no civil preparedness storages for medical equipment left in sweden. the national board of health and welfare did however keep an emergency storage of reserve ventilators. until 2009, the swedish state-run pharmacy chain apoteket had the responsibility to ensure drug supply in case of emergency. following a controversial privatisation, the responsibility was handed over to the private sector. however, a lack of regulations meant that the companies had no incentive to keep a bigger stock than necessary, effectively leaving sweden without an entity responsible for medicine preparedness. at the start of the pandemic, the swedish healthcare system were instead relying on a "just-in-time" deliveries of medication and medical equipment, and sweden had no medicine manufacturing of its own, which was considered to make the country's drug supply vulnerable as it relied on global trade and long supply lines. the swedish healthcare system was already experiencing a growing number of backordered drugs in the years leading up to the pandemic. the lack of medicine preparedness had been strongly criticised in several inquiries and reports since 2013 by a number of swedish governmental agencies, including the swedish national audit office, the swedish defence research agency and the swedish civil contingencies agency. the latter had regarded disturbances in the drug supply as one of their biggest concerns in their annual risk assessments. strategy infographic representing the epidemiological concept of flattening the curve.according to the swedish public health agency, the swedish strategy aimed to protect its senior and vulnerable citizens, and to slow down the spread of the virus, to keep the healthcare system from getting overwhelmed. they are also mandated by law to make their response based on scientific evidence. the swedish state epidemiologist anders tegnell has questioned the scientific basis of some of the "stricter" measures taken by other governments, including lockdowns and border closures. "closedown, lockdown, closing borders – nothing has a historical scientific basis, in my view. we have looked at a number of european union countries to see whether they have published any analysis of the effects of these measures before they were started and we saw almost none." -anders tegnell, current state epidemiologist of sweden, in a nature interview, april 2020 while many countries imposed nationwide lockdowns and curfews, such measures were prohibited by the swedish constitution as they are considered to be a violation of freedom of movement, and the swedish laws on communicable diseases (smittskyddslagen) only allows for quarantining individuals and small areas such as buildings, not for entire geographical areas. instead, it's mostly based around the individual responsibility. although the government were later granted more authority for imposing restrictions on transport following a temporary amendment in april, the swedish authorities considered lockdowns to be unnecessary, as they believed that voluntary measures could be just as effective as bans. although many considered this to be a 'relaxed' approach, it was defended by the authorities as well as government officials, among them prime minister stefan löfven, to be more sustainable, as unlike lockdowns, it could be in place for "months, even years" as it wasn't assumed to be likely that the disease could be stopped until a vaccine was produced. therefore, the swedish response only included measures where an exit strategy wasn't needed. unlike many european countries, including neighbouring denmark and norway, sweden did not close its preschools or elementary schools as a preventive measure. this was met with criticism within sweden. according to the health agency, the main reasons for not closing schools was that as a preventive measure it lacked support by research or scientific literature, and because of its negative effects on society. they argued that many parents, including healthcare professionals, would have no choice but to stay home from work to care for their children if schools were closed. there was also concern for a situation where elderly people babysit their grandchildren, as they are of bigger risk of severe symptoms in case of infection. according to the agency's estimations, closures of elementary schools and preschool could result in an absence of up to 43,000 healthcare professionals, including doctors, nurses and nurse's assistants, equalling 10 per cent of the total workforce in the sector. additionally, there was concern of school closures having negative consequences for disadvantaged and vulnerable children, and according to the agency yet no evidence of children playing a major role in the spread of the virus, nor of a high infection rate among children or preschool teachers, and that children who become infected showed mild symptoms. in may, tegnell said that the decision was right, as the healthcare system would not have managed the situation the past months if swedish authorities had chosen to close elementary schools. he later said that the decision to close secondary schools might have been unnecessary, because it possibly had little effect in slowing the spread of the disease. after the danish government went against the advice of the danish health authority and closed their national borders in march, tegnell remarked that there were currently no scientific studies supporting border closures to be an effective measure against a pandemic, and that "history has proven it to be completely meaningless measure", and argued that it could, at best, delay the outbreak for one week, and also pointed out that border closures went against the recommendations from the who. he later said closures would be "ridiculous" in a situation where the disease had spread across all of europe, saying that movements within the country were of more concern. state epidemiologist anders tegnell, the architect of the swedish strategyrepresentatives of the swedish government, as well as its agencies, have repeatedly denied that pursuing herd immunity is part of the swedish strategy, as suggested by foreign press and scientists in and outside sweden. according to state epidemiologist anders tegnell, herd immunity had not been calculated in the strategy, and if it had been the goal, "we would have done nothing and let coronavirus run rampant". but he believed, in april 2020, that sweden would benefit from herd immunity in the long run, and reasoned that all countries would eventually have to achieve it to beat the virus. in may 2020 he said that he believed it was unlikely that sweden, or any other country, would ever reach full herd immunity, and also that it would be a mistake to base a strategy on a hypothetical vaccine, as it would likely be years until there is a vaccine that can be distributed to an entire population. instead, he believed covid-19 was something "we’re going to have to live with for a very long time". however, in august 2020, email exchanges obtained by swedish journalists under sweden’s freedom of information laws found that tegnell had discussed a herd immunity strategy in mid-march 2020. as the strategy was built by the health experts at the public health agency without any influence from the government, it was built solely on a public health perspective, without any political considerations to the economy. the agency did however regard the economy as part of its broader public health considerations, due to unemployment and a weakening economy typically leading to a poorer public health. although sweden was regarded to have succeeded with making sure the hospitals would keep at pace, it admitted to have failed with protecting its elderly, as 47% of its deaths had occurred among nursing home residents or those receiving home care. the health agency saw the spread at the homes as their biggest concern, but "not as a failure of our overall strategy, but as a failure of our way to protect the elderly". in an interview with sveriges radio in early june, tegnell was asked if he would have done things differently if he could ‘back the tape’, to which he replied that sweden should have done more earlier during the outbreak. this received extensive coverage in national as well as international media and was interpreted as he was distancing himself from the swedish strategy. tegnell however denied this being the case, and said they still believed the strategy being good, but that "you can always improve things, especially in hindsight". when asked to give examples, he said that it would have been much better if they had been more prepared at nursing homes, and that it would have been better if the testing capacity had been increased earlier on during the outbreak. he also said that the closure of secondary schools might have been unnecessary. measures on 10 march 2020, responding to indications of community transmission, the public health agency advised everyone with respiratory infections, even mild cases, to refrain from social contacts where there is a risk of spreading the virus, in private as well as working life. they also ask health care staff working with risk groups, including nursing homes, not work if they have any symptoms of respiratory infection. relatives of elderly were advised to avoid unnecessary visits at hospitals and in facilities for elderly, and never visit if there are any respiratory symptoms. face masks were initially not recommended or were actively discouraged by authorities for the general public and in healthcare settings. on june 25, 2020, masks were recommended in care home and healthcare settings only in cases of treating covid-19 patients. in december 2020, it was announced that masks would be recommended on stockholm public transport from january 2021, the first time authorities had advised the public to wear them. some healthcare institutions, care homes and schools implemented rules outside of government guidance. as covid-19 progressed so did the measures taken. on 10 january 2021 an act was passed that provided the government the right to place rules on curbing public and private gatherings, and limit international and domestic travel. the law was a temporary pandemic law and allowed for sweden to place time limits on when businesses can open and close. on 30 june 2021 a travel ban was introduced on anyone from the united states or eea. exceptions were on travellers from denmark, finland, iceland and norway. the ban was set to be lifted on 31 october 2021. regulations were then created to take place on 1 july 2021. numbers of people who could be in one place such as a restaurant, or store was limited, as well as social gatherings being limited to no more than 8 people. remote work was recommended if possible, and on 17 march school was made fully online. furthermore, recommendation to be tested after staying abroad was added and will be extended. starting from 29 september 2021 more pandemic-related restrictions were lifted. advice was reintroduced on 8 december 2021 to work from home, wear face masks on public transport and free covid-19 testing was reintroduced in response to the omicron variant. social distancing on 16 march 2020, the agency recommended that people over 70 should limit close contact with other people, and avoid crowded areas such as stores, public transport and public spaces. at the end of march, 93% of those older than 70 said that they were following the recommendations from the health service to some extent, with the majority having decreased their contacts with friends and family. in may, the agency looked at easing the recommendations for the 'young elderly' of good health, but ultimately decided against it. they did however encourage those over 70 not to isolate completely in their homes, but to go outside for walks while still following the recommendations. on 16 march 2020, they also recommended that employers should require remote work. one month later, statistics showed that roughly half the swedish workforce was remote working. the following day, the agency recommended that secondary schools and universities use distance learning, with schools following suit all over the country. the decision to recommend distance education for secondary and tertiary education, but not for elementary schools, was that studies at secondary schools and universities to a higher extent require commuting and travelling, and that students would not depend on parental care while not in schools, and school closings therefore did not risk interrupting society. in may, it was announced that the health agency were to lift the recommendations on 15 june, and thereby allowing secondary schools and universities to open up as normal after the summer holidays. in april, many of the organisations running the public transport systems for the swedish