Why aren’t a ton of Swedes on their way to being dead?

by philg

Sweden is geographically close to and tightly connected via commerce and tourism with some of the world’s coronavirus hotspots, e.g., Italy, Spain, and Germany. Yet the government in Sweden hasn’t closed the schools or done much of anything else about coronavirus. Why don’t the WHO COVID-2019 situation reports show a dramatic upward trend for Sweden compared to its European neighbors?

“As the rest of Europe lives under lockdown, Sweden keeps calm and carries on” (Guardian):

While every other country in Europe has been ordered into ever more stringent coronavirus lockdown, Sweden has remained the exception. Schools, kindergartens, bars, restaurants, ski resorts, sports clubs, hairdressers: all remain open, weeks after everything closed down in next door Denmark and Norway.

Universities have been closed, and on Friday, the government tightened the ban on events to limit them to no more than 50 people. But if you develop symptoms, you can still go back to work or school just two days after you feel better. If a parent starts showing symptoms, they’re allowed to continue to send their children to school. [!]

Anders Tegnell, Sweden’s state epidemiologist, believes it is counterproductive to bring in the tightest restrictions at too early a stage. “As long as the Swedish epidemic development stays at this level,” he tells the Observer, “I don’t see any big reason to take measures that you can only keep up for a very limited amount of time.”

His team at the Public Health Agency of Sweden is critical of the Imperial College paper that warned this month that 250,000 people in the UK would die if the government failed to introduce more draconian measures. A week later Johnson ordered the police to implement a partial lockdown to combat the virus, telling people they “must stay at home”.

“We have had a fair amount of people looking at it and they are sceptical,” says Tegnell. “They think Imperial chose a number of variables that gave a prognosis that was quite pessimistic, and that you could just as easily have chosen other variables that gave you another outcome. It’s not a peer-reviewed paper. It might be right, but it might also be terribly wrong. In Sweden, we are a bit surprised that it’s had such an impact.”

Is it that the Swedes have so much hospital capacity they don’t care how quickly the patients come in? No need to flatten the curve (or remind everyone you know on Facebook to flatten the curve) if an infinite supply of universal health care is available. The World Bank says that Sweden has 2.6 hospital beds per 1,000 population, less than the U.S. (2.9), Italy (3.4), Germany (8.3), or Japan (13.4). Has Sweden been hoarding ventilators? Exactly the opposite: “Sweden’s Getinge to deliver 500 ventilators to Italy as demand rockets”.

If you believe that hot/humid weather helps keep the virus in check that can’t be a factor for Sweden (high of 39F tomorrow in Stockholm). Here they are wearing jackets in summer (from my Sweden photos):

Maybe they’ve just given up? From the above article:

Tegnell even questions whether stopping the progress of the virus is desirable. “We are just trying to slow it, because this disease will never go away. If you manage, like South Korea, to get rid of it, even they say that they count on it coming back. Stopping it might even be negative, because you would have a pent-up possible spread of the disease, and then once you open the gates, there is a possibility that there would be an even worse outcome.”

While Tegnell understands that he will be blamed if Sweden ends up in a similar situation to that of Italy, he refuses to be panicked. “I wouldn’t be too surprised if it ended up about the same way for all of us, irrespective of what we’re doing,” he says. “I’m not so sure that what we’re doing is affecting the spread very much. But we will see.”

Why haven’t we seen the effects already? If a shutdown works, Sweden should have a higher infection rate per capita than Denmark, right, since Denmark is shut down. But WHO reports show Sweden with a lower infection rate (Sweden has twice the population of Denmark).

Why don’t we read about overwhelmed hospitals in Sweden? With exponential growth, we’ve had enough time to see a difference between Germany and Denmark (schools shut afternoon of March 13) and Sweden, no?

(Maybe two weeks isn’t enough if Denmark and Sweden are like Massachusetts and don’t test people until they’ve been admitted to the hospital and are at death’s door. And then the tests don’t get reported out to the public until after they’ve come back from the lab (can take 2-4 additional days). So Sweden could have been experiencing far more infections during the last two weeks, but it wouldn’t show up in the data just yet. Though you’d think we’d see hysterical articles about the hospitals filling up, as we have been getting out of New York.)

Related:

  • From 2018: “Denmark plans to house the country’s most unwelcome foreigners in a most unwelcoming place: a tiny, hard-to-reach island that now holds the laboratories, stables and crematory of a center for researching contagious animal diseases. As if to make the message clearer, one of the two ferries that serve the island is called the Virus.” (nytimes)
  • family law in Sweden (a divorce following a coronavirus quarantine is unlikely to be profitable; alimony is unavailable and child support revenue is capped at about $2,500 per year)
  • getting to the same place, but perhaps from a less-obviously-informed-by-epidemiology perspective, “Brazil’s Bolsonaro makes life-or-death coronavirus gamble” (Associated Press): “Brazilian President Jair Bolsonaro has staked out the most deliberately dismissive position of any major world leader, calling the pandemic a momentary, minor problem and saying strong measures to contain it are unnecessary. “The Brazilian needs to be studied. He doesn’t catch anything. You see a guy jumping into sewage, diving in, right? Nothing happens to him. I think a lot of people were already infected in Brazil, weeks or months ago, and they already have the antibodies that help it not proliferate,” Bolsonaro said.
  • my photos from Sweden (back in the film days)

24 thoughts on “Why aren’t a ton of Swedes on their way to being dead?”

  1. Hi Philip,

    There is a debate among the experts about whether the best long-term strategy is to allow natural herd immunity to evolve (and only isolate the most vulnerable).

    Here is the Atlantic’s take on the various timelines to recovery which factors in herd immunity:

    When Will Coronavirus Social Distancing Be Over?
    https://www.theatlantic.com/family/archive/2020/03/coronavirus-social-distancing-over-back-to-normal/608752/

    The Dutch, Israeli, and British governments are suggesting herd immunity is the better option:

    Coronavirus: Dutch adopt controversial ‘herd immunity’ strategy
    https://www.irishtimes.com/news/world/europe/coronavirus-dutch-adopt-controversial-herd-immunity-strategy-1.4204578

    Israeli Defense Minister: Herd Immunity Could End Coronavirus Pandemic But Must Isolate ‘Elderly Population’
    https://dailycaller.com/2020/03/22/israeli-defense-minister-naftali-bennett-coronavirus-herd-immunity/

    Herd immunity: will the UK’s coronavirus strategy work?
    https://www.theguardian.com/world/2020/mar/13/herd-immunity-will-the-uks-coronavirus-strategy-work

    The whole fiasco is a fascinating social commentary on our times. It seems to me these governments and articles imply that “It’s just the flu, bro,” while this MIT article states waiting for herd immunity would be “devastating,” and “the worst-case scenario.”:

    What is herd immunity and can it stop the coronavirus? – MIT Technology Review
    https://www.technologyreview.com/s/615375/what-is-herd-immunity-and-can-it-stop-the-coronavirus/

    As always, we need more useful data. Recently, the Imperial College projected fatality numbers have been revised sharply downwards (many references but for example):

    https://www.powerlineblog.com/archives/2020/03/forecast-of-british-coronavirus-deaths-revised-um-downward.php

    https://www.dailywire.com/news/epidemiologist-behind-highly-cited-coronavirus-model-admits-he-was-wrong-drastically-revises-model

    • An anonymous critical care doctor from the UK comments on the failure of the UK’s initial herd-immunity strategy, in a Reddit AMA.

      Over the past decade, eminent figures in public health developed complex models that would help inform the UK response to a pandemic. The response plan would allow slow spread through a population and a number of deaths that would be deemed acceptable in relation to low economic impact. Timing of population measures such as social distancing would be taken, not early, but at a times deemed to have maximal psychological impact. Measures would be taken that could protect the most vulnerable, and most of the people who got the virus would hopefully survive. Herd immunity would beneficially emerge at the end of this, and restrictions could relax. This was a ground-breaking approach compared to suppressing epidemics. It was an approach that could revolutionise the way we handled epidemics. Complex modelling is a new science, and this was cutting edge.

      But a model is only ever as good as the assumptions you build it upon. The UK plan was based on models with an assumption that any new pandemic would be like an old one, like flu. And it also carried a huge flaw – there was no accounting for the highly significant variables of ventilators and critical care beds that are key to maintaining higher survival numbers.

      So, come 2020 and COVID-19 causes disaster in China, Iran and Italy. Epidemiologists and doctors from around the world observe, and learn valuable lessons:

      1. the virus is insidious with a long incubation, any population actions you take will only have an effect weeks later

      2. the virus spreads remarkably quickly and effectively

      3. the virus causes an unusually large proportion of patients to require invasive ventilatory support

      4. early large scale testing, and social distancing measures, are effective at stopping exponential growth

      5. stopping exponential growth is VITAL to preventing your critical care systems from being overwhelmed.

      Note that the Imperial College team’s latest projection of UK fatalities is much lower because of the UK lockdown – they haven’t changed their lethality estimate. Comment from Neil Ferguson, included in the Daily Wire article:

      I think it would be helpful if I cleared up some confusion that has emerged in recent days. Some have interpreted my evidence to a UK parliamentary committee as indicating we have substantially revised our assessments of the potential mortality impact of COVID-19. This is not the case. Indeed, if anything, our latest estimates suggest that the virus is slightly more transmissible than we previously thought. Our lethality estimates remain unchanged. My evidence to Parliament referred to the deaths we assess might occur in the UK in the presence of the very intensive social distancing and other public health interventions now in place. Without those controls, our assessment remains that the UK would see the scale of deaths reported in our study (namely, up to approximately 500 thousand).

      Also see FT Alphaville: https://ftalphaville.ft.com/2020/03/26/1585245384000/Let-s-flatten-the-coronavirus-confusion-curve/

    • Russil: The pretend lockdown in the UK started just a few days before this Ferguson guy changed his tune (and revised his guess regarding R0 hugely upward, implicitly agreeing with the Oxford team that much if not most of the UK population was already infected prior to the pretend lockdown).

      Why is the “lockdown” not real? As I noted in a comment on an earlier post, https://www.theguardian.com/world/2020/mar/25/uk-coronavirus-lockdown-rules-what-you-can-and-cannot-do says people can rent a car, go to the park, meet a new friend, go to the friend’s house, have sex, pick up some dry cleaning, buy some supplies for a home repair at a hardware store, pick up some booze at the liquor store, go to the laundromat (which they can’t even spell right!), meet another new friend, go to that person’s house, have sex, and finally return the rental car to be vacuumed out by someone not wearing a mask.

      Since Sweden did not bother with this pretense, it will be interesting to see if the trajectory is dramatically different from the UK.

    • Diversity will be Sweden’s strength! (And why would anyone not born in Sweden want to learn the Swedish language? Immigrants don’t come to Sweden because they have fallen in love with the language and culture, do they? How many people in Somalia read Selma Lagerlöf, Nobel-winning novelist of 1914, and said “I so want to be part of that”? Or the poems of Tomas Tranströmer (while looking in the library for books about “transformers”?), winner of the Nobel in 2011, and said “I need to learn Swedish so that I can read them in the original”?)

  3. Finland, Sweden and Norway don’t need social distancing laws, they’ve been doing it for centuries. If someone builds a house within sight of yours, they’re too close. Also, hygene…

    • Also law-abiding. And socially conscious. And not three generations living in the same household.

  4. Herring, Aquavit, and I Am Curious, Yellow.

    People find a way to live when there is something worth living for.

  5. European monitoring of excess mortality will be interesting to follow in the next few weeks. So far it shows death rates among all age groups have been falling. The effect of the virus “may not be detectable at the national level, even more so not in the pooled analysis at European level”.

    • Lord P: Thanks for that link. I wonder if I am reading the graphs correctly. Does it show that there are large spikes in mortality, especially among those 65+, in January/February of 2017 and 2018? https://www.ecdc.europa.eu/en/publications-data/summary-influenza-2016-2017-season-europe talks about “an estimated 217 000 excess deaths” from flu. Could that account for the spike? And, given that population sizes are comparable, how do we explain that the CDC estimates only about 20% as many deaths in the U.S. from flu each year. https://www.cdc.gov/flu/about/burden/index.html (“between 12,000 – 61,000 deaths annually since 2010”)? Is there a different standard for measurement? Do the European universal health care systems let older people die in order to save money?

    • > Does it show that there are large spikes in mortality, especially among those 65+, in January/February of 2017 and 2018?

      That’s my reading too, so maybe we’re both astray. Flu does look highly plausible as the cause of the bumps in the Euro MOMO graph. Your ECDC link corresponds to the first Euro MOMO peak in ’16-17 and this looks to be about the later “twin peaks” in ’17-18.

      Those two peak periods follow after 7 to 10 weeks of rising death rates in the MOMO graph. Yet the current Coronaplague which threatens the whole of humanity is accompanied, so far, by generally falling death rates in Europe. How is that to be explained?

    • ‘Furthermore, there is always a few weeks of delay in death registration and reporting. Hence, the EuroMOMO mortality figures for the most recent weeks must be interpreted with some caution’

      https://www.euromomo.eu/index.html

      The current numbers for Italy still show a big rise in deaths this year.

      These data series give the necessary big picture, even with delays of reporting. This is also aggregated data with the raw data not publicly available for further analysis.

      Despite the understandable limitations, it is a good source of information. Is there anything similar for the US? Looking at the CDC Flu page is disheartening — the confidence interval is so broad and still open to revision for two years. Lots of extrapolating and you hope their methods of massaging the numbers are accurate.

      In 2022 we will be able to speak somewhat intelligently about the Covad-19 epidemic.

      The Chinese are far ahead of us in statistics — The final figures for all of 2020 were compiled last December and will not need any decadent western-style revision.

  6. Belarus is also relaxed about Coronaplague. So in “Europe’s last dictatorship” people are currently freer in their day to day lives than hundreds of millions of citizens in western Europe and the Americas.

  9. Well this is sort of BS. The Swedes are self quarantining themselves and distancing as well. I bet they are also doing a lot cleaning. The Swedish leader suggested a voluntary stay at home plan and the educated population listened and did the right thing. I would like to see what the school seating charts look like right now… Or how the kids interact and are grouped during recess..

    • Kids are no longer licking each other’s faces during recess at the still-open schools? That’s a complete shutdown of everything that is essential to Swedish life!

  10. My daughter was in Sweden on an exchange program, we decided to get her home around Mar 14 when Denmark closed their border. She and many of her friends at the university got sick last month with some respiratory illness that was going around, for all we know they may have already had covid19. She had a lingering cough for what seemed like a month or more. We can’t tell for sure because there’s no reliable antibody test we can get hold of yet.

    At this point it doesn’t seem like there’s any reliable data to go on to estimate the number of people who will need to be hospitalized. Prepare for the worst, hope for the best.

  11. In my kommun, people have opted for a “self-imposed” lockdown/quarantine. Yes, my daughter’s dagis is open, but there are only 2 children, not the normal 30 children. Yes, my son’s middle school is open, but half of the teachers are out sick and 1/3 of the students are out sick. My wife and her friends normally hold a gathering every month – they have not held their normal gathering now for 3 months. Yes, people go out and walk their dog, but the supermarkets are almost empty during the day. Most activity has ground to a halt.

    • Thanks for the report from the ground, Scott, and best of luck over there. I think your report does confirm the Swedish government’s position that they don’t have to tell people to curtail their mixing. People will do this on their own.

  12. I did a back-of-the-envelope calculation yesterday using Sunday morning’s numbers. The NY metro area per-capita confirmed cases numbers are about 10x the rate for the SF Bay Area.

    I’d speculate this is due to the Bay Area counties shutting down sooner, and cars vs. trains/subways, but fully admit I have no science background on this.

    • TW: The curves are suggestive. Thanks for this. On the other hand, it shows that 2X as many people have died in Sweden as in Denmark, corresponding to the 2X ratio in population between the countries.

      The April 1 WHO report gives the numbers as 180 for Sweden and 90 for Denmark (cumulative total of deaths) and 34 versus 13 for the most recent 24-hour period.

      The numbers are so small it is tough to say that there couldn’t be some differences in how deaths are attributed and also as to how care is rationed. All of the European countries, I think, ration care such that some people, especially those who are old and in poor health, who would be kept alive on a machine in the U.S. (and Medicare billed) would be written off in the UK or Europe. The policies are different from country to country, though.

      Since deaths lag infections, it sure looks as though the number of infections in Denmark may be heading down. On the other hand, the “lockdown” they put in place is theoretically not all that different from what New York applied. They closed schools and restaurants and banned gatherings of more than 10 people (as of March 16 it was a limit of 100, but it was later tightened to 10). So the flat/down trend can’t be explained purely as a matter of policy. New York is still showing a curve that is either exponential growth trending toward “everyone dies” or the first third of a Farr’s law bell curve, right? (see https://www.ft.com/coronavirus-latest and scroll down )

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