This week there were several COVID media narratives. One took aim at Sweden for bucking the shutdown trend. Some of these stories were based all or in part on a new study out of the University of Virginia. So let’s dive into that new research and see what it found. We’ll also examine what’s been happening with Corona rebel Sweden. Let’s dig in.
Sweden and Corona 101
When the rest of the world was shutting down in March, Sweden took a different tack. They kept schools, bars, restaurants, and businesses largely open and asked their population to self-isolate. This really pissed off many in the media so the narrative became that Sweden was on a course to kill a good chunk of its citizens. That’s back when the media was reporting a crude fatality rate of 3-4% for COVID-19. That fatality rate, of course, turned out to be fiction, as the COVID-19 infection fatality rate has since been revised to a high of 1 in 200 to a low of 1 in 2,000 (0.5%-0.05%).
Sweden’s Curious Steep Drop in Daily Deaths
Given that Sweden is an irresponsible and awful country for not toeing the COVID party line, we would expect that the pandemic would be raging out of control there right now. That packed ICU wards would result in ever-increasing deaths and general daily armageddon. However, what’s really happening?
One of these countries above is Sweden and one is the UK (which I chose randomly) (3). The UK aggressively shut down, but Sweden didn’t. The drop in deaths per day as the spring became the summer looks pretty similar. (Tip: on the left is Sweden and on the right is the UK).
The New Research on Sweden
Researchers from the University of Virginia looked at the data out of Sweden through May 15th (1). First, let’s start with their conclusion:
“The Swedish COVID-19 strategy has thus far yielded a striking result: mild mandates overlaid with voluntary measures can achieve results highly similar to late-onset stringent mandates. However, this policy causes more healthcare demand and mortality than early stringent control and depends on continued public will.”
Huh? That’s far from a NY Times headline this week: “Sweden Has Become the World’s Cautionary Tale” (4). So let’s dig deeper.
What Else Did the Researchers Find?
Sweden’s ICU capacity was expected to be overloaded but wasn’t. The researchers thought that this could have been due to lower than expected death rates and the concept that Sweden prioritized ICU beds for the young and sick, and didn’t focus on providing ICU care for the infirmed and elderly, who were already institutionalized in nursing homes.
As I have written before, there is little doubt that Sweden had more death per capita than it’s regional neighbors. However, that’s because they exposed more people with the idea of building herd immunity. In the meantime, it’s death rate has been lower than other countries who decided to lock down like Great Britain (3).
Sweden is also unique in that 7 out of 10 deaths have been in the elderly over 70 years of age (6). In fact, 54% have been in people over age 80. Those numbers skew more heavily towards the elderly than most other countries.
The Financial Narrative
The 2nd quarter GDP data isn’t out yet and we won’t get our first glimpse of that number for about a month. However, the Organisation for Economic Co-operation and Development (OECD) makes predictions (2). Let’s dive in.
The second narrative of the week is focused on Sweden’s economic results which the NYT piece claimed were as bad as everyone else’s. I already reviewed that they beat the pants off the US in the first quarter. If we look at the OECD website, how well is Sweeden predicted to do in the 2nd quarter versus other EU countries?
Sweden (the yellow dot) is expected to do much better than the average of 17 Eurozone countries (blue line pointing to the red diamond to the left) and similar to its region (same as Denmark, better than Finland). That makes sense, as you can’t remove a small country of 10 million people from the regional economy in Scandanavia and the EU.
For example, 69% of the major EU countries that imported goods into Sweden were shut down in the second quarter (7). See the graph below for those countries (yellow squares) and their percentages of Sweden’s imports:
Hence, you don’t need to be a Nobel winning economist to understand why Sweden, the lone man out among EU countries, would be economically hamstrung by both a lack of imports and exports.
The REAL Story
The most interesting story here is why did Sweden do so well? The new research paper above used the term “striking”. Why? There should have been way more deaths and an out of control pandemic. Those deaths should be blowing through the roof right now, far outpacing, on a per capita basis, the countries that locked down. However, as you can see above, Sweden’s deaths per day metric is falling off a cliff just like the countries that locked down.
From a public health standpoint, the obvious question that needs to be asked is whether Sweden’s relative success calls into question the efficacy of lockdowns. The scientists in the paper are hinting at that conclusion, but it’s so against the grain that the question rarely gets asked. In fact, just asking it can paint a big target on your back.
Fattening the Curve and Deaths Caused by Shutdowns
Remember, when this Pandemic hit us in March, we were all told that the purpose of a shutdown was to “flatten the curve”. That meant that the same number of people would die, but that we would avoid health system overload by pushing those cases down the road. That was the prevailing media narrative the the spring.
Now the media has changed the narrative to shaming anyone who doesn’t agree that shuttering the economy longterm to preserve lives is the best plan. Of course, there is no mention of the 150K people that the American Academy of Family Physicians estimates will die due to deaths of despair because of more shutdowns (5). There is also no mention of the hundreds of thousands more who will likely die due to missed or late diagnoses of treatable medical problems. Why? That doesn’t agree with the narrative.
The upshot? So is Sweden an awful country that doesn’t care about its citizens or is it the most interesting data point to date in the pandemic? Public health officials need to pay attention to what happened in Sweden, not as a cautionary tale, but as a result that doesn’t agree with the idea that our large country shutdowns saved lives.
(1) Shina C L Kamerlin et al, Managing COVID-19 spread with voluntary public-health measures: Sweden as a case study for pandemic control, Clinical Infectious Diseases (2020). DOI: 10.1093/cid/ciaa864
(2) OECD Nominal GDP Forecast. https://data.oecd.org/gdp/nominal-gdp-forecast.htm#indicator-chart Accessed 7/8/20.
(3) Coronavirus Worldmeter. https://www.worldometers.info/coronavirus/ Accessed 7/8/20.
(4) New York Times. Sweden has become the World’s Cautionary Tale. https://www.nytimes.com/2020/07/07/business/sweden-economy-coronavirus.html Accessed 7/8/20
(5) The Well Being Trust and the Robert Grahm Center (American Academy of Family Physicians). PROJECTED
DEATHS OF DESPAIR from COVID-19. https://wellbeingtrust.org/wp-content/uploads/2020/05/WBT_Deaths-of-Despair_COVID-19-FINAL-FINAL.pdf Accessed 5/8/20.
(6) Statistica. Number of coronavirus (COVID-19) deaths in Sweden in 2020, by age groups(as of July 8, 2020). Accessed 7/8/20.
(7) Trading Economics. Sweden Imports By Country. https://tradingeconomics.com/sweden/imports-by-country. Accessed 7/8/20.