Over the last year, the debate about lockdown has been driven to extremes – everyone has, by now, made up their mind. Sweden has been used as an example of either a liberal heaven or Covid hell. To the outside world, Sweden is a country that defied lockdown and ended up with what is (now) the highest case-rate in Europe. In reality, Swedes did hunker down: a lot. Schools stayed open (up to sixthform) but there was mass homeworking, social distancing and more. All on a voluntary basis. The puzzle is whether the voluntary nature of this meant higher or lower death toll. It matters because Sweden was, at first, as badly hit as Britain. Its trajectory offers insights into we might have done.
You often hear it said that Sweden did badly compared to its neighbours, and that even the Swedish king now repents. But if so, why does it still refuse to lock down – and why does polling show almost three-quarters of Swedes saying that the health authority’s handling of the crisis was either ‘good’ or ‘very good’? I looked at this in my Daily Telegraph column a few weeks ago. Seeing as this is such a contentious (and misrepresented) issue, I thought I’d include some of the data and sources here for those interested.
Sweden’s story is more complicates than the UK narrative allows. Here, the Covid debate is often reduced to Covid statistics: number of cases, number of deaths etc. The BBC reads them out every day on the news – but we seldom hear about ther aspects of the pandemic. The effect on society, schools, unemployment, the public finances and the likely long-term implications of wider economic damage.
Let’s start with a table where Sweden looks worst: Covid infections. Now, as five weeks ago, Sweden has the worst rates in Europe.
But when you switch to looking at Covid deaths, Sweden is near the bottom. How can that be, given that it has tolerated high Covid cases for so long? Tegnell says that the link between high cases and deaths has been broken by vaccinations: Sweden’s targeted vaccination programme means ‘we should not have to experience these high death rates again’. So a new wave of cases need not mean a new wave of hospitalisations – ergo, no need to inflict more harm on society and the economy. The death picture is below:
Sweden’s economy. In rejecting lockdown, Sweden deliberately tolerated higher Covid levels than locked-down countries in the hope of protecting its society and economy. Last year, Sweden’s economy (which relies heavily on exports) fell 3 per cent vs 10 per cent for Britain. This isn’t just about money, years of experience of recession shows a clear link between economic downturn and public health: the effects are longer term. Most health economists would agree that a lower economic hit now means a lower excess death hit later.
In spite of three lockdowns, the UK ended up with higher deaths than Sweden On a per capita basis, the UK and Sweden had almost identical Covid death ratios by the end of the first wave (both amongst the worst in Europe, but locking down didn’t give Britain much of an advantage over Sweden in stopping deaths). Britain was hit harder in a second wave (still ongoing in Sweden).
The problem with ‘Sweden vs its neighbours’ While Sweden did worse than its neighbours, its population pattern makes it very different to them: it’s more urbanised than even Britain, for example. Vulnerability to Covid is linked not necessarily to where you are on the map. Bristol Uni’s Oliver Johnson came up with an index to reflect population density right at the start of the pandemic. This shows the variety within Scandinavia. Norway and Finland have very low population density, Sweden is in line with the European average (higher than Germany). The tougher comparison to make is Sweden vs Denmark, which has higher density but suffered less excess death and comparable economic damage.
The big picture: all excess mortality The closure of society and discouraging people from seeking basic healthcare will inflict fatalities that will show up as ‘excess deaths’ for other reasons. Sweden’s fall in cancer diagnoses, for example, has been smaller than ours. Ditto the fall in treatment of heart attacks, etc. It’s important to point out that Sweden has suffered a fall, so it’s wrong to attribute declining A&E use to lockdowns. A lot of the collateral damage happens anyway, this is what Sweden shows us. When people fear a virus, they avoid hospitals, lockdown or not. They stay at home and this hits the economy, lockdown or not. The question is how far lockdown – and messages like ‘protect the NHS’ – exacerbate the deadly effect of healthcare hesitancy. The indirect deaths (especially of cancer) would take years to show up, so a 2020 graph will not give the whole story. But here is the overall picture for total ‘excess’ deaths:
Lockdown and excess deaths amongst the under-65s The vast majority of Covid deaths are amongst the over-65s: this is true the world over. But last year, Britain also had a terrible year for excess deaths amongst under-65s: up to 11 per cent in England and 9 per cent in Scotland. In Sweden, there were actually fewer deaths amongst the under-65s than normal.
Adjust for age, as the below Oxford University study does, and the picture changes. Sweden’s figure was up 1.5 per cent last year, the England figure was 10.5 per cent. Is this the lockdown effect, or a coincidence? It’s impossible to tell – it’s just a piece of a still-incomplete picture.
The Swedes cut mobility – thanks to common sense, not diktat One of the biggest errors in the UK’s lockdown response was Imperial College’s controversial cliff-edge hypothesis: the idea that no advice or lower-level restrictions would really work so only a mandatory lockdown would do. Sweden thought that people would change their behaviour after advice, due to folkvett or common sense. Swedes also were big on the fundamental point that the state has no business criminalising everyday life. So was Sweden right? The below graph uses Google mobility data to show that mobility to Swedish workplaces fell by a quarter and in transit stations by a third. This not as much as in Britain but, it seems, enough to stem its second wave. This raises the question: how far would a similar common-sense approach have worked in the UK?
Sweden forced down both of its waves without locking down It’s sometimes said that the UK and Sweden are not comparable due to latitude, landscape etc. But setting aside our identical urbanisation levels, our experience with Covid has been eerily similar in terms of deaths per capita. Whatever led Britain to get hit by Covid so badly also applied in Sweden – and just as bad. But as the below graph shows, Sweden twice forced down its Covid deaths without lockdown. The UK’s tier system and lockdowns do not seem to have stopped us getting a deadlier second wave than Sweden.
To repeat: this is not to say that Britain got it wrong and Sweden got it right. The above is simply a snapshot, clues in an unsolved mystery about a virus that keeps surprising us. It’s premature to draw any firm conclusions at this stage. But the above might help explain why Swedes, even now, are not pushing for lockdown, even with cases so high as to have them placed in the UK’s ‘red’ category. They seek to limit the damage inflicted on people’s lives and health and pursue a policy that will lead to least harm overall.
There’s plenty Sweden got wrong (chiefly, a failure to protect the elderly in care homes). Tegnell is keen to say that it will take months, perhaps years, for the picture to settle. But to understand Sweden, you need to look at more countries than its neighbours. You need to look at more than just Covid deaths. You need to compare Sweden to countries with similar levels of urbanisation, not just its neighbours.
When these other points are factored in, it becomes easier to understand why, after all the last year has brought, Swedes still think they will be proved right in the end. <//>
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