level, and we believe our results are robust despite the unbalanced selection of respondents.
A standard questionnaire was not adequate for our study, as we wanted the survey to reflect issues related specifically to the pandemic, raised in ongoing focus-group interviews. We therefore designed our own survey, with the drawback that it could not be formally validated beforehand, due to the time-sensitive nature of the survey. However, the survey was tested on volunteers outside the study-group.
The survey was first performed in Norway, about ten days after the Norwegian government had introduced the most restrictive infection prevention measures ever seen in Norway. The media focus and the population’s attention to the pandemic was large at the time. This resulted in 3000 responses in less than 24 hours. In Sweden, the survey was performed three weeks later, and we needed six days to reach our goal of 500 respondents. This may have influenced the comparability between the two countries. However, during the entire study period from mid-March to mid-April 2020, the COVID-19 situation was stable in both countries, and no substantial new preventive measures were taken in this period, although the COVID-19 mortality rates increased more in Sweden than in Norway (24). We repeated the survey in Norway in the period April 4th-8th and found that the results did not differ substantially from the results from the first round presented here (Appendix 2a and b, 2a: Norwegian version; 2b: English version). In addition, other surveys performed repetitively in the population shows that the level of trust in the government was stable and high in Norway in the period between March 15 and 31 (25). A survey performed repetitively in Sweden also shows that the trust in government and health care system was high and stable from March 21 to April 8 (26). Thus, we believe that our survey provides a valid comparison of the two countries.
Our results indicate that preventive measures can be applied successfully both through regulations, like in Norway, and through advice based on mutual trust between the authorities and the population, like in Sweden. Basing infection prevention on volunteer measures has been a long-standing tradition and is a statutory right in both countries and has probably been the recipe for success for instance to achieve a high vaccine coverage (14, 15). Danish scientists wrote in 2015 about the stock of social trust being an important part of the reason for the successful Scandinavian welfare-state (27). They end their piece with a warning: “If the Scandinavian high-trust societies should in the future turn into control societies, they will probably no longer be among the world’s leading countries in terms of socio-economic success” (12).