Is Sweden's Covid-19 Handling a Failure or a Success?

Mish

Sweden did not have a hard lockdown like its neighbors although people were advised to work from home when possible. It also banned nursing home visits on April 7.

Sweden says its model worked, but Numbers Suggest a Different Story.

Sweden's Covid-19 deaths per capita are 3 to 6 times its Nordic neighbors.

Nordic Country Restrictions

Nordic County Restrictions

Sweden vs Nordic Neighbor Deaths 

Sweden vs Nordic Neighbor Deaths 2020-05-02

On a per capita basis, Sweden's Covid-19 deaths are 3 to 5.5 times the other Nordic countries.

Sweden has just over 3 times the death rate of Denmark. But note Denmark's population density disadvantage of 138:25.

Success or Failure?

Success is in the eyes of the beholder. 

A death rate 5.5x is acceptable to some but not others. 

But Sweden has a ton of pressure to under-report Covid deaths. I would be shocked if they didn't.

Regardless, one can easily look at this data, ignore the undercounts (perhaps even factor some in), and conclude Sweden did the right thing. 

But how does that translate to the US?

Population Density of NYC

For comparison purposes, the Population Density of New York City is 26,403 people per square mile (10,194/km²), makes it the densest of any American municipality with a population above 100,000.

Manhattan's population density is 66,940 people per square mile (25,846/km²), highest of any county in the United States

Sweden Not a Good Model 

Even if one is happy with Sweden's results, it is not a representative model for large US cities.

R0 - Infection Transmission

Nate Silver has an Interesting Twitter Thread on R0, the the number of people someone will infect on average, if they catch it.

Nate Silver Followups

  1. The positive test rate, which I believe is a better metric than the raw number of + tests, continues to show slow, incremental improvement. But I do mean *slow*. It's consistent with a nationwide R of around 0.9, where R>1 means the epidemic is growing & R<1 means it's shrinking.
  2. That is a national average, however. There are places like NY where there's a reasonably steep decline (R of perhaps 0.7-0.8). In turn, there are likely to be other places where infections are still growing (R of perhaps 1.1 to 1.3) and it isn't just an artifact of more testing.
  3. Overall, there isn't a lot of room for error. A few states have had clear, sustained improvement and may have room in their R "budget" to relax restrictions. But for many others, even slight changes could bring R >1. Or R may be >1 already.
  4. That's not to say it's necessarily up to policymakers. I don't care about the state capitol protests, which are an overplayed story. But it's clear from e.g. mobility data that people are moving around more and abiding less strictly by social distancing.
  5. I wish we knew more about what this activity consisted of. Taking a nice, long drive to a non-crowded state park should be pretty safe, for instance. But pressure points seem to be outdoor activity in more crowded spaces, and small-to-medium-sized social gatherings.

Reopening Too Early 

At an R0 that's well below 1, the disease will die out (but perhaps return later in the Autumn or Winter).

Ar R0 of 1, the current results can go on for a long time. 

An end to the lockdowns too early could easily send R0 back well above 0.

The latter is what everyone want to avoid.

Mish

Comments (138)
No. 1-50
Aethor
Aethor

Of course a country that doesn't lock down will have more cases and more deaths, since lock-downs slow the spread of the virus - that's their entire point.

But that means that cases and deaths in Denmark are just delayed, it's not like they have been permanently prevented.

In effect, you're comparing apples and oranges, since in Sweden you can see in x months what in Denmark will happen in X+some number, the difference depends on the slow-down efficiency of the lockdown.

Eventually in both countries it will run its course, and when neither has any cases for a month or so, then compare deaths.

Those under lockdown do not develop immunity. They can hide at home for as long as they want, the virus can still get them when they finally go out.
Unless you plan on keeping the lockdown until a reliable vaccine is made, and made in quantities to cover the entire population. Good luck with that, since by then we won't have any economy remaining.

wootendw
wootendw

"But Sweden has a ton of pressure to under-report Covid deaths. I would be shocked if they didn't."

There are reports that coroners in the US are being pressured to report deaths as covid19, even when there are multiple possible causes. I've seen one tweet where a coroner, himself, said he was being so pressured.

Yes, there were people who died of covid before it was known to be out there. But that has surely ended by now.

As far as government numbers go, I no more believe the US than China.

The real test for Sweden - and all countries - is after it's over and the numbers have been accurately reported, INCLUDING THOSE WHO HAVE THE ANTIBODIES BUT HAVEN'T REPORTED BEING SICK.

I expect Sweden will achieve herd immunity early and that, ultimately, the death rates will be about the same if numbers are honest, here and there.

ADDENDUM: "Funeral Directors Blow Whistle on Fake Coronavirus Death Reports"

Don't know whether the source is reliable or not.

Sechel
Sechel

The data isn't looking good for Sweden yet conservatives are lauding the approach. It's as if the proponents are tone deaf to the data

hmk
hmk

I think something between what Sweden is doing and what that dictaster Gov in Mi is doing. She is a tyrant. A short quarantine ,or not, followed by mandatory mask and social distancing is probably the best compromise versus decimating the economy with a toll as devastating as the deaths from the Wuhan virus. I tend to think that once the lockdowns are over the virus will resurface again. So what are we going to do in that case quarantine forever? The best solution is to try and maintain personal protection as best as possible and restart the economy asap.

ChadK
ChadK

Using the average population density for Sweden (and Norway and Finland) is misleading. 25% of the population lives in the Stockholm metro area, with population density 360/km^2. The population density of northern 2/3 of Sweden is miniscule.

gregggg
gregggg

They pay the hospitals extra to put COVID 19 on the death certificates. We never did any random testing to figure out the percentage of the population infected, and then they quarantine everybody instead of just the sick people and bankrupt the masses. Okee dokey then, and Building 7 fell down all by itself because of a few office furniture fires.

TCW
TCW

The other countries will catch up to Sweden's numbers, the quarantine just slows it down so the hospitals aren't overwhelmed.

Carl_R
Carl_R

The death rate in all of the Scandanavian countries has been curiously low. Compare Sweden with Brazil, which followed similar policies, and according to news reports, is now digging mass graves as fast as they can. Why the differences? Why can Sweden only have 256 deaths/million, while UK, France, and Spain have twice that number, and San Marino has nearly 10x the number? The more you look at the data, the more you realize that you don't understand.

Zardoz
Zardoz

" But pressure points seem to be outdoor activity in more crowded spaces, and small-to-medium-sized social gatherings."

... like Statehouses crammed full of fat guys with rifles.

wootendw
wootendw

"Manhattan's population density is 66,940 people per square mile (25,846/km²), highest of any county in the United States"

Social distancing is meaningless in places like Manhattan. How does living in a huge apartment building keep you from catching the virus if someone else in the building has it?

If people in New York City want to practice social distancing, they ought to just move out of that place. Had they gone when it was still easy, they might have gotten a free or cheap motel/hotel room.

Sechel
Sechel

Sweden only has a population of 10 million.

astroboy
astroboy

Two important things:

  1. One third of Sweden's deaths have occurred in nursing homes:https://www.webmd.com/lung/news/20200501/sweden-sticks-with-controversial-covid19-approach

Yeah, they dropped the ball on that one but that doesn't necessarily mean their general approach is wrong, because:

  1. 40% of deaths in Stockholm, and perhaps 18% of deaths in the entire country, are Somalis, who make up .69% of the population.

WebMD is a reasonably reliable source of news, at least. There seems to be no doubt that Somalis have a much higher death rate even if one is suspicious of the exact numbers and reasons given in the second link. The gist of which is that Somalis aren't doing anything resembling quarantine if they're sick. Unfortunately, the second article doesn't say a thing about which Somalis are dying. The old and sick? The young and healthy?

The average fatality in Italy was 80 years old with four pre-existing conditions. It's callous to say it, but you're getting your ticket punched even by a Taco Bell burrito when you fall into that category.

So.... if you ignore the nursing home deaths (yeah, it would have been a good idea to have had an iron curtain quarantine around those from day one but that's sort of a different issue than the general Sweden approach), and the number of Somali deaths, then it seems Sweden isn't doing too bad at all....

I see only two outcomes:

  1. herd immunity.
  2. an effective vaccine.

Even if covid were wiped out in Europe and the US today it would still be introduced time and time again from the rest of the planet until either of the two outcomes happen. You just can't shut down the country forever.....

thimk
thimk

We can postulate,hypothecate, extrapolate,speculate and pontificate till the cows come home.This is a "novel" virus with no historical data , no treatment, and little science . This is the pay me now or pay me later virus. We have no choice but to selectively ,slowly open the economy up prophylactically or anarchy will ensue. Sorry but at a certain point , you have to face the enemy .

killben
killben

It is indeed a difficult choice between death and economic catstrophe for any country. The population, density of population, hospitalisation capacity etc. will likely decide the course. The bigger issue is the media hype. The whole atmosphere of fear (and stay home stay safe message) that has been created is what has wrought extensive economic damage and atmosphere of pervasive fear. If the message had been that this is contagious like chicken (where we also quarantine for 14 days), more than flu etc. with statistics, it is likely that people would have a reference with which they are familiar and thus the negative atmosphere of fear would have been avoided and the economic damage would have been reduced.

All countries should have closed their airports in January 2020 when China started closing its cities (no point in closing only flights from China as the passenger can fly from elsewhere). This way only airlines would have gone bust but the hospitality industry as a whole could have been saved as they could get national tourists.

Metronome
Metronome

Economic devastation will result in deaths that won't be directly attributable to the measures taken to fight the virus. How about using "Jobs lost per death" statistics when analyzing effectiveness of intervention. Those who are well off, who don't have finances on their mind seem to favor life and defend quarantines. Those to whom unemployment means death see them as representatives of the elite dictating everyone how to save lives that matter the most to them - their own at the expense of every person now unemployed.

Webej
Webej

I thought Mish was a numbers guy.
[1] Population density is an important factor, but only factual population density matters. The actual population density in Indian cities or in Egypt is far higher than dividing the population by the area of the country (Egypt is 95% desert), and far higher even than Manhattan with its vertical housing. Population density calculated by arbitrary units called nation states is meaningless. There is virtually no difference between population density in Stockholm and Copenhagen.
[2] It's about the accumulated number of deaths. We have absolutely no data on that, so how can we judge the effects. We also have no data on the costs over decades, and probably never will, since it is all based on counter-factuals.

This is all about the seen and the unseen...

My prediction. More life years will be lost in the US due to losing health care coverage than could possibly be saved by staggering ventilator use.

gregggg
gregggg

Sweden has a stronger constitution than we do in the US? Maybe they have less sheep.https://www.youtube.com/watch?v=2QVCg2eVPbA

sebmurray
sebmurray

I am always wary of comparisons to Scandinavian countries. They have relatively small, very well educated populations that generally elect sensible leaders. So they mostly govern sensibly and the people go along with it. I know a couple of Swedes and they say that although there is no lockdown, people only go out if they have to and most people still stay home as much as possible. In essence they still practice all the recommended social distancing and hygiene. There are few places left in the world where the social contract is strong enough that people will willingly make sacrifices and endure inconvenience for the sake of their fellow citizens. This is where I struggle with these lockdowns, people have have rights and freedoms but along with those come responsibilities as well, and in too many places do people expect to enjoy freedom without that responsibility.

Jojo
Jojo

Why Sweden Succeeded While Others Failed
Mike Whitney • April 30, 2020

How do you measure success in dealing with an illness for which there is no cure?

This is the question we need to ask ourselves before judging which country’s approach has been most successful in dealing with the coronavirus. The fact that there is no silver bullet, no vaccine, does not change the fact that leaders must seek the best possible way forward by crafting a social policy that helps to achieve their goals. In my opinion, most of the European countries and the United States have imposed a social policy that is the least likely to help them achieve the objectives that they should be pursuing. In other words, while the “containment” strategy of self isolation and social distancing might temporarily prevent the spreading of the virus (and prevent the health care system from collapsing), the infection will undoubtedly reemerge when the lockdown is lifted causing a sharp uptick in the cases and deaths. This is the problem that many countries, including the US, now face. They want to loosen the current restrictions, but additional easing unavoidably triggers a surge in new cases. So, what is to be done?
...

ChristoK5
ChristoK5

Sweden's laissez-faire #lockdown is working.
And they are saving their economy!
Sweden’s unusual approach to fighting the coronavirus pandemic is starting to yield results, according to the country’s top epidemiologist.
Facts are:
Distance from Sweden to Belgium 1,610 km via E4.
The current population of Belgium is 11,581,402
The current population of Sweden is 10,088,936
#Covid19 deaths - Belgium: 7,765 ( 0.067%)
#Covid19 deaths - Sweden: 2,669 (0.026%)
Please check my math?
Why are they are lying?

Tengen
Tengen

I still wish we knew what was going on in China. Despite their minuscule (reported) figures, they just locked down an additional 10 million+ people (Harbin) a few days ago.

Some transparency from China would accomplish two major things:

  1. show everyone what a worst case scenario is for the virus
  2. provide insight on reinfection rates and how reopened cities fare, like Harbin

We're all still groping around in the dark to this point. We won't even know if Sweden is a success for a while, but it has been weird seeing so many people praise them, especially since they're usually portrayed as a basket case by the same people.

danieledomenicali
danieledomenicali

Lemmings! Swedes deliberately chose to let octogenarians die, save economy over spread of epidemic, and on top of all that, some of them tatoo Tegnell face on their arms. No people is more dupe, shallow, naive than majority of swedes.

ColoradoAccountant
ColoradoAccountant

The article I read on Belgium is that they are including deaths at home and nursing homes where the deceased had symptoms of Covid-19. That is consistent with a 5-year history of 300 deaths per day, and now 600 deaths per day during the pandemic.

shamrock
shamrock

What about the other side of the coin? How is Sweden's economy faring compared to neighbors?

Blurtman
Blurtman

Age 90+: 24% of deaths. Age 80-89, 40.5% of deaths. Age 70-79, 23% of deaths. Age 70 and above, 87% of deaths. Perhaps seniors should consider remaining under lock down.

Democritus
Democritus

About 10 days ago in the Netherlands, the official medical team announced that some 3-4% of the population seem to have antibodies now - with the usual caution not to draw too many conclusions out of it. If Sweden much higher now, the quarantine thing was just delaying the inevitable destroying the economy in the process. One can also let the young all get it quickly, then use their serum to help the elderly. Of course, if a serum/vaccine is developed next month I would have to take this all back.

njbr
njbr

It is truly proof of the skull-bone to brain ratio present in America and in this discussion.

These are the known facts.

Without a vaccine, approximately 80% of people will be exposed to this virus.

Of that, 10 or 15% will require hospitalization.

A small percentage will die.

If everyone is exposed in a short time, all medical systems are overwhelmed and far more will die than would happen if the case load were throttled to keep the case load manageable.

Ways of managing case loads include social distancing and masks. Enough testing to identify active cases and to determine who has had it. Enough medical supplies to ensure that the medical systems are effective and not destroyed by killing off or sickening your medical providers.

The problem is that you knuckleheads (high ratio of bone to brain) refuse to do ANY of the mitigation in that last paragraph.

Quatloo
Quatloo

Yes, Sweden has more deaths upfront, earlier than other countries. But when other countries start opening up, the virus will sweep in again in waves and they will go back to lockdowns. The Swedes will be protected from these waves through herd immunity. And their economy remains practically intact. Sweden has not been following the herd; instead of emulating China‘s method of fighting COVID like the U.S. is doing, Sweden is successfully fighting the virus and will thrive while the rest of the world craters its economy huddled inside until a vaccine comes along (October of 2021 by Dr. Fauci’s estimate).

The lockdowns in America will not be sustainable though the Summer, people will not remain inside all Summer, it just won’t happen. The protests will turn into riots soon and governors will lose control.

MATHGAME
MATHGAME

RE: "The Swedes will be protected from these waves through herd immunity."

Funny that I hear all these people referring with such certainty to "herd immunity" to SARS-COV-2 when things still unknown about COVID-19 include prevalence, effectiveness, and duration of post-infection immunity.

People need to keep in mind that SARS-COV-2 is a coronavirus. Influenza viruses are NOT coronaviruses. Common cold viruses ARE coronaviruses.

There is no vaccine for and no immunity to the common cold coronaviruses.

I'm not saying all this proves that there will be no immunity to SARS-COV-2 ... only saying that the assumption there will be is based far more on hope than on evidence.

Photon
Photon

Although there are many "expert" opinions, I take what Johan Giesecke (infectious disease specialist and advisor to the Swedish Government regarding COVID-19) says seriously. Sweden may have a higher mortality rate at the moment, but if his analysis is correct, in the end, the total number of deaths will not be much different regardless of policy methods used to slow the spread. Sweden will achieve herd immunity (assuming this is possible with COVID-19) sooner than other countries. As long as the capacity of the hospital system to treat COVID-19 patients is not exceeded, then ripping off the band-aid quickly would seem to be a sensible strategy.

Regarding Mortality Rates: Apparently these are calculated differently between countries. Yes there would be incentive for Sweden to under-report deaths. In an interview I listened to recently with Johan Giesecke, he states that the Netherlands does not use COVID-19 deaths that occur in nursing homes in its official mortality rate calculations. I cannot confirm this but if true, the actual mortality rates reported by the Netherlands could be significantly higher. Nursing home deaths related to COVID-19 account for 30% or greater of all COVID-19 deaths in some countries.

Another point that isn't discussed enough is the morbidity and mortality associated with a lock down state and with worsening economic conditions. Although there are ZERO reported COVID-19 related deaths in my county, I have seen an increase in the number of serious child abuse cases over the past month. In addition, patients that would normally be receiving medical care, including cancer screening and follow-up care, are not receiving it. This will worsen with the loss of health insurance and subsequent avoidance of seeking care due to inability to pay. Although these secondary effects are difficult, if not impossible, to measure, they are very real and will no doubt be substantial and lasting even after the coronavirus has vanished.

Jdog1
Jdog1

So far Sweden's numbers statistically would indicate their policy has caused far more infections and death than would have otherwise happened.
Take into consideration also that because there was no formal lockdown, that does not mean the people of Sweden did not practice precautions such as social distancing, self quarantine, and improved hygiene. This statistical difference is measuring in fact the success or failure of failing to close businesses that are deemed high risk by their nature.

Realist777
Realist777

Current numbers are meaningless. I bet as soon as restrictions are erased in the locked down countries their numbers are going to rise, while Sweden's will stay the same or trend lower. All that the locked down countries have accomplished is prolonged the pain while ruining their economies and angering population. While certain measures make sense, everything should've been voluntary and people should be responsible for their own well being. I'm very surprised that you have completely opposing philosophies - you support free market capitalism while suggesting that society's behavior has to be micro managed by the government. Really odd to me...

Montana33
Montana33

Remember the three little pigs and the wolf? Only one pig built a house to survive. Most governors are behaving like the two dumb pigs and are moving to the Sweden model. These lockdowns should exist until we can lower the case count and implement more testing and contact tracing. Every Governor is on their own and the Blue States are wealthier. Bloomberg is investing in NY and CA has deep pockets. Hawaii will be the first to beat the virus. What surprises me is the short-sightedness of many Governors, particularly Southern ones. Wave 2 will slam their residents within 4 months or less. They know the wolf is blowing their way. So sad.

RonJ
RonJ

"The New York Post begrudgingly acknowledged that Sweden received praise from the high chair of global public health at the World Health Organization (WHO), now lauded it as a “model” for overcoming the coronavirus crisis."

RonJ
RonJ

"The latter is what everyone want to avoid."

What everyone supposedly wanted to avoid was overwhelming the hospitals.

Anders Tegnell, Sweden’s government advisor for epidemiology explains, “We are all trying to keep the spread of this disease as low as possible, mainly to prevent our healthcare system from being overstretched, but we have not gone for the complete lockdown. We have managed to keep the number of cases low enough so the intensive care units have kept working and there has always been 20 per cent beds empty and enough protective equipment, even in Stockholm, where there has been a huge stress on healthcare. So in that way the strategy has worked.”

Sweden hasn't trashed their economy, like the U.S. has. 30 million unemployed in the space of weeks is overwhelming the unemployment departments. People are not getting benefits in a timely manner. The Paycheck Protection Program hasn't been a shining model of success, either. Food banks are overwhelmed.

As far as i am aware, Sweden doesn't have these problems, not to mention an increasingly restless population that wants to get back to work, so they can pay their bills.

aqualech
aqualech

We are talking 2/10,000 population. Maybe we should be talking hypertension and smoking/lung cancer. Or alcoholism. Big gov hasnt gone full retard on any of those health threats.

Outdoorsman
Outdoorsman

I am not sure why it keeps getting removed from the comments, but I strongly encourage viewing Bill Maher's interview with Dr. David Katz. I have posted the YouTube link a couple of times, including today, and it keeps disappearing after I post it.

4IndividualLiberty
4IndividualLiberty

I assert that the personal and economic mayhem that is caused to the 99.9% survivors of the virus will be at least an order of magnitude worse for society than any benefit (assuming there is one when all is said and done) of the various degrees of quasi-martial law being inflicted on societies.

awc13
awc13

"But Sweden has a ton of pressure to under-report Covid deaths." and the other 3 countries don't? of course they do. imagine if finland reported the same rates as sweden. people would be upset

Jojo
Jojo

Fareed Zakaria's Sunday GPS show had a good segment on why Sweden never locked down. Also some other good segments worth watching. See the list below.

RT89
RT89

Agree with some of the comment above that using simple, arithmetic population density can be very misleading. A better option would be "lived density" proposed by Alasdair Rae in 2018. If one uses this metric, the difference in numbers between the countries discussed here is much less dramatic: Sweden 84, Denmark 183, Norway 89, Finland 53.

WildBull
WildBull

The new word on the duration of social distancing is now 2 years. My chance of dying in that time of causes other than C19 is about 2.8% My chance of dying of C19 if I get it, maybe 1 to 3%. Two years of isolation is a big chunk of my time left on the planet. It is my choice. I'm going to see my grandchildren. Sweden has it right.

Carl_R
Carl_R

It's easy to say "Sweden has it right", but harder to identify exactly what it was that they have right. Other countries have tried similar policies, such as Brazil, or even Italy. They kept their economy open, until they reached the point that they couldn't dig graves fast enough . Sweden didn't do anything Brazil didn't do, so why did is "work" for Sweden, but lead to a disaster in Brazil, and other places? What is different about Sweden that caused their death rate to be "only" 274 per million, rather than the 684 per million in Belgium? What, exactly, did Sweden do "right" that enabled them to keep their economy open?

The only hint we have is that deaths have been unusually low in all the Scandanavian countries, including Norway, Denmark, Iceland, and Faroe Islands. Why? Is it something we can implement here? Is genetic (say, pale skin gives them a better ability to convert Vitamin D?) Dietary (lutefisk smells like it would kill anything). Cultural (built in social distancing, or perhaps they often wear scarves?)

Before jumping to a conclusion, we need to figure out what enabled Sweden to stay open without the massive deaths that happened in every other country that tried the same thing. Suppose you have ten people, each with a car. Six of them opt to put on the brakes, but four of them choose to drive full speed into a wall. Italy, Spain, and Brazil all die, but the Swede lives. Should you conclude "the Swede has it right! We can all drive safely into the wall.", or should you examine his car to try to find the differences before you head for the wall yourself?

WildBull
WildBull

Sweden is running 4 to 10 times the death rate of its neighbors. Sweden will be done in a few months without causing social and economic mayhem. People here are starting to travel, so, infections will pick up. We will get to approximately the same number of deaths per age group and co-morbidity as long as hospitals are not overloaded. But, we will do it in slow motion with enormous collateral damage -- economic, political, social and psychological.

The plan here is to push the infection rate to the point that contact tracing is viable and wait for a vaccine. That is the beginning of next year at the earliest, maybe never. How long are you willing to wait? What percentage of your life are you willing to live isolated from friends and family in our new-normal police state? Social distancing is not a viable response for long periods of time. It is contrary to basic human social behavior and will not last.

Martin Sv
Martin Sv

What? Did less people get the flu when everyone was put under house arrest? Who would have thought! Gues we just have to lock people up indefinitely then! Then we wont even have traffic accidents anymore... Look at all the fine numbers! Damn Sweden, letting people still drive... Look at their traffic accidents now compared to all those other countries who have abolished driving!

And by the way... what do you think will happen when everyone gets out again? Hint: They will catch the flu regardless. And then you crashed the economy for absolutely nothing. You have to compare the same country with the same numbers from erlier years of course. And in Sweden it's still no worse than the flu of 2018.

BLUEWIN
BLUEWIN

You are so wrong on this one Mish it is very surprising . . . I would hazard a guess that Sweden's overall infection rates is many time greater than any of its neighbors which means it will reach herd immunity earlier than its neighbors and it the end death rates between the countries will be probably be more or less the same unless medicines that can help cure the virus are found and used before herd immunity is achieved. Keep an open mind . . . Science is far from perfect especially when humans are manipulating it for other purposes . . .