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Second Look at Sweden’s Response to COVID-19
It’s not too late to learn from Sweden‘s management of the COVID-19 pandemic. As the first phase winds down and the results can be tallied, it is clear that Sweden is in an enviable position both economically and medically.
Rather than relying on speculative models to justify draconian policies, Sweden’s public health officials noted the lack of evidence that social isolation mandates could reduce COVID-19 deaths over the full course of the virus. Plainly put, you can change the timing of the damage but you can’t make the virus go away.
So Sweden pursued a policy of targeted precautions rather than the shotgun approach adopted in the US. Only the most vulnerable were isolated. There was no lockdown. Businesses stayed open. Students attended school. Patients continued to receive non-COVID medical care.
So what happened? Swedish hospitals never suffered the crush of ICU patients predicted by our experts if we were to adopt such “reckless“ policies as they did. It turns out that shutting down the economy and practically imprisoning the young and healthy weren’t necessary to flatten the curve.
Sweden recently reported 265 deaths per million population, less than many of its locked down European neighbors, but slightly more than the 204 reported at that time in the US, (where multiple reports of overcounting are emerging).
Sweden has a more elderly population than the US and didn’t initially do a good job of protecting nursing homes. As a result, 90% of Sweden’s deaths were over 70 years old, half were over 86, just one percent were under 50. Age adjusted, Sweden‘s case rates and death rates are comparable to ours, maybe better.
That’s where the similarities end. Sweden, because they didn’t isolate their non-vulnerable population, is positioned to achieve herd immunity possibly as early as this month. We are facing a probable “second wave“ sweeping through our non-immune, formerly quarantined population as we return to normalcy.
Unlike pretty much everywhere else, Sweden isn’t facing the tough choices of when and how to end social isolation. They don’t have to select who goes free and whose civil liberties to violate.
Moreover, Sweden’s economy suffered nothing like the crippling damage inflicted on ours. Their recovery will be much quicker and easier. There will be no deluge of the “deaths of despair” that accompany economic catastrophes. They won’t have to cope with a new mountain of government debt.
It’s easy to second-guess now, although many of Dr. Fauci‘s worst recommendations were first-guessed at the time. What’s done is done. But there’s no excuse for missing the boat again, now that the outcomes of the contrasting strategies can be seen.
Unfortunately, many experts are choosing to nitpick Sweden’s success, seeing it is an affront. So we still have governors like Cuomo and Newsom claiming that, based on Fauci’s advice, they can’t end the lockdown until it is “safe“ and we know there will be no increase in cases.
But we know now that’s not necessary or even possible. We were told we were at war with the virus and our main weapon, for now, was isolation. But viruses can’t be eliminated by permanently denying them hosts. At some point life has to go on.
Only immunity can provide protection. In the absence of a vaccine, that means herd immunity, accepting that the virus will run its course, while protecting those likely to perish from it.
Another lesson is that experts should be consulted but not in charge, Particularly when opining from models, rather than controlled experiments or experience, they’re often wrong. Moreover, they’re not qualified to determine whether following their advice is worth the economic and social costs. That’s a decision we all share.
Finally, we should have learned by now that government taking over our lives and throwing gobs of money at the problem doesn’t work. Rather than shutdowns and subsidies, we should have relied more on the personal decisions of informed citizens.
Because of our extreme risk aversion, we conducted a massive novel experiment, the first-ever attempt to defeat a viral epidemic by isolating millions of well people and shuttering business activity. We have squandered trillions. It’s time to move on.
Published in Economics, Healthcare
Great Report.
Amen.
Yes. Thanks.
Tom,
This has been my concern all along. Fauci and the whole gang have been stampeding us into a lockdown. The lockdown itself may be counterproductive as it delays Herd Immunity and makes a second wave more likely.
Regards,
Jim
That’s an assertion that needs a lot better support than it has.
We’ll know in a few months what the reality is.
What about mortality?
Statistica reports 3831 COVID-19 deaths in Sweden; for Sweden’s population of 10.2 million that gives a death rate of 376 per million, not the 265 you’re reporting; 3377 are in people 70 and over (the next reported cohort is 60-69.)
Again from Statista, about 20% of Sweden’s population is 65 and over. So about 2 million people. The 3377 reported deaths among Swedes 70 and over makes that a death rate of 1670 per million even excluding the 65-69 year olds.
It’s also not just that Sweden initially didn’t do a good job of protecting its nursing homes. Multiple caregiver reports allege that Swedish policy was to offer palliative care only in its nursing homes. It’s possible that this policy, in addition to saving money over providing medical treatment, didn’t affect the death rate in the relevant age cohorts.
About 20% of Swedes 45-84 have a BMI>30 and are classified as obese. In the US, it’s over 35%. Many of the comorbities associated with poor COVID-19 outcome are strongly associated with obesity. I’ll use obesity as a rough proxy for the health of the respective populations. If Sweden does have a healthier elderly population, its higher mortality than the US is noteworthy.
According to the CDC, 80% of US COVID-19 deaths are in people 65 and over, so that would make about 76,000 deaths in the US. The US Census estimates that 16% of the US population is in that age group, about 53 million people. 76,000/53 comes out to 1434 COVID-19 deaths in the US per million population. That’s assuming that the mortality reporting for COVID-19 is accurate.
I’ll concede that 1670 per million is, arguably, “about the same” as 1434 per million. I wouldn’t call it “better,” though. US and Swedish mortality for under 60 is about the same.
I suspect that what we will likely discover, and what Sweden’s numbers suggest, is that the 70-80% number often cited for herd immunity is nowhere close to accurate. But… We’ll see.
It depends on how contagious an infected person is herd immunity is, but herd immunity usually needs half or more of the population immune via recovery or vaccine. As you get closer to breaking the epidemic, the R0 drops. When it drops below 1, you’ve contained it. Alternatively, Sweden’s figures may also suggest that in a healthier population than the US (assuming “less obesity” is a decent proxy for “more healthy”) you have less mortality.
Sweden’s population density is pretty low, too. Even Stockholm’s.
Right. Assuming everyone is susceptible. There is reason to believe that not everyone is… Question is, how many?
Yeah, there’s scattered evidence that there are people already immune. For example the Aircraft Carrier Theodore Roosevelt had only about 25% of its crew infected with COVID-19. Does that mean the herd immunity need only be 1/4 of sixty percent? That would be fifteen percent.
A pretty good piece from Reason Magazine:
The story of Sweden is that there is almost never a clean “story” in pandemics with an easily-digestible take-home message.
They have definitely managed to avoid the explosive transmission that other countries experienced despite no official lockdowns. That in and of itself is very noteworthy, and disproves thousands of doomsayers predicting that Sweden’s hospitals would be hopelessly overrun.
But there’s still much more detail required.
For example, even though Sweden didn’t officially lockdown, the government recommended that their citizens greatly curtail their activities, and the citizens complied. Tourism and other travel dropped by around 90%. Mobility (measured by smartphones) dropped in Stockholm to almost the same degree as it did in many US states that had mandatory lockdowns.
So even if the government didn’t impose an official lockdown, the people voluntarily locked themselves down to a similar extent as in many US states with mandatory lockdowns. Does anyone seriously think that Americans would voluntarily restrict their movements that much because the government asked them nicely to do so?
Is Sweden now or did it ever advise or require masks in public spaces?
Just to throw in a few overlooked countries, South Korea, Japan, Indonesia, Taiwan, and Belarus did not lock down. Those first four countries have death rates per million 1/100th as much as the Western European countries, with Belarus about 1/25th as much. Japan has the eldest population in the World, and our Ricochet friend living in South Korea reports that South Koreans are unlike other Asians in that they jostle against one another in crowded public places and the men don’t wash their hands after using public restrooms. Go figure.
I hear that Germany, who has a notably lower death rate, did not have as strict a lockdown, as they let manufacturing businesses continue during the pandemic. Perhaps our expert @mendel can elucidate on more details.
I think there must be other overlooked factors that make the spread of the virus so wildly uneven throughout the World and within the borders of each country.
Of course we could always ask the Swedes themselves
It is important also to realize that Sweden is a tiny homogeneous country whose citizens can agree on something and follow it, so Sweden was capable of the lock down the US is attempting but they let citizens decide. The US is giant, our geography from tropic to ice and population the most diverse on earth. The center can’t know about 50 states and thousands of cities towns and villages. The idea that anything can be run centrally that pertains to all of the issues involved in a communicable disease (or anything more than foreign, defense and trade policy)is utter nonsense. Most of the states are too big and diverse to manage from the top down as well. The original design worked and is even more necessary now which this disease shows again.
What do you mean by original design?
I’m glad that someone is actually doing the research the CDC is supposed to be doing. Thank you, Tom.
No, but we might have done it out of self-interest.
Yes. Isn’t that what we keep hearing from the “let’s stay home for another six months” crowd. They say re-opening won’t matter because people will be afraid to go to restaurants or get their hair cut. Of course, the longer we wait the fewer business’ that will be able to open. This is America. We won’t know unless we allow people to abandon house arrest. My guess is that people will come out and maybe save some business’ and people at the same time.
I’ve been wondering about this too.
The Epoch Times is pushing the idea that the closer a country’s or locale’s ties to China, the more COVID-19 it had.
Iran has also signed onto the BRI.
The German experts attribute it to very early testing/tracing/isolation. Our “Anthony Fauci” has literally spent his entire career working on coronaviruses, so when the first reports of a coronavirus outbreak in Wuhan emerged, he started devising a PCR test and contacting all labs/hospitals around the country to get the test set up and be on the alert – all while authorities in neighboring countries were still staring at the images on TV thinking “hmm, that looks weird”.
While we won’t know all the reasons why some countries got hit harder than others for years, I think there’s some plausibility to the theory that early and aggressive testing and isolation helped. Several regions of Germany border directly with Alsace, France and Belgium, two of the hardest-hit areas in the world. There’s lots of commuting across those borders, and the countries on either side look almost identical, but the German side was nearly untouched while hospitals overflowed only miles away. That’s evidence that the public health strategy might have indeed made a big difference.
I think a key factor here is how quickly Germany responded. Interestingly, Anders Tegnell, the famous head epidmiologist in Sweden, has said in several interviews that the reason why Sweden has been so successful is that they intervened early – even if the interventions were lighter in other places. This does seem to be a common theme: it matters less how strictly you close down than how early you do it. Too bad many US states with very low case counts didn’t take that into consideration two months ago.
I think this will definitely turn out to be the case. There’s a lot of chatter going on right now between high-level epidemiologists about “heterogeneity”, i.e., the fact that most people don’t pass the virus onto anyone, or at most one person, whereas a small number of “superspreaders” account for a huge amount of overall transmission.
If that’s the case – and there’s lots of good evidence it is – it means we could probably keep transmission in check very easily by surgically prohibiting certain types of interactions or sequestering a small but dangerous fraction of the infected.
This last suggestion would require an ability to identify the superspreaders in advance. Is this plausible?
I’ve been skeptical of suggestions of successful contract tracing in Germany, because Germany’s case count is pretty high, though its death count is unusually low. Looking at Worldometer at the moment, and comparing test, case, and death counts:
This makes me hypothesize that Germany may have done a better job protecting its elderly population than the other countries, or perhaps that the elderly population in Germany was more isolated before the lockdowns, or a combination of these factors.
If Germany had a highly successful tracing and isolation program, I would have expected it to have a lower case count.
Funny how different people interpret the same numbers in different ways:
https://www.nationalreview.com/2020/05/how-does-the-swedish-model-look-right-now/#slide-1
For what it’s worth, though, John McCormack has been banging the same drum for quite a while; confirmation bias happens on all sides of any sort of debate, but I stopped paying attention to McCormack a while ago because it was particularly strong in him…
Yep.
Contact tracing is still kind of labor intesive. If Germany was doing much of it, we’d be reading about a new medical Stasi.
Very good question. Maybe if you link everyones medical record to their cell phone, heavily fine them if they’re not carrying the registered one and give the public health authorities access to both and lots of data mining ability.