Wednesday 30 September 2020

The thing about Sweden and coronavirus

If you speak of the Swedish approach to COVID-19 without disparagement, a horde of mid-wits will descend on you to explain that, actually, Sweden has had a large number of Covid-related deaths compared to its immediate neighbours.

And so, if you show mortality figures like this...

 Someone will respond with this...

Note that the way the data is displayed in the second graph disguises the fact that, at the time of writing, the death rate is slightly lower in Sweden than in its neighbours and the rate is falling in Sweden but rising in its neighbours. That is not a trivial point, but it is not the point of this blog post.

The point is that you don't need to compare Sweden to any country to make the crucial observation about lockdown. Lockdowns were introduced because it was believed that they were the only way to prevent cases spiralling out of control, leading to most of the population being infected, health services being overwhelmed and 0.5% to 1% of the population dying of the disease. 

This was not an unreasonable prediction. The coronavirus is highly infectious and is several times more lethal than flu. Case numbers were growing exponentially in March, as were deaths.

When academics adapted Neil Ferguson's model to Sweden, it predicted 96,000 deaths by the end of June. Ferguson himself said on 25 April that “I think we’re going to see their daily deaths increase day by day. It is clearly a decision for the Swedish government whether they wish to tolerate that.”

In fact, the daily number of deaths peaked on 17 April, barely a week after they peaked in Britain, and the cumulative total currently stands at less than 6,000. When a prediction is so far off, it should command attention, particularly when similar predictions have led to cataclysmic policy decisions elsewhere. Let's remember how the Swedish approach was reported at the time...

The Guardian (March 30):
'They are leading us to catastrophe': Sweden's coronavirus stoicism begins to jar 

The Sun (April 1):

Sweden’s refusal to enter coronavirus lockdown leaving schools and pubs open ‘will lead to catastrophe’, doctors warn

Time (April 9):

Sweden's Relaxed Approach to the Coronavirus Could Already Be Backfiring

Various post hoc justifications have been put forward for why things didn't turn out as expected. Since none of them were mentioned by the doomsters back in March, you have to wonder whether this eagerness to show that there is something special and unique about Sweden reflects a yearning for the truth or a pathological desire to promote lockdown at all costs. (The other counterfactual, Belarus, is very unlike Sweden but is largely ignored.)
The most stupid of the excuses is Sweden's low population density of 59 people per square mile. Forgive me for insulting your intelligence but it seems some people need to hear this: Swedish people are not evenly spread out across the country. Scotland has a low population density of 65 people per square mile because most of the country is wilderness. It has not stopped Glasgow becoming a COVID-19 hotspot. 

The country with the highest per capita death rate from Covid is Peru, which has a population density only slightly higher than Sweden (65 per square mile). Brazil and Chile have also had more deaths per capita than Sweden despite having low population densities of 65 and 60 people per square mile respectively. Like Sweden, these countries have vast areas in which nobody lives. There is no reason to think that this should help combat the coronavirus.

It is not as if everyone in Sweden lives in little villages either. 88 per cent of Swedes live in urban areas. This compares with 84 per cent in the UK, 78 per cent in Peru and 81 per cent in Spain. Sweden is one of the most urbanised countries in Europe.

The second post hoc explanation is that Swedes did lock down, but voluntarily. Unless you have a very loose definition of lockdown, this is simply untrue. This is a typical report from the Guardian in late March:
Outdoors, couples stroll arm in arm in the spring sunshine; Malmö’s cafe terraces do a brisk trade. On the beach and surrounding parkland at Sibbarp there were picnics and barbecues this weekend; the adjoining skate park and playground were rammed. No one was wearing a mask.

And here's Time magazine in April:

When Chloe Fu, 24, went for a run on Monday evening, the streets of Stockholm were filled with people drinking on restaurant patios, enjoying the first warm day of sunshine after a long winter.

“When you walk around, there is a total and utter absence of panic,” Fu says, who moved to Sweden from the United States last year. “The streets are just as busy as they would have been last spring.” 
.. A head doctor at a major hospital in Sweden says the current approach will “probably end in a historical massacre.”

This kind of stuff was filmed for TV news reports. There's no point denying it. Life was relatively normal in Sweden compared to the countries that locked down. That's not to say that people didn't make changes. There was plenty of social distancing and working from home. Gatherings of more than 50 people were banned and children aged 16 to 18 no longer went to school. The crucial point is that this was sufficient to prevent exponential growth of transmission. It did not require a lockdown.

But! - the lockdown aficionados protest - Sweden still had many more deaths than its Nordic neighbours. This is true. Sweden typically has 90,000 deaths a year. It looks like it will have at least 6,000 deaths from COVID-19 this year. Some of those who died would have died this year anyway, but some would not. 

The first thing to say is that this a marathon, not a sprint. The Swedes always accepted that they would see a higher rate of mortality in the spring and summer than countries which locked down early. The argument against lockdown was that every country would see a similar number of deaths in the longterm and that it wasn't worth disrupting people's lives and livelihoods in an extreme way by quarantining the entire population. 

Perhaps the northern hemisphere will keep the virus under control this winter and not enact extreme measures again, but it's still only September and it's not looking good.

The second thing to say is that I have never heard a compelling reason why Sweden can only be compared to other Scandinavian countries. What is it about the Nordics that gives them special protection from COVID-19? Salty fish? Elks? 

But the main thing to say is that there is a world of difference between locking down because it's the only way to prevent the digging of mass graves and the collapse of your health service and locking down because it might prevent your annual mortality figures being 5-10 per cent higher than average. Given the immense cost of lockdown and the knowledge that it only delays the problem, the latter is a much harder sell.

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