Sweden’s Coronavirus Strategy: Has It Failed?
What the data says, over a year after the first pandemic wave.
It is by now well-known that Sweden has made some distinctly different decisions in handling the Covid-19 pandemic, compared to most other countries around the world. The debate around whether Sweden’s strategy is effective or a failure has been raging since March 2020 and it is still ongoing. As a medical doctor working in the country, I have argued that Sweden’s strategy made sense to begin with and that despite its failures, it seemed to be working a few months into the pandemic.
How Sweden’s Coronavirus Strategy Makes Sense
And why it may not be applicable in other countries — a Swedish doctor’s perspective.
Despite the controversy especially the later piece caused, I still stand by my opinions at the time. But since so much has happened during the past year, I think we now have enough information to make a more informed judgment. Still, if you think the answer is going to be a single yes or no, either success or failure, you probably haven’t read any of my previous work and you are going to be disappointed.
It is true that many, even authority figures and respectable scientists, where quick to label Sweden’s coronavirus strategy as a clear failure. The most prominent examples were initially a group of researchers that wrote an angry open letter to the government and later the King of Sweden himself! The outrage sparked by the second article I wrote, where I deemed the strategy to be working — despite its failures — told me that many people, even fellow medical doctors, had already decided that such a conclusion was simply unacceptable and at odds with the obvious reality.
Many factors at play
Last spring, my main point was that we were at a very early stage of the pandemic. It was way too early to draw any meaningful conclusions on the effectiveness of any national strategy against CoViD-19, much less so to compare between countries. Now, more than a year later, despite the pandemic being far from over, we have a lot more data to try and make a better assessment of the effectiveness of the Swedish strategy, compared to the rest of the world.
While many insist on entertaining and spreading positive or negative narratives by examining only a specific variable or comparing between particular subsets of countries, I would like to look into the question by examining all the important aspects, in order to come to a more nuanced conclusion. For me these would be the following parameters:
- Deaths per million in the population
- Overall excess mortality
- Protection of the most vulnerable
- Social and economic impact
All these are very significant to consider both individually and collectively if we are to understand the complexities of managing this pandemic and the differences between countries. So, let’s take them one by one.
Sweden’s society and economy
We can start with what possibly is the clearest advantage of the Swedish strategy; the significantly smaller amount of pressure a more open society is supposed to experience during such a long-lasting crisis. This was the early argument against lockdowns, their potentially devastating side-effects. Not that Sweden, with its recommended personal and group restrictions, wasn’t expected to suffer socially and economically, but definitely less so, compared to societies that have been locked down again and again. Well, now that we have the luxury to talk with data and not just speculations, does this reasoning and argumentation seem to hold true?
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While the country didn’t avoid a historic economic downturn, owing partly to its great dependence on international trade, it definitely landed softer than much of the rest of Europe, as Eurostat data showed already in August. The Swedish economy shrank by 8.6%, much less compared to the European average of 11.9% for the same period, as well as the economies of individual nations like Spain (-18.5%), France (-13.8%) and Italy (-12.4%), who did even worse.
The ensuing recovery from the spring 2020 crisis was even better than expected during the third quarter and the improvement has only continued from there. The situation is still of course quite serious, and unemployment remains at high levels, but the future seems brighter and brighter.
When it comes to the social pressures of coronavirus measures, Sweden’s population has showed high compliance with the national and local recommendations, while experiencing few forced measures and thus less overall dissatisfaction. Although trust in Swedish institutions has somewhat been weakened since the start of the pandemic, Swedes have barely had to protest on the streets, unlike what has been happening around the world, including the rest of Europe. The reactions keep mounting as new lockdowns are again introduced during the third coronavirus wave.
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Even though there is a long way to go and more data to be gathered and evaluated, I think it is fair to say that Sweden has so far managed to do better economically and socially compared to many of the countries that chose stricter measures and quarantines, which don’t seem to be ending as early as some expected.
This positive difference for Sweden may not come as a surprise, but you might think that the country achieved this by sacrificing many more human lives. The popular reasoning is that much less than 14.000 people would have died if the country had only chosen to lock down like most others. But instead of rushing to conclusions, let’s examine the other important parameters to see if this reasoning is in fact sound.
Deaths per million
The number of registered CoViD-19 deaths in a country, relative to its population size, has been the most prominent parameter discussed in both public and private discourse since the pandemic took hold around the world. Already last spring, European countries like Italy, Spain, France and Sweden topped the world rankings on deaths per million. As the first wave exploded, Sweden soon rose to the top 10 and at a point even topped the world in weekly deaths per million in population.
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This development alone raised serious questions about the risks of continuing without a proper lockdown in Sweden and was very damning to some, even within the country, who saw this as an utter failure of the no-lockdown model. This despite the fact that even countries with strict early lockdowns sadly topped the world rankings in deaths per million at this stage.
When Sweden’s head of National Health Agency, Anders Tegnell, explained this and pointed out that it was too early to tell how the virus would impact different countries overall, the critics were not convinced. I was shocked to hear depressive predictions that Sweden would soon easily top even the likes of the gravely affected Italy in this aspect.
A year and a coronavirus wave later, the picture is much different. The early effect that quarantines had around the world, couldn’t really last the long course of the pandemic. And the deaths started mounting in many other countries, more and more greatly surpassing Sweden’s seemingly unacceptably high number of deaths during the first wave.
The list of countries racking up more deaths per million than Sweden has only been getting longer and many more are getting closer and closer. How many of those have chosen a stricter strategy with large-scale lockdowns? The answer is most of them, including (but not limited to) Italy, France, Spain, the UK and the US. And the difference from Sweden is more than significant.
So, the claim that Sweden’s lack of strict measures has cost lives doesn’t seem to be accurate. But let’s go further.
The number of reported coronavirus deaths may be the simplest and most popular parameter to compare between countries, but it has a major flaw. Counting the reported deaths in a country can be greatly affected both by how meticulously and consistently CoViD-deaths are registered, as well as what the actual criteria are for counting a death as “caused by CoViD-19”. In other words, it is quite possible that some countries are over-counting their coronavirus deaths, while others likely do the opposite in one degree or another.
A parameter that is not affected by these variables and is much more difficult to manipulate — because there definitely are countries that are willing to do even that, in order to protect their powerful facades — is the total number of deaths from all causes within a year, compared to an average of previous years. The term for these extra deaths for a given year is the excess mortality of a country. So, let’s take a look at Eurostat’s recent report on excess mortality in 2020 and the differences it demonstrates between EU-countries.
According to the report, some countries like Greece and Poland seemed to have effectively implemented strict, wide quarantine measures against the pandemic early on. Greece had only about 150 total coronavirus deaths during the spring of 2020 and Poland less than 40 per million during the same period. But their general mortality skyrocketed together with enormous spikes in coronavirus cases and deaths during and after the second coronavirus wave, quickly nearing or surpassing EU’s average. Sweden on the other hand, initially had a relatively high excess mortality, only to see it go down to negative values after the first wave and only moderately rising during the second.
Sweden saw lower 2020 death spike than much of Europe - data
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Thus, to the surprise of many, the report shows that Sweden has had a relatively low excess mortality compared to the majority of other countries in Europe. In particular, “Sweden had 7.7% more deaths in 2020” while, “countries that opted for several periods of strict lockdowns, such as Spain and Belgium, had an excess mortality of 18.1% and 16.2% respectively”. The U.K. and France didn’t do better with their lockdowns either, having +15.1% and +10.4% deaths respectively.
While this does not prove that Sweden’s open strategy is superior, it certainly raises the question whether repeated, harsh lockdowns are indeed the number one effective strategy against a persistent and easily transmitted airway virus like CoViD-19. And it shows that holding off and implementing other measures, as Sweden has done, maybe has its merits after all.
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Protecting the vulnerable
But now we come to the seemingly indefensible failure of the Swedish strategy. On this front, even the political and epidemiological leaders of the country, have admitted that Sweden failed during the first wave, which was later confirmed by an independent committee. Sadly, the coronavirus was allowed to widely spread among elders in Sweden’s nursing homes, the most vulnerable population during such a pandemic. This apparently happened due not only to systemic, pre-existing shortcomings, but also a poor response to equip and shield nursing homes from the easily transmissible coronavirus. The result: more than 45% of Sweden’s death toll by late 2020 (around 6,000 people) were nursing home residents.
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This sounds very severe and is indeed a significant failure to protect the vulnerable. It isn’t by any means though unique to Sweden and its open strategy. An ECDC report on nursing home deaths during the same period, showed similar results for many EU countries — nursing home deaths made for example about 45% of the total coronavirus deaths in France and 42.5% in Belgium, both countries that opted to lock down repeatedly. In the US, the number was just above 30% according to the New York Times.
It is therefore worth examining the assumption that strict quarantines and repeated lockdowns would have made any meaningful difference, even in this aspect.
Wait, what about the rest of Scandinavia?
Despite all this evidence, many prefer to focus solely on the difference between the Scandinavian countries, to show that Sweden has really and profoundly failed with its coronavirus strategy. It is true that Norway, Denmark and Finland have so far done an immensely better job than Sweden — and honestly, most of the rest of the world — in managing this pandemic, in essentially every aspect.
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You cannot argue however that this is only due to stricter measures, as the same and even stricter measures have given much worse results in most other western countries. Doesn’t Italy, France, Spain, Belgium and the US — to name only a few that have implemented repeated and extended lockdowns — all have a much worse situation in their hands in practically every aspect, the number of deaths being the only the simplest parameter to compare?
One might still think that Sweden’s cultural and geographical closeness the rest of them justifies this isolated comparison and proves that Sweden would’ve done much better if it only hadn’t stuck to its stubborn open strategy. Yet, despite the obvious similarities, Sweden is profoundly different from its Scandinavian neighbors, insofar as it has a significantly larger and more diverse population, with more immigrants and bigger city centers, all factors favoring the spread of the coronavirus. All this makes the country more similar to other European nations, like Belgium.
The failure of strict lockdowns to limit either the spread of the virus or the death toll in most other European countries also make it very hard to argue that the key difference between Sweden and its Nordic neighbors in the fight against the coronavirus has been the latter’s lockdown strategies.
Has Sweden’s Coronavirus Strategy Failed?
In conclusion, more than a year into the pandemic, both the CoViD-19 death-toll and the overall excess mortality in Sweden surely has been worse than in some, but significantly better than many more developed countries that chose to implement and focus on lockdowns, especially in Europe. Even the amount of nursing home deaths — that could absolutely have been much more limited — is similar to many of the countries that were harshly hit by the pandemic, despite their lockdowns. And this while doing fairly better socially and economically.
The way I see it, all things considered at this point of the coronavirus pandemic, how can one claim that Sweden’s strategy has been a failure? Sure, there’s much to be improved and many costly lessons to be learnt here — not only in Sweden, but all around the world. I can’t say that Sweden has succeeded or done well, when so many people have died, but the country has evidently done better than many of its peers in many aspects. And those who have managed to better handle the pandemic, probably owe it to a wide set of factors that we should absolutely study and try to understand before the next pandemic hits.
But thinking that a simple solution, like more and more lockdowns, exists and could have made everything better is in my opinion both over-simplistic and misguided. I understand the need to hold on to a simple and clear narrative about an unprecedented and profoundly uncertain global situation, but comparing countries on a surface level in order to find someone to blame, doesn’t help anyone.
The important thing is that the pandemic is still raging around the world. Despite the end of the era of strict quarantines being now in sight, our hopes and expectations hanging on the new vaccines rolling out as fast as possible, the global fight against the coronavirus is far from over. Let’s all dedicate our energy in holding out and protecting both ourselves and everyone around us, in order to see this crisis soon over.
What is your view on the subject? I’m glad to discuss in the comments.