Want To Be More Like Sweden? What If We Already Are?

Mish

Let's investigate the Success, or lack thereof, of Sweden's handling of Covid-19.

Unlike most of the rest of the world, Sweden did not mandate coronavirus lockdowns.  Instead, most measures were voluntary, but it did cutoff access to nursing homes after a surge in deaths.

It has been an experiment worth monitoring. And for weeks, many in the US have been clamoring for the US to be "more like Sweden". 

But what do the results really show and what is Sweden saying now?

Surprise, Surprise

Please note the head of Sweden's no-lockdown coronavirus plan said the country's Heavy Death Toll 'Came as a Surprise'

We never really calculated with a high death toll initially, I must say,” said epidemiologist Anders Tegnell.

 We calculated on more people being sick, but the death toll really came as a surprise to us.”

The deniers will point out that about half of Sweden's deaths came from nursing homes as if those deaths don't matter. 

Covid-19 Deaths Per Million Log Scale 

Covid May 8 Deaths Per Million

Many will criticize the lead chart because it is in linear format. So there is the same chart in log format.

When it comes to per-capita counts, both charts show the same thing: The US is remarkably like Sweden.

This can be portrayed two ways.

  1. See, the lockdowns didn't help.
  2. Based on population density, Sweden is a total disaster. 

You should not compare a tiny Nordic country to the US but there it is anyway, for those clamoring to be more like Sweden.

Tests Per 1,000 People

Covid May 8 test per 1,000 People2

When it comes to tests, unfortunately the US is far more like Sweden than denmark or Italy.

Covid May 8 Deaths how Rapidly are they Changing?

Covid May 8 Deaths how Rapidly are they Changing

Here the US is far worse than Sweden, but Sweden's alleged success may be poised to break down.

Case Fatality Rate

Covid May 8 Cse Fatality Rate

On a fatality rate basis, we better hope the US does not become more like Sweden.

Clearly Sweden is not the success story widely claimed. 

Unfortunately, people will look at these charts, continue to make inane flu comparisons and continue to tout Sweden's success.

The one area of attack left open is whether or not the US approach was economically justified. 

Was it Worth It?

I will not address that question because I will not change anyone's mind.

Importantly, it's impossible to know what would have happened if the US had not undergone these lockdowns. 

But we do know that deaths are way underreported and the US is only as good as it is because of the lockdowns. 

Was it worth it? The debate is on.

Mish

Comments (164)
No. 1-50
numike
numike

Covid is here What it does is up to covid We know very little

pvguy
pvguy

Is Sweden really a low density country? Most of the population is in Stockholm, Malmo, and Gothenburg.

I will also point out that Sweden took their death toll up front, while other countries may end up at the same place, but take longer to get there. June 1 this year to June 1 next year will be an interesting comparison.

Kimo
Kimo

Appears the correct choice was to lock down the nursing homes, and perhaps the staff workers. Let everyone else go their merry way.

BaronAsh
BaronAsh

"But we do know that deaths are way underreported"
Many articles of late indicate the opposite, that CV deaths are over-reported/counted. In any case, and more importantly, the average daily death rate is down, so whilst lots of people have been dying from CV supposedly, almost as many have NOT been dying from diabetes, heart disease, flu, old age etc. Obviously this is because they are counting anyone who dies from whatever cause and has CV as a CV death, and no longer counting the other co-morbidities at all. Stupid or disingenuous, take your pick.

Comparing Swedish to US numbers is not all that helpful unless you have data about the infection rate in the population. i.e. if Sweden has 50% of the population exposed and the US only has 20% exposed, then Sweden is further along the path to herd immunity so their high death rate is basically better from that pov. We need a way to measure the death rate relative to % of population infected.

Originally, the lock-downs were explained as necessary to avoid a collapse of the health care system, not to avoid exposure and infection overall. Flatten the curve etc. That has been achieved but now the goalposts have shifted to what exactly? Avoid any unnecessary death from CV at all at any cost? Even at the cost of many more bankruptcies, suicides, divorce, poverty, depression, economic collapse, what?

This whole thing has gotten out of hand. Mish, you are much too intelligent to keep analysing this thing as only a medical crisis. It's also a geopolitical war of sorts going on, or if that's too much for you, then a massive economic dislocation because the response has been so draconian. Discussing it mainly in medical terms - esp. given that nearly all data is suspect - is a bit of a red herring.

Here is a slightly old article on the death rates from a somewhat odd site. I've seen others but don't have links handy:

And a broader perspective from an experienced hand, Lord Black:

Carl_R
Carl_R

The whole Sweden argument is a red herring. We know for a fact what happens when most countries follow the path Sweden took. Brazil can't dig mass graves fast enough. New York also took that path, and ignored it for a long time. Had they continued to ignore it, obviously they would have more deaths than they do now. Had the rest of the country followed suit, they could have as many deaths as New York city.

What we DON'T know, is why Sweden's death rate was so much lower than other countries that ignored it. Is it hereditary? Perhaps. The death rate is eerily low in Iceland, the Faroe Islands, but also low in Denmark and Norway. So, because of their heredity, they were able to get away with it. Ours, unfortunately, is very different, and had we adopted their strategy, we can use NYC for an indicator of what would have happened.

Casual_Observer
Casual_Observer

Not a useful comparison as there are at least two strains of the coronavirus going around. Chinese researchers reported 33 strains with the worst ome being 250 times as virulent. The east coast and west coast of US dont even have the same strain. This is the only logical explanation as fo why the death rate varies even when nothing else about the makeup of the population varies as much. Covid is a cold virus that keeps mutating like a cold virus. At some point everyone alive is going to get it.

numike
numike

Again there is NO inoculation for Covid19 The human animal spews saliva Thus anyone/everyone is at risk of contracting/re-contracting it

gregggg
gregggg

The only meaningful thing I see here is the log death rate chart. Testing was inconsistent and varied from each local area according to how many test kits they had, how many of the test kits were actually reliable, and who actually got the tests. Most tests were used for patients that were being admitted to hospital, and outside that realm not many people other than "important government officials". Add the facts about hospital funding: $12,000 bonus to hospitals admitting covid patients and another $39,000 reward for each patient who used or got killed on a ventilator to polish up incentives for covid death certificate. Now, let's take that data and make something representative? Really???
"I'll stick with death rate and population density for $600, Alex".

tokidoki
tokidoki

Our stock market is higher. The Swedes lost.

DaKine509
DaKine509

All I see is the randomness we see everywhere with this disease. These are not huge differences. Compare within states in USA. Compare other countries and their responses. I get he is comparing Scandinavian countries, I bet you could find others to blow this up

And the point with the funeral homes is that maybe it would have been smart to focus on those at risk. Sweden+

Axiom7
Axiom7
  1. US data is skewed by NY numbers. We don't know why NY is such an outlier. Could it be the governor is a possible backdoor Pres candidate? :)
  2. Sweden has huge land mass but most of the population live in large cities (someone else said that above).
  3. We are ignorant of the "real" denominator. But studies are showing that the death rate is 0.12% - 0.2%
  4. If you adjust deaths for people in nursing homes you get a more accurate assessment of risk for, say, college students returning to college.
  5. The cost in GDP of remaining closed is MASSIVE - these depression levels of unemployment and bankruptcy will cause many deaths.

It really is a no-brainer at this point to re-open. The politicians need to save face over a catastrophic top-down intervention.

TimeToTest
TimeToTest

Ultimately the answer will probably be - It doesn’t matter.

I predict we will get back to the left side of the growth curve before the end of the summer. The R0 is about to start climbing again.

Before the lockdown I estimated I had at least 1000 people I was in contract with weekly. I can count them now. That number is climbing now.

The second lockdown is going to be real.

Felix_Mish
Felix_Mish

Are there any meaningful statistics other than, perhaps, perhaps, perhaps, deaths-compared-to-other-year-deaths? And hospitals overloaded with patients - which isn't much use without knowing demographics and what the hospital situation was going in, among other things.

Oh! Yes. Statistics tell you to avoid Covid19 if you're gonna die soon. That's useful.

Sweden? Sheesh. Did they stay-at-home more or less than the US? How does "Sweden" compare with Swedish Americans? And so much more - see various comments above.

Felix_Mish
Felix_Mish

What I'd like to see is a real time web feed with photos and quick blurbs about people who die. All of them.

b2b
b2b

As a swede living in Sweden i think the approach so far in Sweden is reasonable, the health system still have beds and respirators for those in need, and compared to our neighbours we still have something resembling an economy and a life.
The deaths at the nursing homes are a real disaster though. Yes, you cant visit them anymore, but lots of personel moving through anyway spreading the disease (talked with a friend yesterday who is a physiotherapist at a nursing home, he´s still working and yesterday they had a hairdresser coming from outside to cut their hair...).
Compared to Norway which has been in total lockdown for a while with only 1%? of the population infected, well, they can wait for the vaccine, end the lockdown and accept the losses, or wake up one day and be back in the stone age.

ZZR600
ZZR600

Useful to compare excess mortality in the UK under hard lockdown, with that of Sweden, lockdown lite. UK far above average and far worse than Sweden in the charts below for country Z- numbers

kram
kram

Some graphs are on log scale and some on linear. So, is there some kind of rationale on what the basis is for selecting the scale (apart from making all charts appear like a bell curve)? For a majority of people who do not understand the difference in visual perception between a log and a linear scale (for example, while a linear scale makes the death curve look like a steep hockey stick, the log scale looks like it has peaked and is on the way down) and that one measures number increase while the other measures percentage increase, it can easily confuse people into believing that the pandemic is dying down while it is actually increasing in large numbers each day (approx half a million people infected globally every 6/7 days (3/26-0.5 million, 4/2-1 million, 4/9-1.5 million, 4/16-2 million, 4/22-2.5 million, 4/28-3 million, 5/4-3.5 million, 5/9-4 million). Uncanny data series; any conspiracy theories here?!

cienfuegos
cienfuegos

Maybe you should go back to Illinois Mish...the Nanny-State needs you.

Isaiah217
Isaiah217

Mush, you say it’s impossible to know what would have happened without a lockdown. Then you say we are only as good as we are because of the lockdown. Non sequitur

Actually we know that death counts are over reported.

maverick12
maverick12

CFR comparison misses the point entirely. Swedes only test people in hospitals thus only those with already bad condition can ever become cases. If they did large scale testing on all-ages non-hospitalized patients the CFR would be much lover, in line with other countries.

Blurtman
Blurtman

For months, scientists have been poring over data about cases and deaths to understand why it is that COVID-19 manifests itself in different ways around the globe, with certain factors such as the age of the population repeatedly popping up as among the most significant determinants.

Now, one of the largest studies conducted of COVID-19 infection in the US has found that obesity of patients was the single biggest factor, after age, in whether those with COVID-19 had to be admitted to a hospital.

"The chronic condition with the strongest association with critical illness was obesity, with a substantially higher odds ratio than any cardiovascular or pulmonary disease," write lead author Christopher M. Petrilli of the NYU Grossman School and colleagues

Writing in The Lancet on March 31st, RNA virus researcher Gregory Poland summed-up the conditions aggravating the COVID-19 situation globally: "We have an increasingly older age demographic across virtually all countries, as well as unprecedented rates of obesity, smoking, diabetes, and heart and lung disease, and an ever-growing population of people who are immunocompromised—all comorbidities that lead to significantly higher risks of severe disease and death from coronavirus disease 2019 (COVID-19)."

And Drs. David S. Ludwig and Richard Malley of Boston Children's Hospital wrote in The New York Times on March 30 that Americans' risk from the virus is compounded by the fact that they are generally "too diseased."

"The huge burden of obesity and other chronic conditions among Americans puts most of us at direct risk," they wrote. "In fact, with obesity rates in the US much higher than affected countries like South Korea and China, our outcomes -- economic- and health-wise -- could be much worse."

Webej
Webej

The seen and the unseen: The more successful containment is now, the more you are pushing the problem out into the future. Comparing mortality in different approaches makes no sense until the virus has gone through the whole population. The hare and the tortoise.

Then add on the life-years lost due to lock-downs. Success bought at the price of permanent lock-down is still suicide.

MiTurn
MiTurn

The story of covid-19 doesn't end when every nation's curve is finally a bell shape. There will be a second wave and how Sweden's response to that in comparison with other nations will give a more complete picture of whether Sweden did the right thing or not.

parks6n580
parks6n580

Is there likely to be a vaccine any time soon? N0, see MERS and SARS
Is there legal authority to lockdown the populace? Not that I can see.
In what World does it make sense to quarantine the healthy vs the infected?
Why wouldn't you strongly recommend elders & folks with co-morbidities take extreme caution as they are most at risk?
Given that no vaccine is in sight, what if lockdowns only serve to extend the duration of Covid-19 and effectively prevent herd immunity from even occurring?
What if lockdowns mean extending the duration while opening things up shortens the duration?
What if the overall death count is exactly the same but in one case this goes on for years & the other it is over much more quickly?
What motivation is there to extend the duration & who benefits by these actions?
Why are the people so willing to give up liberty without a fight?

Just a few questions I'd love to see answered.

Quatloo
Quatloo

Those are great questions Parks6.
As pointed out, we have essentially the same result so far in the US and Sweden, though the US has wrecked its economy and is entering into a depression while Sweden has chosen to leave its economy open while the vulnerable are quarantined.
Further, of course Sweden will have more deaths upfront without lockdowns. The test will be where things are a year from now after the Swedes have developed herd immunity with an intact economy and the US gets hit by wave after wave of new infections each time part of the economy tries to open up.

shamrock
shamrock

Sweden is unlikely to see any economic benefit to the policy, with an expected drop of 7-9% in GDP this year. Inline with the rest of Europe.

aqualech
aqualech

I returned all my n95 masks to Home Depot last week. Some day I might get infected, if not already. I doubt that I will become seriously ill. All rational actions and conclusions.

Tn builder
Tn builder

Just a schmuck from tn... and not even close to the intellect of most people posting here. But in the last month the consensus of my old rich customers and poor workers is all the same ...lock down the elderly... create a different set of rules for subway cities... but everyone else goes back to work and school.
Humans need to go to work ...else bad stuff happens. We have all sorts of people who wont go back to work now because of 900 bucks per week from govt. (Whoever set that amount didnt want a v shape recovery).
Yes more people will die today... but the ramifications to freedom are worth it. We send 18 year olds to die in wars for oil, but we cant risk lives of 70 yr olds to save livelihoods and future generations. In october when both flu and covid blow up, whether a treatment or not... politicians, silicon valley, msm, and even chinese,russian hackers will create more hatred among americans before elections.
Just lucky to have my head buried in small tn town. Gonna get uglier for the big city people in next few yrs.
Maybe i am looking into the 2nd and 3rd order effects too much though...

get
get

Mish, you are only looking at this from a very short term perspective. Sweden may experience a higher initial CFR but they are also moving towards herd immunity much faster than other nations so the price they pay on the front end may very likely payoff with a lower CFR on the back end of this.

It's almost certain that all other countries will experience another wave of COVID infections and deaths as we re-open the economy. A long term economic lock down was never really feasible.

Sweden will not likely experience a second wave as intense as other countries because of their decision to not close down the economy so over the long run, their CFR will average out much like other countries but without the same economic devastation. Of course, since the rest of the world chose to take a sledgehammer to their economies, Sweden will not likely escape the economic consequence of this.

get
get

It also seems you cherry picked the data:

nationalreview.com/2020/05/coronavirus-crisis-sweden-refused-lockdown-other-countries-following/

Anda
Anda

Slightly off topic, world tourism projections on this thread remind that a large part of the economy is in trouble no matter what an individual country might do. I'm not sure how travel will be able to shake off all the different legislation going on in different countries.

astroboy
astroboy

40% of covid deaths in Stockholm and around 18% of deaths in all of Sweden are from Somalis, 0.69% of the population. Why is that? If you take out the Somalis the Swedes are doing a whole lot better than all these graphs indicate.

RonJ
RonJ

"Clearly Sweden is not the success story widely claimed."

Clearly, the totality of outcome has not occurred yet. Sweden did not trash its economy. What is the fallout going to be from trashing the U.S. economy? What will be the death toll from that?

njbr
njbr

The lockdown was never supposed to last for the duration. No one had delusions that this was going to be the only, permanent answer.

You should be fully aware that the duration of this pandemic will last for years throughout the world. The world has changed in many ways, for a long time.

It is bitterly funny how so many miss that the purpose of the lock-down was to slow the spread in order to get ahead of the disease--make tests, stockpile supplies, prepare reaction teams, get some highly coordinated level of plans and learn more about the disease.

Has any of that happened under the leadership that we have?

NO.

Absolutely not.

We have an effing maroon at the top who cannot be bothered to promote any safe practices, will not promote actual science with respect to treatments or cures, puts out "it's gonna disappear" as fact, hides his agencies plans for safe reopening, pushes premature ending of lockdown a day after his "commission"issues guidance, and has his son-in-law steal PPE from hospital sourcing, etc., et., etc.

A wasted month-and-a-half of economic disaster.

We are ending the lockdown without making any advantage from its costs on how to handle what is coming.

And that is why we are screwed with respect to the next phases of the pandemic.

njbr
njbr

Is it fault or feature that the inaction, chaos and division engendered by Trump in the month-and a-half of lockdown means that the costs of the lockdown will not be repaid by a greater ability to handle what is still to come?

Anda
Anda

FWIW IMF data places US GDP contraction as about same as Sweden

RSM
RSM

Mish - Sweden’s high CFR comes from low testing rates. It’s been proven time and again during this pandemic that there is a very clear correlation between CFR and testing rates. When we look at antibody tests, the estimated IFR drops substantially.

In hindsight, the most effective response for US and others would have been as follows:

  1. shut down air travel sooner
  2. Lockdown nursing homes
  3. Encourage masks and social distancing
  4. Tell people to stay home and self-quarantine for 2-3 weeks if they’re sick, and only come to the hospital if short of breath, or showing other signs of serious illness.

The testing obsession was absurd. Mobilizing medical professionals to stand around waiting to test people doesn’t make any sense with no treatment available. If you’re short of breath, you need oxygen. So go to the hospital. If you don’t, what’s the point of a test?

njbr
njbr

“Everyone has a plan until they get punched in the mouth.” Tyson

“No battle plan survives first contact with the enemy.”Moltke

Trump---a plan of, of.., of what?

February 28...“It’s going to disappear. One day, it’s like a miracle, it will disappear.”

May 8...“This is going to go away without a vaccine, it’s gonna go away, and we’re not going to see it again, hopefully, after a period of time,” Trump said, according to a Yahoo News report. “You may have some flare-ups, and I guess I would expect that.”

No new plan, no new reaction.

And that is why Trump is a criminally inadequate leader.

BrainDamagedBiden
BrainDamagedBiden

Too early into this to determine the best policy. If Sweden gets herd immunity and avoids a more devastating 2nd season, they'll be praised. But, hind sight is 20/20. One things is clear. The lack of accurate information from China and the WHO played a big role in stoking the pandemic.

BrainDamagedBiden
BrainDamagedBiden

We'll need to revisit this chart to see how things play out. My guess, a slight uptick which may be attributable to the slight down tick in2019.

Metronome
Metronome

Whether it was worth it for Sweden depends on who's asking the question. An aged person in a high risk category in good financial standing and with no fear of job loss, of course, would have mortality as the top issue on his mind. Someone who's been affected economically and does not belong to a risk group sees things differently. He sees his life being sacrificed to keep the "academia" alive.

BLUEWIN
BLUEWIN

Way to early to make any calls on who was right or wrong . . . One thing is for sure . . . we will all have a better idea a year from now . . .

njbr
njbr

Deaths actually go up in good economic times....

The negative relationship between the unemployment rate and the mortality rate has been documented in a series of influential papers by Christopher Ruhm (2000, 2003, 2005a, 2005b, 2007). A typical estimate suggests that a one-percentage point increase in a state’s unemployment rate leads to a 0.54 percent reduction in that state’s mortality rate (Ruhm, 2000). When applied to U.S. mortality counts from 2006, this implies that a one percentage point increase in unemployment would lead to about 13,000 fewer annual deaths. Ruhm’s findings are widely cited in the health economics literature and have been echoed in work by Dehejia and Lleras-Muney (2004) who find that infant health outcomes and economic downturns are positively linked. The most common interpretation throughout this literature has been that good economic times have a negative impact on individuals’ health because of an increase in work hours, the opportunity cost of time, and resulting changes in individuals’ decisions about how to allocate their time.

guidoamm
guidoamm

Mish,

What do you make of the claim by Off-Guardian that Ferguson's model applied to Sweden would produce 10x more deaths than they are having?

Montana33
Montana33

Sweden has the worst of both worlds. Economic shock = yes and high death toll = yes. How could anyone call that a success? They are social distancing and businesses are heavily impacted but they have managed to keep their hospitals from getting overwhelmed. At least sick people can get health care there though.

Montana33
Montana33

I find it odd that some people commenting here think Sweden’s economy isn’t trashed. Their unemployment is staring to skyrocket And they already have GDP declines. Please Don’t give the speculative could have been worse argument. They have a double negative with massive death and poor economics. Maybe next year they reap some benefit from herd immunity but that’s totally speculative too. Listen to Mish. He is objective and speaks the truth.