Among the nearly 6,000 people whose deaths have been linked to the coronavirus in Sweden, 2,694, or more than 45 percent, were living in nursing homes.

In the United States, 40 percent of total coronavirus deaths have been linked to nursing homes, according to a New York Times database. In Britain, Covid-19 has been directly blamed in more than 15,000 nursing home deaths, according to government data.

But those are countries characterized by extreme levels of economic inequality.

Sweden, which has some of the highest taxes in the world, is supposed to be immune to such dangers. Yet the country of only 10 million people has been ravaged by the virus, with per capita death rates nearly as high as those of the United States, Britain and Spain, according to World Health Organization data.

Sweden’s government avoided imposing the kind of lockdowns that occurred elsewhere in Europe, but the tragedy of the nursing homes is in part a story of how Sweden has, over decades, downgraded its famously generous social safety net.

Since a financial crisis in the early 1990s, Sweden has slashed taxes and diminished government services. It has handed responsibility for the care of older people — mostly living at home — to strapped municipal governments, while opening up nursing homes to for-profit businesses. They have delivered cost savings by relying on part-time and temporary workers, who typically lack formal training in medicine and elder care.

Also, Sweden has substantially reduced its hospital capacity over the last two decades. During the worst of the initial outbreak, older people in nursing homes were denied access to hospitals for fear of overwhelming the facilities.

When nursing home residents displayed Covid symptoms, guidelines in Stockholm in the initial phase of the pandemic encouraged doctors to prescribe palliative care — forgoing efforts to save lives in favor of keeping people comfortable in their final days — without examining patients or conducting even blood or urine tests, said Dr. Yngve Gustafson, a professor of geriatrics at Umea University. He said that practice amounted to active euthanasia, which is illegal in Sweden.

NYTIMES

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